Family Communication Style
Behavior as a Call for Help
Adolescents are known for their reluctance toward treatment. Their continuity in therapy is more difficult compared to adults. Rogers pointed out that “these young people need to reject therapy at first, only to accept it eventually.”
The refusal that arises from the conflict between passivity and activity is actually the first step necessary for eventual acceptance of therapy. As the process continues, these young people often become genuinely engaged in treatment. Thus, the initial refusal is, in fact, an attempt to test the atmosphere to which the adolescent will surrender and ultimately accept a passive position.
We see these boundary-testing behaviors frequently, especially in borderline adolescents. What usually brings them to treatment is a series of escalating incidents—incidents that pierce through the parental unawareness caused by their inability to perceive their child as an adolescent with real struggles.
The adolescent is drowning in a stormy sea created by their own internal conflict and cannot stay afloat; as they sink for the third—and perhaps final—time, they cry out for help.
The long history behind these behavioral calls for help is striking evidence of the strength of the adolescent’s resistance. Parents often respond to each behavior with visible indifference, which pushes the adolescent to express themselves in more dramatic and extreme ways—eventually leading to an intervention, often not by the parents, but by a friend, a teacher, or even police or a judge.
Parental resistance also shapes their first contact with the clinician. Rather than seeking “the best doctor,” they usually look for someone who can offer treatment without truly touching upon the issue of separation from the adolescent. As a result, the clinician must be very careful in providing feedback; for example, if they emphasize anxiety too much, the parents may understand the therapeutic intent and immediately look for another clinician.
Note: Families of such adolescents often hide their own problems behind the adolescent’s pathology, or they attempt to influence the clinician beforehand. A common scenario is that the therapist first receives a call from a parent who requests a preliminary meeting before the adolescent attends therapy. Just like the phrase “they became a victim of bad friends,” they try to bias the therapist by constantly criticizing the adolescent—this is cognitive manipulation. For instance, in a recent case, the parents of a 15-year-old girl said she had been cutting herself for two months and wanted to bring videos from her phone to show how she cut herself. I said this would not be appropriate. Such manipulations are common.
When meeting the families of adolescents with boundary problems, I sometimes refer them to another therapist or recommend short-term couples therapy so they can cope with the difficulties of this process. When this referral is made, I have witnessed temporary cessation of family conflicts—or, in some cases, absolute refusal to see another therapist. In such situations, the boundary-testing adolescent proves to be both courageous and more stable than expected.
At this point, the clinician’s approach must differ. It is essential that the clinician perceives the adolescent’s unspoken urgency and underlying anxiety and responds accordingly. This response is as real as the rescue action of a lifeguard diving into the sea with a life buoy. The therapist’s intervention becomes the buoy that helps the adolescent stay afloat until actual therapeutic work begins.
Since borderline adolescents and their families lack the capacity to verbalize or symbolically process their emotions, their communication at home consists mostly of constant arguments, yelling, swearing, or—at best—written messages. Thus, they communicate either through action or silence, because they do not know any other way. When seen together early in treatment, the session is often filled with yelling and purely behavioral exchanges.
In a hospital session with a borderline adolescent, the adolescent seized control, insulted the therapist, slammed the door, and locked themselves in the bathroom. Feelings were not verbalized; distress was not expressed in words—it was acted out. Initially, such adolescents announce their behaviors to their parents, but if unnoticed, the severity increases until it becomes impossible for the parents to ignore. For example, a 16-year-old adolescent who had been inhaling solvents in his room for weeks, without any parental intervention, escalated to stealing a large sum of money from the house—eventually leading to legal consequences.
Another case involved a 15-year-old girl whose mother was extremely controlling and demanded explanations for everything. Her parents divorced when she was six. According to her mother, the girl should have no private space—her room door had to remain open, and her letters and diary were inspected. This eliminated any sense of privacy. The mother believed this was “responsible parenting.” In reality, it prevented individuation and fostered a fused relationship. This led to depression, declining grades, emotional withdrawal, school absences, behavioral problems, and disciplinary actions. Secret alcohol and cigarette use followed. She drank excessively in binge-like episodes, and the mother interpreted this with harsh moral judgment. Eventually, the girl disappeared for two days, staying with relatives, and the school referred her for treatment. These patterns—depression, dropping grades, truancy, disciplinary issues, substance misuse, and eventually running away—represent systematic escalations of help-seeking behavior and cries to be noticed.
The clinician must not look for the adolescent’s motivation in verbal statements but instead “read” the message in their behavior and respond according to the severity of their desperation. Otherwise, the adolescent will experience the same disappointment they feel when their parents fail to understand their signals—and will likely drop out of therapy.
