Perspectives on parenting and adolescent depression

Imagine you’re a therapist treating a girl with clinical depression. She’s suffering from a prolonged depressed mood and negative self-image. Her parents attend a therapy session. During this session the parents are making an effort to be supportive, but they also give advice like “if you just get out of bed on time, you’ll probably feel a lot better”. At the next session the girl tells you she didn’t like the session with her parents and perceived their advice as controlling and criticizing. What happened here? And how can you integrate this into treatment?

RE-PAIR study

In the RE-PAIR study my colleagues and I, under supervision of Prof. Bernet Elzinga, researched parent-adolescents interactions. Two groups of adolescents (11-17 years) came to Leiden with their parents: a group with clinical depression and a group without psychopathology, as a control group.

As part of the study the adolescents had three conversations with their parents (separately with their mother and father). The participants were instructed to focus on a specific topic for each conversation: conflicts in daily life (e.g., phone use), planning a trip together, and the adolescent disclosing a negative experience (ranging from a poor grade to suicidality among friends). Directly following each conversation adolescents filled out a short questionnaire about their own mood and their parents’ behavior. The conversations were videotaped, and the parental behavior was assessed by trained observers who had no prior knowledge of the family.

The life stage of adolescence is marked by increasing independence and the development of autonomous functioning. Parents can actively support their adolescent child in these development, or, alternatively, limit their child’s development. Alet Meurs, clinical psychologist at GGZ Rivierduinen and I developed a coding system to observe parental autonomy support and psychological control. We trained master students in this coding system. Autonomy support concerns behavior by which parents actively stimulate their child to explore and express their own thoughts, feelings, and decisions (e.g., asking the adolescent about their opinions, accepting differences in perspectives). Psychological control concerns controlling or manipulative attempts by which the adolescent is forced into a parent-directed perspective (e.g., invalidating feelings, inflicting advice, inducing guilt).

Results

The analyses showed two main results. Firstly, there were no differences in observed the parental behaviors between the two groups, whereas adolescents’ perceptions of their parents behavior did differ. Adolescents with depression rated their parents’ behavior more negatively than adolescents without psychopathology. The more negative perception of adolescents with depression can possibly be explained by several factors, such as characteristics of depression itself (negative outlook) and/or previous experiences with the parent(s).

Secondly, the mood of adolescents with depression worsened if the parent showed more observable psychological control (as rated by coders) in the conversations. Interestingly this negative type of parenting behavior did not affect the mood of adolescents without psychopathology.

Translation to clinical practice

Thinking back of the girl who came to session with her parents, these results indicate that it is important to consider the adolescent’s perceptions as well as ‘objective’ parental behavior. This girl is in a depressed mood and has a negative self-image, so any critical or controlling comment by her parents hits harder. As a clinician, you could discuss what this girl needs and explore the origins of certain sensitivities, or what is helpful or unhelpful in interactions with her parents. Further, it could be important to psycho-educate the girl’s parents about the impact that psychologically controlling behavior can have on their daughter’s wellbeing. Without blaming the parents, you could explore how certain behaviors could be converted to helpful behaviors.

Conclusion

As a clinician, think back to this study the next time you’re treating an adolescent with depression. It may very well be that the adolescent’s perception of their parents is more negative than is objectively the case. Try to understand how this perception came about and whether it could be changed (e.g., CBT).

It may further be of value to involve parents in psycho-educative sessions to talk about the impact of their behavior on their child. Try to use these two perspectives to improve family dynamics, and thus hopefully also improve the wellbeing of both the adolescent and their parents.

The full, peer-reviewed paper ‘Balaning boundaries: Observed parental autonomy support and psychological control in the context of parent-adolescent interactions and adolescent depression’ is published with open access in the scientific Journal of Research on Adolescence.