Teenage girl sings a new tune and takes a swing at setting boundarie
Sharon is a 14-year-old female who enters treatment secondary to mother’s concerns about her irritable mood, isolative behavior, lack of communication with parents and the type of friends with whom she surrounds herself. Sharon initially presents to this writer as very reserved, guarded and reluctant to answer questions.
With an aim to develop rapport, I inquired about Sharon’s hobbies and learned that she enjoyed softball, drawing and singing. She added that she played on a girls’ softball team and is in the school chorus. Because I was a former baseball player, I focused on my strength to help her up her game and asked how she was hitting softball to which she replied, “not great.” I then asked her to demonstrate her swing using a broom handle for a bat and encouraged her to bring her elbows back, to loosen her grip, take advantage of the strength in her legs by striding 6” to a foot towards the pitcher (me), simply rotating her back foot without lifting it off ground, lean her elbow against her chest as she began her swing, watching the bat hit the ball as she drives through the pitch and follows through until her arms naturally stop the swing.
After hitting her stride with the broom, we listened to some of her favorite music on YouTube, discovered a couple songs that we both enjoyed. I then requested that she play some of her favorite songs many of which contained lyrics centered around depression, tragedy and sex. Now Sharon was speaking her language and talking to me. I took a swing at getting Sharon to sing a song in my presence which she was too embarrassed to do though agreed to try expressing her feelings by writing her own song. However, after trying to write her own lyrics for a couple weeks she said she was blocked and would rather stick to singing. Sharon also brought in some of her sketches which were quite good but her depression began to come through via her focus on violence and death in her drawings.
Sharon began to open up a bit about her friend group which included three kids suffering from depression, a couple of whom were struggling with suicidal thoughts and one engaging in cutting behaviors. Sharon finally disclosed that she also struggled with depression and had engaged in cutting behaviors in the past. She acknowledged that her friends often vented to her about heavy issues but she does not share her struggles with friends or parents.
I suggested Sharon to work on developing relationships that are mutually supportive by beginning to share some of her thoughts and feelings. I also recommended that she give up the adult role of caretaker of for her younger sister and instead communicate her concerns to her parents. Along with drawing, I recommended that Sharon begin to identify and express feelings utilizing an emotions sheet with faces to match the name of the emotion to not only build her vocabulary of feelings but also to express herself utilizing “I feel ...” statements. In the event that Sharon gets so overwhelmed by the intensity of her depression or feelings of hopelessness that she has an urge to cut, I asked Sharon to identify at least one adult with whom she can be completely honest about her urges and emotional pain.
In order to improve Sharon’s self-worth and build on a strength, this writer suggested that she get individualized singing lessons, a recommendation with which she followed through. Given that Sharon is very self-critical and focuses on the glass half empty, I asked her to identify at least three small victories at the end of each day and communicate these successes to her mother or father. Also based on the empathy she showed to her friends, I suggested that she utilize this gift of compassion towards herself using David Burns’ CBT double standard method in which one imagines guiding a friend who’s dealing with the same issues as oneself.
I had a conversation with Sharon and her mother about the option of psychopharmacology as an adjunctive treatment for depression. Based on Sharon's intractable depression, the family's history of depression and Sharon's tendency to ignore and internalize feelings, Sharon's mother and I agreed that Sharon ought to go for a medication evaluation. We established a baseline for Sharon’s depression by scaling her depression from 0 to 10 with 10 most severe and Sharon rated herself a 7 while her mother rated her an 8.
In the meantime, I recommended that Sharon practice consistent habits including regular intense exercise, spending at least 30 minutes a day singing and drawing and maintaining a habit of identifying at least three small victories a day so Sharon can communicate to Dr. or nurse practitioner that she has put in significant effort into alternative therapies. Sharon was placed on 10 mg of Celexa and after 3 months on this dose her depression was downgraded to a 4.