There is a certain type of child that I have seen in my psychotherapy practice over the years. He is often a boy who is between the ages of twelve and seventeen. He can be an only child or have siblings. His physical health is good, and he has many excellent qualities. However, his parents complain that he is unmotivated in school and is an underachiever. They think he seems depressed, has oscillating moods, is labile, angry, sad, and this causes them a great deal of anxiety. They say he appears stuck, and school doesn’t seem particularly concerned about him. He might have one or two teacher-allies, but he has little ongoing contact with them.
I usually ask the parents to come in so I can take a history and begin my evaluation. The parents describe their son in glowing terms and yet with much frustration and apprehension. I’m told that this boy is very bright and yet has been inconsistent with his grades. With the beginning of each trimester, he is hopeful and appears eager to get a fresh and productive start with his classes. But this is often followed by a pattern of declining grades approaching the mid-semester mark usually due to a lack of completing and/or not turning in homework. When his parents attempt to monitor homework, offer help, or apply pressure, they are rebuffed, and this often leads to an angry confrontation.
The parents continue describing their son as creative and yet not productive. Perhaps he was an excellent illustrator but then lost all of his interest in drawing. Whereas he used to be socially involved with two to three close friends, he has ceased to initiate contact outside of school and mostly keeps to himself. He is quiet or brooding at home and keeps to himself in his room playing video games or lying on the family-room sofa watching TV. He might have been an avid reader at one time, but this passion also waned. When he was younger, he would often play by himself and be happily absorbed in lego design and construction for long periods. But this pattern of hyperfocusing has lapsed as well.
My sessions with the parents seem to shift from their being hopeful and positive to being doubtful and anxiously concerned. They talk about their son’s wonderful sense of humor, how comfortable and charming he can be with adults, his love of travel with the family, and his strong capacity for empathy. They say he can be genuinely remorseful and quick to apologize for a hurtful comment, and he can be supportive, gentle and kind with animals, children with problems and disabilities, and close friends.
They add that he has highly attuned social radar enabling him to be very perceptive when it comes to others’ feelings or thoughts. And yet this child who is so capable of being loving and compassionate is also exquisitely sensitive to frustration and criticism. He is thin-skinned and easily wounded psychologically taking many sarcastic or off-colored comments personally. He believes the world should treat people fairly and is indignant when it does not. He can be quick to assume that others regard him as less than adequate and possibly see him as troubled, soft, overly emotional and unmasculine.
His questionable self-esteem and lack of confidence cause him to be fraught with shame and fear (which aren’t always so obvious). There appears to be disappointment about letting his parents down, self-criticism for not forcing or motivating himself to practice at homework, athletics or piano. He cannot get to bed at a reasonable time and being a night owl, he is often up late trying to make up homework or playing video games. Beside having difficulty slowing his thoughts down and falling asleep, he is usually a restless and light sleeper as well. A sleep deficit is usually present no matter how much he tries to nap in the afternoons or sleep-in on the weekends, and getting up in the morning for school is nearly impossible. Parents sometimes resort to screaming and throwing cold water to get him out of bed. This can easily develop into another confrontation.
Cognitively, there appears to be an executive functioning deficit. There is a lack of planning and organization regarding time, money, and belongings. Short-term memory problems and distractability exist. Procrastination prevails and getting started is very difficult. Focus is entirely on the present. Parents’ emphasis on preparation for the future falls on deaf ears. The boys often become defiant and oppositional when frustrated parents make any attempt to appeal to reason or to help. These boys are easily bored, and jump from one thing to the next. And they refuse to ask for help. They give the appearance of being very independent, and some insist that they have no need for electronics or other creature comforts. However, this counter-phobic façade belies strong dependency longings and magical feelings of entitlement.
It’s painful to want academic success more than your son wants it. Parents suffer watching their children struggle this way. They also grow to feel helpless, and angry as their fear intensifies. But these boys’ fears also intensify when they cannot uphold the family tradition of excellence. They can feel like the black sheep of the family who cannot compete with any siblings or their parents.
The task of psychotherapy is to help parents and their sons recognize that what is happening is non-pathologic. These children are not abnormal or failures. The enemy is the boys’ shame and the parents’ guilt. These boys are in no hurry to grow up! They want to enjoy life, to feel alive. They want to play. They are passionate individuals who want to develop and feel alive while doing so. They often experience their parents as going through the motions to become successful and accomplished. They see them as being so serious. They would rather see their parents as happy, playful, spontaneous and loving.
Psychotherapy is a wonderful means of attaining many of these family and individual goals. If a family history of depression and/or anxiety exists, this will be factored into the clinical picture. Attentional problems and depression have many overlapping signs and symptoms, and all of this needs to be sorted out in order to make an intelligent diagnosis with useful recommendations.
Pathologizing, however, is not a part of this approach. These boys are wonderfully gifted, bright, normal, passionate, affectionate, and genuine people who need help restoring faith in themselves. They are navigating the developmental phase which Erik Erikson called “Identity vs. Role Confusion.” The task of this adolescent phase is to discover who we are as individuals and to begin developing a philosophy of life. They need to connect with, learn to trust, and respect themselves as valued members and future contributors to our society and culture.