William R. Beardslee, M.D., Bringing the Family Together when a Parent has Depression

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expert_profile_williambeardsleeDr. Beardslee is a professor of child psychiatry at Harvard Medical School.

Dr. Beardslee is a nationally recognized expert on families and depression. He is the author of Out of the Darkened Room - When a Parent Is Depressed: Protecting the Children and Strengthening the Family. Through a series of long-term studies with families, Dr. Beardslee has developed a step-by-step approach that helps families cope with depression while nurturing resiliency in children.

On its own -- parenting can be an extraordinarily difficult job. By being a parent who struggles with depression, an entirely new set of worries evolve. Dr. Beardslee, who has treated families with depression for 30 years, shares his advice for fostering a healthy home emotionally. Children from families with a parent who has depression may be at an increased risk of it themselves, but there are specific steps a parent can take to help their children.

If my spouse or I are wrestling with depression, does that mean our child will be damaged in some way?
The short answer is no. Developmentally, children are resilient, and there are steps you can take to help them. The first is to take care of yourself and get treatment. Today's treatment options are better than they've ever been. In fact, depression is perhaps the most treatable of mental illnesses -- and that's encouraging. Remember to take time to reassure your children that help is being sought. Second, understand that while a parent's depression may not cause permanent harm to their children, it will impact their lives, and undoubtedly, kids will have questions about it. As a parent, it's important that you talk openly with your children about your depression.

What can I do to help my child become resilient?
In our practice with families, we've discovered that resilient children - that is, children who've had parents with depression but didn't develop depression - had three characteristics:

  1. Good relationships with others
  2. Ability to get tasks done
  3. Self-understanding

You can help your child develop these skills by encouraging them to form relationships with relatives and friends who can help ease the burden they might be feeling. Explain to your child how you became depressed so they understand, and are able to put that understanding into words. That gives them the tools to survive, and an understanding that their actions can make a difference.

You suggest six steps that can strengthen the family. What are they?
In a simplified form, they are:

  1. Share your history of depression. That means that you must take time to communicate one-on-one with your spouse and your children about how you have developed and now experience depression.
  2. Relate your knowledge of depression to your circumstances. Explain what depression is and that it's a biological illness. Try to understand and alleviate your child's fears about it. Discuss your own symptoms and how they are part of the illness.
  3. Address the needs of your children. Younger children might feel burdened by worries that the depression is their fault. Take the time to reassure them that it isn't. Depression and other illnesses can be hereditary. Does your child show signs of depression? If so, make sure your child gets an evaluation.
  4. Plan the family meeting. Before gathering together to talk about depression and how it affects your family, take some time to plan out what you will discuss. Perhaps there are some things that are too painful and are off limits for discussion. Take into account what's age appropriate for your child as well: a teenager can likely tackle more complete information than an eight year-old could handle.
  5. Conduct a family meeting. Give your family an opportunity to talk openly. Let your children know you're taking action to get well again, and give them the chance to share their own fears and concerns with you. Make sure to talk about events your children have witnessed - particularly upsetting events. The family meeting is a powerful tool, and one that can go a long way in easing the stress surrounding depression.
  6. Keep the dialogue going. The family meeting could raise more questions. As your child digests what you've shared, give them the opportunity to ask more questions as they arise, and keep them informed on your treatment and progress. Plan to have a family meeting again every six months.

What's a common mistake you see families make?
I don't use the word "mistake" in families generally because families have such a tendency to blame themselves.

What I do see is that it is very hard to talk about these things. What we've found again and again was that there is simply not enough discussion. Even families who talk about many things openly, avoid being open about depression because the person who is depressed feels so bad and often blames himself or herself and those around him or her are frightened and confused. I think what is helpful for families is to ask themselves, "How can I have a conversation first with my spouse and then with my children about this that leaves everyone positive and with more understanding?" Remember that depression attacks a sense of being able to feel good about things or remember the many positives in a marriage or in raising children. In addition to talking about depression, I think sharing stories and talking about other positives are important. Try to remember the positives when you do -- particularly if the stories mark important life points such as births, deaths, graduations and other important events. Relish those positive moments with your children.

However, teens with depression don't tend to pull away from their friends, whereas adults tend to withdraw. If you ask most teens with depression if they have friends, and if they are still socializing, they say yes. They may socialize less, or their friends may push them to get out. But they usually don't give up their friendships. If a teen is disconnected from his or her friends, the depression is fairly severe and has been going on a long time.

If a teen ever says that they want to kill themselves, or are thinking about death, this is a serious sign! The person needs to be evaluated immediately. These symptoms are not part of normal adolescence. Some teens are very impulsive, and they tend to confide in their friends, not adults. I had a young girl tell me that she and one of her friends had both been feeling suicidal, and they thought that they might do something together. They had never told anyone before.

While I prepare myself for the family meeting, should I do anything to prepare my child too?
Absolutely. Let your child know that you'll be having a family meeting, and that you're doing this because you want them to understand that you will be okay, and that you want to keep them safe. Explain to them that this is a chance to explore and talk about something important - while going through this illness, you haven't had the opportunity to talk about it, so you're creating that time now.

What if I don't feel comfortable conducting these family meetings on my own?
Families certainly don't have to do this alone. There are family therapists with experience with family meetings who can help, and referrals are available through the American Association for Marriage and Family Therapy (AAMFT). Also, often one's own therapist can help if one is receiving treatment for depression.

We wrote "Out of the Darkened Room" to try and provide resources to families to understand how to have meaningful conversations and I think that is a good resource.

At Children's Hospital Boston, we have a special program to help families with depression and build resiliency in children to prevent them from developing depression. Please call the mood disorders center, Dr. Stuart Goldman, at 617-355-6745.

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