The stress of providing clinical care for an adolescent engaging in any type of behavior that results in self harm is incredible. When will the high risk behavior subside? Are they telling the truth about their urges to re-engage in such a behavior? What is the best treatment recommendation to continue to support the adolescents as they move further from a scary behavior? It completely makes sense that the clinical care revolves around the at risk adolescent.
And while providers, schools and families rush to provide support for the struggling adolescent, parents are often the most neglected group of people that are intimately involved in patient care. As children and adolescents sensibly have resources that aim to assess, treat and alleviate clinical needs and residual suffering, the parents of the very same children and adolescents are asked to balance their children’s care, their own stress and whatever life responsibilities come with being a parent and adult. This is where parents are not just a neglected group of adults, they are a neglected clinical population (more on this later). Parents of children and adolescents struggling with mental health difficulties, particularly when those challenges come with high risk, life threatening behaviors, have risk factors and vulnerabilities that mirror first responders and military. While providers are adept at assessing and diagnosing trauma in their patients, far fewer look for trauma symptomatology in the parents of those patients.
Let’s start with secondary or vicarious trauma. According to the American Counseling Association, vicarious trauma is the emotional residue of exposure that (providers) have from working with people as they are (experiencing) their trauma stories and become witnesses to the pain, fear, and terror that trauma survivors have endured. While we often equate the vicarious trauma phenomenon with professional care providers, there is little reason to believe that lay providers such as parents should not be included. People that experience vicarious trauma do not need to be the person that has directly experienced a traumatic event; rather, they can experience the trauma through the person for which they are providing care. There is an abundance of vicarious trauma research in populations such as significant others of returning military, clinicians, first responders and medical professionals. However, similar to the lack of attention from providers for parents, the research community has engaged in little investigation on this incredibly important group of lay care providers. And when we think of a group of non-professionals bearing witness to their child’s trauma and suffering, it makes sense that they, too, would experience trauma at significant incidences. Quite simply, the more exposure to traumatic material through others, the greater the risk that a provider or caretaker will develop vicarious or secondary trauma.
If we were to look at the affect and behaviors of those struggling with secondary or vicarious trauma, let’s consider using the lens of parents providing care for high risk behaving adolescents. Do these behaviors and emotions make sense for parents trying to care for kids exhibiting high risk and life threatening actions?
- Poor Boundaries
- Inability to Listen
- Diminished Self Care
- Survival Coping
- Social Withdrawal
- Chronic Exhaustion
At best, providers may recommend self care to parents and, at worst, parents can be villainized for exhibiting such behaviors. Through careful assessment and support to parents with loved ones that have engaged in dangerous or life threatening behaviors, it is imperative that providers assess and provide either help or referrals for support for parents in the same compassionate manner with which patients themselves receive care. When this does not occur, parents are at extremely high risk for becoming a clinical population themselves.
Some of the most compelling trauma research has come out of the most unfortunate circumstances. Natural disasters and terrorism have provided organic information as to how and why some people that experience trauma develop PTSD and some do not. Five criteria have been identified as risk factors in developing PTSD when experiencing trauma or vicarious trauma and two relate directly to caregivers:
- People who hold their trauma without an outlet, feel undeserving of receiving care because they were not the ‘primary trauma victim’ or those that are isolated without support
- Those that experience trauma over an extended period of time (which typically defines adolescents exhibiting high risk behaviors)
When we consider the impact that providing support for parents can have in a parent’s mental health and the protective factor that having support and care has on a parent’s capacity to avoid developing PTSD, it becomes easy to understand how important it is to support this vulnerable population of parents. The National Institute of Mental Health has defined five protective factors for those experiencing trauma that can easily apply to parents of kids with high risk behaviors:
- Seeking out support from other people, such as friends and family
- Finding a support group after a traumatic event
- Learning to feel good about one’s own actions in the face of danger
- Having a positive coping strategy, or a way of getting through the bad event and learning from it
- Being able to act and respond effectively despite feeling fear
For parents and/or providers of adolescent care, it is essential that we support parents with the same care and attention that we care for their children and adolescents. Through assessment, psychoeducation and support, providers can not only support a vulnerable group of caretakers, but we also increase the efficacy of the very care provided for their children.