Marie Yap, PhD
Associate Professor of Psychology at Monash University in Australia.
Dr. Yap has disclosed that she has no relevant financial or other interests in any commercial companies pertaining to this educational activity.
“To love and work” was how Freud saw the goal of psychiatric treatment. Mental illness robs people of many meaningful roles, from work to parenting. We spoke with Marie Yap, director of the award-winning Parenting Strategies program, to learn how to help our patients function better as parents and prevent psychiatric disorders in their children.
TCPR: When a parent has a psychiatric disorder, how do you recommend they talk about it with their children?
Dr. Yap: Children do better when parents talk openly about the reality of the illness and its impact on the family. Openness can also dispel the stigma around mental health. The talk needs to be age-appropriate. In younger children, I would use analogies with physical illness: “It’s like if Dad had a really bad case of flu. It would sap his energy, and he would be in bed most of the day.” As the child gets older, for example after puberty, you can speak more directly about the condition.
TCPR: Would you use the actual diagnostic terms?
Dr. Yap: If they want to know a name, I think it’s good to tell them, “This is what the doctor calls it. When you talk to your friends, you can just tell them, ‘My mom has an illness. She is unwell.’” But more important is to address how the condition is affecting the family and to let children know that it’s safe to talk about it within the family and with trusted adults. It’s an ongoing conversation, and it involves practical matters. You might say, “So, during this time Mom won’t be able to cook dinner; we might get takeout, or Grandma will come in and help.”
TCPR: What else can parents do in the face of active mental illness?
Dr. Yap: They can talk about specific strategies to manage the effects on the family, such as, “I’ll let you know when I’m feeling unwell and need to be alone. Here are some things you can do if that happens.” Find age-appropriate ways for the child to help out. Children need to have a role, but the burden of the illness should not be their responsibility. It may not be appropriate for a 7-year-old to cook dinner, but a teenager could take that on. Also, draw on support from friends, teachers, counselors, and extended family.
TCPR: What about more damaging effects, like when a parent yells or breaks things during a manic episode? How should this be addressed with children?
Dr. Yap: I do think parents should address the effects of their illness openly with children. That doesn’t mean the illness is an excuse. They could say something like, “I’m sorry. You don’t deserve to be treated that way, and that’s not how I want to treat you.” Clearly, when the interaction was traumatic, it’s more complicated. I’d want to make sure the parent is stable enough to have that conversation without getting triggered. If the parent doesn’t feel ready, there could be a family meeting with a mental health professional there to mediate. That could contain any further explosiveness.
TCPR: Often these families are worried that their children will grow up to have the same problems. Are there parenting strategies that can prevent psychiatric disorders?
Dr. Yap: A lot of research has gone into that question, and if I had to boil it all down, it would be these words: acceptance, support, and autonomy. Parents need to develop an accepting and warm relationship with their children, while encouraging them to step out more on their own as they grow. A big challenge is to adapt as they age; to know how much to let go and when. Can they trust their 7-year-old to cross the road at a traffic light?
TCPR: Sounds like it takes a lot of flexibility—not an easy task for someone with anxiety or depression.
Dr. Yap: They have to try and think, “What’s the worst thing that could happen if I don’t step in and it turns out wrong?” The process of the child’s learning is as important as the child’s success. Encourage children for trying! When they make mistakes, it’s an opportunity to talk about what happened. What led them to the decision? What could they do differently in the future? When there’s a foundation of support and acceptance, children will know that the parent is available if they need to reflect or bounce ideas off someone, or if they need a shoulder to cry on.
TCPR: Are there any counterintuitive findings in the parenting research?
Dr. Yap: Not exactly, but we have found that overinvolvement, or “helicopter parenting,” increases the risk of mental health problems in a child. It’s quite a robust finding in depression and anxiety (Yap MB & Jorm AF, J Affect Disord 2015;175:424–440). It gets back to autonomy: “Am I doing things for my children that they could reasonably do themselves?”
TCPR: What are some examples of appropriate involvement?
Dr. Yap: Knowing where your children are when they’re not with you. What are they doing? Who are they with?
TCPR: Technology has made that easier. We’ve got web cameras and GPS trackers.
Dr. Yap: I’d suggest that developing a relationship where the child is comfortable disclosing that kind of information is more important than accurate surveillance, particularly with teens. It’s not just about the knowing, but wanting to know because of parents’ interest in their child’s life.
TCPR: What about poor boundaries and emotional overinvolvement?
Dr. Yap: That takes overinvolvement to another level, and it’s also a predictor of poor outcomes (Yap MB et al, J Affect Disord 2014;156:8–23). An example is withholding affection or giving the cold shoulder if a child is not doing what the parent wants. Saying things like, “If you love me, you would do this” or making the child feel guilty for having a different point of view is about psychological control. It’s manipulative, but I don’t think most parents do it intentionally.
TCPR: Boundaries can break down when the parent has an active mental illness.
Dr. Yap: Yes. That’s an important factor when children feel responsible for taking care of their mentally unwell parent. That’s hard to process, even when the parent is supportive, because a young child is going to feel responsible when the parent is depressed: “It’s my fault that Mom’s in bed all day because I disobeyed her and made her upset.” Teens may react the other way and just blame the parent.
TCPR: What else do we know about prevention?
Dr. Yap: There’s quite a lot of evidence that diet, physical activity, and sleep play an important role. Sleep is not as much of a challenge with younger kids, but when puberty hits, the circadian rhythm goes out of whack a bit (Dolsen MRJ et al, J Physiol Paris 2016;110(4 Pt B):467–479). Young people need to get enough sleep, but they also need consistency in their sleep and wake times, including weekends. Parents can set rules, like staying away from screens a half hour before bed.
TCPR: What do we know about alcohol use in the home?
Dr. Yap: To start with, providing the child or teen with alcohol is not a good idea. Nor is it helpful to model excessive drinking or to drink as a way to manage stress (Yap MBH et al, Addiction 2017;112(7):1142–1162). But should the parent abstain completely? The way I interpret the evidence is that it goes back to the child’s autonomy. If you take the extreme view that alcohol is an absolute no, end of discussion, then the child has no opportunity to make an autonomous decision. That’s what matters. Making it an open discussion allows children to learn to weigh the pros and cons on their own.
TCPR: Final thoughts?
Dr. Yap: There is no inoculation against mental illness, but there is reason to be hopeful. There are things that parents can do to reduce those risks in their children, and they don’t need to be perfect parents to do it. Many parents, including parents with mental illness, have strengthened their parenting skills and benefitted their child’s mental health by doing parenting programs (Yap MBH et al, Clin Psychol Rev 2016;50:138–158).
TCPR: Thank you for your time, Dr. Yap.
Editor’s note: Parents can find Dr. Yap’s free guides at www.parentingstrategies.net. Another useful resource is Triple-P Parenting (www.triplep-parenting.com), which offers free training in parenting strategies in many states.
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