Ask Dr. Mike: College Therapy, Nannies and Aging

Anxious About Therapy Transition for College-bound Son

Dr. Mike,

Our son has a mental health condition and has been in therapy throughout much of his childhood and teen years. He is heading off to an excellent university this fall, and while my husband and I are proud parents, we are also concerned parents. We recently learned that our son will not be able to continue his weekly therapy at the university’s counseling center. We were told by the administrator at the center that they only handle “crisis situations” and that they refer students to private therapists near the school for ongoing counseling. We are upset by this news and are worried that our son will not get the help he needs on campus at such a challenging time in his life. Saying goodbye to his therapist of many years is going to be difficult enough for our son, and now his not having adequate treatment options on campus is going to be additionally difficult for us all. What do you think we should do?

A Concerned Parent

Concerned Parent,

Your problem is actually becoming a very large one that is negatively impacting many students across the nation. More and more college and university counseling centers are providing only short-term counseling or crisis intervention to students and then are referring students needing more ongoing therapy to private clinicians nearby. This is due to increased need and limited on-campus resources.

In a recent survey conducted by the Association for University and College Counseling Center Directors, 95 percent of college and university counseling directors reported an increase in students with significant psychological problems at their centers with 70 percent of the directors surveyed asserting an increase of students with severe psychological problems on their campuses within the past year alone. The survey cited anxiety, depression and relationship struggles as being the top three presenting problems at college and university counseling centers. According to the surveyed directors, a significant number of students seeking assistance from college and university counseling centers were also taking psychiatric medications, but over 36 percent of directors reported that psychiatric services at their centers were inadequate.

As a psychologist in private practice who works a lot with adolescents, I have found that the transition of mental health services and care from home to college or university is managed best with planning and preparation. Many of my clients heading off to college elect to just inquire about services when they get to school, but sometimes that approach can lead to poor outcomes. Because of this, I usually recommend planning ahead.

I think your son (or you as parents) should call the counseling center, and if possible, speak to one of their therapists. You did not mention if your son also takes medications but that would also be something discuss as well. If your son is planning to continue weekly therapy at school, then it does not make sense to me for him to meet with an on-campus therapist who will only be able to see him a handful of times before referring him out. Thus, I would ask for the names of at three therapists near to the school who have training and experience in your son’s area of need. I would then call those individuals to discuss your situation and needs. Those clinicians will likely also have websites, and your son and you may wish to research their backgrounds and experience online. Selecting a new therapist is a very important decision for your son that I feel he should actively be a part of at his age. After those initial calls, I recommend that your son (or you as parents) schedule consultations with at least two therapists, so your son can be in a position of selecting the therapist with whom he feels most comfortable. If possible, I also recommend having those meetings prior to the start of the school year. Your son will have enough to manage on campus during the first few weeks of school without having to also worry about finding a new office he has never been to or meeting a therapist for the first time off campus. 

Your son’s current therapist can also serve in the transition process by speaking to your son’s new therapist about your son’s history and needs. Your son’s current therapist may also be comfortable scheduling phone or Skype sessions with your son while your son transitions to his new therapist at school.

I Think My Nanny Needs a Nanny

Dr. Mike,

My husband and I work, and we hired a teenager from the neighborhood to watch our two kids for the summer (they are 4 and 9). As a summer nanny, her responsibilities are minimal, but we do expect her to be responsible and to pick up after the kids. I know my kids can be a handful and messy at times, but coming home to a kitchen table of dried out playdough, a sink full of dishes, cups all over the house and bicycles, beach towels and toys strewn every which way on our front yard, is not acceptable. I’ve spoken with her twice now but to no avail. Ideally I would’ve already replaced her, but I feel I can’t because she’s a neighborhood kid, and I don’t want to be “that mom.” Any advice?

A Concerned Parent

Concerned Parent,

I think you should have another talk with your summer nanny and the kids should be present. While you are right to have expectations of the nanny, at 4 and 9 your children need to manage themselves better too. At your talk, I would present your nanny (and your children) with a checklist of expectations for her to complete by the end of each day. I would make sure your children understand that their cooperation and participation is required – they would be expected to listen to you if you were home, and their nanny is the one in charge when you are not. During the meeting, I would also keep your expectations clear and simple, and I would make sure your nanny and children are in full agreement of what is expected of them.

I would also check in with your nanny a couple of times a day to support her and to just to see how things are going. Also, I recommend that you praise the good you do see in your nanny’s performance and let her know how much you appreciate her. As a teenager, your nanny probably has not had many jobs (if any at all), and she already knows that you are not pleased with her. If you handle this well, this could be a teachable moment for her to become more independent and responsible. If, on the other hand, your efforts continue to fall on deaf ears, you certainly have the option of letting your nanny go. You will not feel like “that mom” if you know in your heart that you tried your best to work with her before letting her go. 

I am hopeful that things will work out for your nanny with added structure and a shared positive attitude. Do not forget that her main job is to be there for your kids and to provide a fun and well-rounded day for them. If your children really like the nanny and are enjoying their time with her, I say a little bit of dried playdough and some toys strewn about the lawn is not that big of a deal.

Coping with the Aging of Our ‘Pillars’

Dr. Mike,

My mother and father are in their early 70s. Neither of them works anymore, and they are both thankfully very healthy. They live out of state, and we recently visited them, and my husband and I noticed how helpless my mom seems to have become … almost overnight. I knew she stopped pumping her own gas last year, but now we found out that she no longer drives. She also takes naps daily, and it seems my father is cooking all of the meals and is doing all of the laundry and housework. Neither my mother nor father seemed unhappy; just different. I left my visit pretty upset. I called my sister who hasn’t seen our parents for about a year, and she was very surprised by what I told her. How do I approach my mom with how I am feeling? Or do I approach my dad or do I not say anything at all? My mom has always been my pillar of strength, but now she just seems so weak to me.

A Concerned Daughter

Concerned Daughter,

It seems that the changes in your mother that have upset you most have to do with her slowing down, which by the way is quite normal for someone of her age. You write that your mother and father are healthy, and that you are thankful for that. You also write that neither your mother nor your father seem unhappy. That your parents are healthy and happy in their early 70s are very positive things, but I can understand how those things are overshadowed by your fears associated with their aging. 

I do not think that you should speak to your mother or father about the changes you saw in them during your visit and how upsetting they were to you since you would just run the risk of worrying or upsetting your parents in turn. Instead, I think you should turn your upset into action and enjoy your parents more now, which should serve to better help you come to terms with their aging.

Perhaps you could call them and visit them more frequently. There may be things that you have always wanted to speak to them about but have put off. This might be the right time to broach those topics. There may also be hurtful topics from your past or unfinished business to address with them. You may also want to learn more about your parents; their experiences in life and your family history. Perhaps you could write them cards or letters or send them small gifts to let them know how much you love them and how important they are to you. Maybe you and your sister could purchase a larger gift that would be meaningful to your parents (e.g., a fancy dinner reservation or a vacation).

Watching our parents age is difficult because it reminds us of the painful fact that they are not going to live forever. Whether you are 3 years old or 47 years old, one’s parents are always one’s parents and the longing that they will always be there is a comforting one. But parental aging and death are realities that none of us can avoid.  Use your upsetting experience to enjoy your parents more now, and again that should serve to better help you come to terms with your fears and also remind you that your mother is still your pillar … she is just an older and more careful one.