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Editor's Note: Every Wednesday, Lori Gottlieb answers questions from readers about their problems, big and small. Have a question? Email her at dear.therapist@theatlantic.com.

Dear Therapist,

My 26-year-old son has been through a lot in his life, and I think he has some anger-management issues as a result. He was adopted as a newborn, though stayed in touch with his birth mother, who went on to have other children. His father and I divorced when he was 9, and a few years later his father got cancer and passed away. As a child he was diagnosed with ADHD. When he was a senior in high school, he came out to me as gay. (I was very supportive.) I don’t think he has really emotionally processed much of this.

For many years, he took Ritalin and did well in school. He was accepted into the arts college of his choice but, once at college, he stopped taking his medication and struggled. Last May, after seven years, he graduated with a degree in photography.

Since then, he has lived at home with me. He does not want to work with people or for a boss or have a schedule or go to an office. He feels he has no skills. I support him financially, for the most part. He did get a job working for a dog-walking service in March, but it does not pay a lot. That said, he got it himself and I have tried to be supportive of that effort.

Lately he has been having frequent outbursts of anger. I try very hard to phrase requests carefully to him, but things as small as “Do you think you could try a bit harder to turn off the bathroom light?” or “Can you please call your grandmother in the hospital?” have resulted in huge outbursts of anger toward me. I know that he could benefit from therapy, but I don’t know how to bring that about. Starting conversations is very difficult and I usually have the best luck around the time that he needs money. Do you have any suggestions on how I can get him help? Is it out of the question to say that my continued financial support is dependent on him getting some therapy?

Anonymous


Dear Anonymous,

A universal paradox of being a parent is that in trying to help our children, we often make things harder on both ourselves and them. Of course, it’s hard to see our kids suffer, and your tendency might even be to let things slide so as not to further upset your son. But you’re going to have to remember that not only is your son an adult, so are you. Neither of you is helpless.

Which is to say: In order to help him feel better, you’ll both need to change.

For starters, your son seems to think that he isn’t able to function as an adult, and without intending to, you’ve been reinforcing that belief (even if you don’t share it) by tiptoeing around him as if he’s fragile, allowing him to mistreat you, supporting him financially with no expectations, and not directly addressing important topics like his future goals and, most important, his evident pain.

I’m going to call that pain depression, because depression, particularly in men (and children), often presents as anger. In fact, depression more generally has been described as “anger turned inward,” and though you’re the target of your son’s outbursts, I imagine that his self-directed anger—his critical inner voice—is even harsher than what he hurls your way. It sounds as though his childhood came with some loss, and while he appeared okay on the outside, it could be that he didn’t know what he was feeling, or kept it inside, or went numb—at least until college. Many teens struggle with this transition, but the newfound freedom and lack of structure in college can be particularly challenging for someone with ADHD (layered on top of an underlying depression). Sometimes people with ADHD confuse their struggles with a lack of ability rather than a lack of appropriate support, and that profound misunderstanding—essentially, a distorted self-concept—can create a downward spiral.

Here’s what can help turn this around. Most of us need both structure and purpose in our days in order to feel good about ourselves. Feeling good about ourselves, in turn, creates a virtuous cycle: When we feel good about ourselves, we’re motivated to treat ourselves and other well, which in turn helps us to form meaningful relationships, engage in work we enjoy, and feel valuable in the world (which in turn, makes us feel good about ourselves … and round and round it goes). This is especially true with both ADHD and depression.

To convert your son’s vicious cycle into a virtuous one, he’s going to need some support in the form of a metaphorical aquarium: A fishbowl is too constraining and an ocean is too vast, but an aquarium provides a balance of freedom and structure. You’ll need to leave some choices up to him—within certain manageable parameters.

Since it’s your house, only you can decide what’s “out of the question” for these parameters. If he’s so explosive that he can’t have a calm conversation, you can start by writing him a loving letter, letting him know how much you care about him and telling him how sorry you are to see him suffer. Explain that you want to help him feel better not only because you love him, but because you believe fully in his talents and abilities and potential to create a fulfilling life despite how hard the past several years have been. Then tell him that you’ve come to realize that you may be part of the problem, by not respecting him as adult and treating him as one, and that you’d like to start by clarifying your expectations if he chooses to live with you. Those expectations might include:

  • “I’m here if you want to talk, and I also know how much easier it is to talk to someone in a space of your own. I’m concerned about you, and imagine you might be feeling lost, so I’d like you to go talk to a therapist of your choice. If you feel I’m part of the problem—as I imagine I am—and would like me to participate in family therapy with you so that I can understand your perspective better, I’d be happy to do that too.” Then give him a link to Psychology Today where he can search for providers in your area.
  • “I’m not sure why you stopped taking Ritalin. I read that sometimes it can make people feel wired, or tired, or it stops working and the dosage or type of medication needs adjusting. But I also read that people with ADHD are some of the most successful and creative in the world, and that with the right support, you can really thrive. I’d like you to go see someone who understands ADHD so you can get some recommendations that might make things a lot easier for you.” Then give him links to a few well-regarded ADHD specialists in your area, along with a link to some good books on the positive aspects of ADHD, like this one.
  • “I like that you took initiative by getting the dog-walking job. At the same time, I know how talented you are as a photographer, and because the dog-walking job won’t pay your bills or lead to something you’re passionate about, I’d like you to starting researching how you might find a job in an area that interests you. I realize that you don’t want a traditional office job, and with your skill set, I imagine there are many opportunities in non-office environments that you’ll enjoy.” Then give him some links to, say, photographer-assistant jobs, or entry-level graphics jobs. Also include links to career counselors in your area (as well as the career-counseling center at the college from which he graduated), along with email addresses of people you know who work in fields he’s interested in—and float the idea that he might get in touch with alumni from his college who are doing the kind of work he wants to do.
  • “It breaks my heart to argue so much with someone I love so deeply. I know that you’re a loving, kind person, and while I understand that you’re having a rough time, you’re going to have to find a more productive way of expressing that.” Then you lay out your terms. Maybe it’s that if he continues to yell at you, you’ll give him a month’s notice to find other living arrangements along with six months’ rent to give him time to find a job that supports that rent.

However you deliver it, the message is: I’d like nothing more than to help you, and while I can help you out financially for now, I think you need to understand more about how to feel less angry or stuck. I will pay for therapy. I will support you for [choose a time frame], so long as you treat me with kindness and find someone to talk to about the future. I realize that you may not like this and might not see this as loving, but it’s the most loving thing I can do because we only get one life and I know you want a fulfilling one. 

Emphasize that the choice is his about how he wants to proceed, but that if he chooses to live with you, this is the deal you’re willing to make with him, and that you hope he’ll accept. Be prepared for the possibility that he may decline. And, if you have trouble setting and maintaining boundaries (which can sometimes be more challenging without a co-parent on board), talk to a therapist who can help support you through this.


Dear Therapist is for informational purposes only, does not constitute medical advice, and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician, mental-health professional, or other qualified health provider with any questions you may have regarding a medical condition.

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