The feelings are very real.
Because of their sense of uniqueness, teens often avoid the one thing that will help alleviate their emotional pain—talking about it.
Tracey is a 14-year-old girl who can’t wait to spend Friday nights at the mall with her boyfriend, Patrick. They belong to a clique of teens who like to dress in similar clothing styles. Their music tastes and other interests are also much alike. But Patrick, who is regarded as the leader of the group, shatters Tracey’s world when he announces to her and the others that he is breaking up with her.
She’s devastated. In addition to losing her boyfriend, whom she truly likes, her standing in the group and sense of belonging are diminished because most of her peers relate so positively to Patrick.
Tracey’s mother notices that she has become withdrawn and apathetic and is surprised when she no longer wants to go to the mall on Friday nights. Although she knows Patrick broke up with Tracey, she dismisses her daughter’s ardor for Patrick as nothing more than “puppy love” and thinks she will get over it soon. (Puppy love is defined as intense but relatively shallow romantic attachment, associated with adolescents.)
Another week passes, and Tracey’s mother is now concerned. She has noticed several scratches on her daughter’s wrist and asks about them. Tracey responds: “You’d never understand. You’ve never been in love with anyone as deeply as I am. How can you know how I feel?” Besides not wanting to go to the mall, she doesn’t want to go to school. She feels everyone is watching her and laughing.
Tracey’s mom is worried that her daughter is depressed and may hurt herself. Tracey says she is not suicidal, and the cutting makes her feel better. It gives her a sense of control over her feelings and relieves her profound sadness. When her mom continues to express concern about it, Tracey starts cutting her inner thigh where the cuts are not visible.
Why is Tracey cutting herself, and what explains her feelings? She is in early adolescence, and a developmental element of this phase is called the personal fable/imaginary audience. The “personal fable” aspect is a teen’s egotistical view: “No one has ever felt like I have before. No one has loved as deeply as I have. I am unique.” The “imaginary audience” component is this belief: “Because of my uniqueness, I am the center of everyone’s world. I am being watched.” Because of this sense of uniqueness, teens often avoid the one thing that will help alleviate their emotional pain—talking about it. They feel no one can understand them.
Mom takes her to see Mary, a psychiatric clinical nurse practitioner. Mary believes Tracey is in severe pain and reassures her that the breakup is not her fault. Conveying her concern, she encourages Tracey to tell her story and listens as she describes her sense of shame and anger and other feelings. By reflecting back to Tracey what she hears to ensure clarity and help her sort out her emotions, Mary helps her find a way to express her feelings in words.
Using cognitive therapy techniques, Mary challenges Tracey’s faulty thinking patterns. Thoughts such as “I’ll never love again” or “I must be unlovable” can be shown to be untrue and changed to be more positive. She also monitors Tracey to make sure that her symptoms don’t worsen and she doesn’t have other underlying issues such as substance abuse—and to determine if medication might be helpful. After more sessions, Tracey starts to feel better, and Mary teaches her some coping skills to deal with stress and her desire to cut.
With time, the cutting stops, and Tracey’s mom is surprised when she announces, “I'm going to the mall Friday night to hang out with some friends.”
Early adolescence can be a critical time in mental health development as it is accompanied by the physical changes of puberty and the psychological processes that are occurring in the developing brain. Getting teens to talk and share their feelings at this early age can ease emotional pain and help them acquire the support, coping skills, and self-regulation needed to proceed into adulthood. RNL
Michael C. LaFerney, PhD, RN, PMHCNS-BC, is a psychiatric clinical nurse specialist at Arbour SeniorCare in Haverhill, Massachusetts, USA.