A Conversation About Childhood Depression With Grace Lester, LMFT

Grace, will you tell me a little about your education and background?

I received a sociology degree from Hanover College and went on to earn my MSSW at the University of Louisville.  I am a Licensed Marriage and Family Therapist (LMFT ) and I have worked in the field of child and family therapy for 13 years.  Currently, I work as a supervisor and school-based clinician in a community mental health organization.

What do you think is most important for parents to understand about childhood/adolescent depression?

The word “depression” can be scary for parents so there is a tendency to avoid thinking about it – understandably – but parents should know that depression is very treatable.  Whether it is organic or situational in origin, it is treatable.  Depression can be a very natural reaction to trauma.

Can you tell me more about depression being a natural reaction.

Yes. A lot of times people equate depression with “brain chemistry” or a genetic predisposition but Depression can be a normal response to an abnormal situation such as abuse.  And, again, it is very treatable with the right interventions.  I really want to stress this point. There should be no stigma.

What are some differences in symptom presentation of depression in children and teens?

The biggest thing I ask parents to look for is a change in functioning. Has their child lost interest in activities they once loved?  Are they withdrawing or isolating? Is he or she having a change in mood patterns out of the norm? Are there changes in appetite or sleep (either too much or too little)? Depression doesn’t always look like the stereotypical picture of someone who is simply sad for an extended period of time.  They may have trouble focusing on the task at hand.  This is where parents or teachers sometimes make the mistake of thinking the problem is an ADHD issue when it is really a Depression or Anxiety issue. Think about it as an adult: If you are struggling with something it occupies your mind and you may have trouble focusing on what you need to be focusing on.

Some parents will say my child isn’t super sleepy or distracted or isolating themselves but then I will ask if their child has been more irritable than usual and they will say, “Yes! Absolutely. Every. single. day!” Parents don’t typically think of irritability as a sign but it can be the number one symptom in young people.  Feeling depressed and/or anxious is really irritating to experience.

Would there be one thing you see children struggling with the most in treatment?

What I see the most specifically in community mental health is the accumulation of stressors and the effects of poverty.  Now I am not saying being poor makes a child depressed but the multiple systemic stressors and crises that impact families and communities in poverty can lead to an emotional fatigue and difficulty dealing with everyday stressors.   We can’t forget too the impact of community violence.  Where I work children lose friends, family members and neighbors to gun violence on a regular basis.

Even if the family is healthy but they are surrounded by violence; the children are still experiencing trauma.  

A child may be just beginning to heal from the loss of a loved one and someone is killed again.  It rips everything open.  We can’t underestimate the impact of gun-related violence in the mental health outcomes of our children.

Do you see medicating a child as a treatment approach heavily utilized in your community?

I can only speak to my experiences in my community, where typically a pediatrician will give a child a referral for therapy before they prescribe medications.  It is more difficult for physicians  to prescribe ADHD meds in my state  now due to increased regulations.

Wow. That is a huge change from what I experienced in my work and in my community.  When I worked with children and teens in the school system in Indiana I saw doctors prescribing left and right.  Why do you think it is so different in Kentucky now?

There has been a big push to regulate. Very few of my clients are on medicine but that may also be because I am slow to refer for medicine.

Do you think that has anything to do with the opioid epidemic in your region?

Yes. I am sure.  However, even before the epidemic the culture in my office was to “go low and go slow.” Meaning we do not take the option of medication off the table but if it is used we will do the lowest dosage at the slowest rate.  We want to be able to take away the stigma for people who truly need medication.  Some children can’t go to school without using their medication for ADHD or anxiety.  They may be too distracted by their symptoms to learn in school and we fear they may be passed along without having their educational needs met.  I have had some children try to go off of their medication and it was difficult.  I think for some people who are so multi-stressed; medication is needed.  It is unrealistic to expect for all those other stressors to change so that a child can go without medication.

What do you think of the medicalization of mental health? Meaning there are a subset of parents going to primary care doctors for prescriptions with no desire to enter into therapy or adjust lifestyle choices first?

For parents who are considering medication without therapy I would have a few fundamental questions so I could understand their motivation: What are their beliefs about and experiences with therapy?  Do they believe it is a sign of weakness or reflects poorly on them as a parent? Or maybe they haven’t been to therapy and don’t know the value it can have to overall healing.

Any misunderstandings about therapy you would like to clear up for the general population?

Going to therapy does not mean you are weak.  In fact, it is quite the opposite.  There is strength in recognizing you need help and asking for it – incredible strength. We all could benefit from therapy.  Just like a car needs a tune up. Therapy can do wonders for self-care.

What changes would you like to see in the mental health community?

The changes I would like to see are actually occurring.  There is a trend toward home based and school based treatment which I fully support.  I think it’s important to have a systemic approach in therapy because humans are social beings.

Children don’t get hurt in isolation so they shouldn’t have to  heal in isolation.   

Not every client-clinician relationship is the best match.  I would like to see clients find the right fit if the therapeutic relationship is not working. If they can’t because of insurance or transportation barriers I want parents and teens to feel empowered to collaborate with the clinician. Please work through the issues with the therapist by telling him/her what would better help you.  I want clients to know they have the right to advocate for themselves.

The therapist isn’t the expert on you. You are on the expert on you. You get to have a say in your therapy.

So you want clients to feel empowered to play an active role in their treatment?

Yes!  Of course.  And if there are cultural differences or power differentials they (the therapists) need to acknowledge it and put it on the table.  Therapists may not know what it is like to be a minority or transgender but ideally they want to understand.  Clinicians are willing to collaborate and adjust their approach and understand again the therapist wants to learn about the spiritual, cultural or racial differences that may exist. They should not be barriers to treatment.  Bottom line, I want the client to feel empowered.  If this isn’t your experience with your therapist time to find a new one.

Biggest piece of advice for struggling parents?

Actually, this is part of my intake process: Where do parents get their support? Most say they don’t have time for it.  But think in terms of a flight attendant.  If you have flown before you know they tell you to put on your oxygen mask before you put on your child’s mask.  Because if you have nothing to give, you have nothing to give.  Therapy is not pampering. It is acknowledging you may need help and when we feel bad we have depleted resources to give to our children.  Parenting is all about giving.  If you’re hesitant about therapy, you may ask yourself:  What is the worst that can happen if I seek therapy or my child does? What’s the best thing that can happen?

Advice for teens out there who may be reading?

My advice for teens that may be reading is to get good help and not just from online sources.  While there are helpful resources online there is also information/advice on the internet that is not helpful or restorative. Straight up – it is hard to be a teen. What you are experiencing is valid. And you don’t have to struggle alone. Sometimes reaching out for help is the best thing. Let someone know. It can be a leader, coach, teacher or trusted adult.  With help it can get better. Don’t give up.  And you don’t have to talk about your feelings ad nauseam.  In fact, when you are depressed you are in your feelings too much.  There are actual ways you can reshape the way your brain is thinking and feeling.  Tools you can use. So ask for help and know it will get better!