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Portteus Psychiatry Group Dr. Andrew Portteus discusses topics related to families, parenting, mental health, counseling and psychiatry.

Over the years, I have visited with many depressed teens and tweens in my office who felt disconnected from their families.  Interestingly, almost universally, they desired more connectedness.  Sometimes the youth were skeptical that things could change... but typically they wanted them to change.

I visited with a young man whose father was a hunting enthusiast and spent most of his free time on the weekends at the deer lease. The brother had a good relationship with dad because the brother liked hunting.  This child who was a bit more sensitive felt very distant from his father.
Unfortunately, the father had made no effort to find out what the child liked.  “We are just different,” the father had told himself.  He used this as an excuse to not nurture a relationship with his son.  The son began to feel inadequate and depressed.

A teenage girl was feeling left out that grandparents came to town to visit other family members but did not reach out to her. The mother relayed the information and then the grandparents invited her to attend a football game.  She declined the invitation because she hated football.  Her rationale?  She felt that if they wanted to spend time with her they would have selected an activity that all would enjoy, or chosen a way to engage in a meaningful way with her.  Rather than communicating her feelings, she retreated to her bedroom and cut her thighs with a craft knife blade to distract from her emotion.

Recently in my office, a high school student shared frustrations with his father’s lack of availability, and his mother was shocked.  “But he takes you to all of your lacrosse practices and sits in the stands, watches and waits for you” she said.  “But I am busy then,” the boy replied.  “’We never get to hang out or talk.”

A boy with ADHD enraged his father with off-task behavior, and the family was frequently in turmoil and conflict.  With a little probing I learned that the father and child were frequently in screaming matches.  “Are they having fun together?”  I wanted to know.   No.  The child did not like what the father liked.   A little problem solving revealed that everyone liked board games, however, the family rarely played them.

When a person is not doing well emotionally or behaviorally, a psychiatrist or therapist will often assess the key relationships in that person’s life.   Sometimes, emotional problems develop when there has been longstanding conflict and tension or lack of nurturing and support.  Changing family dynamics can be a powerful catalyst for healing.   Conversely, when someone has been struggling with depression, anxiety, addiction, stress, etc., family relationships often suffer and may need repair.

Certainly, when children are struggling, it can be helpful to think about the family system:  what strengths and supports are in place to help the child thrive, what support is missing or not working well, how are a child’s negative behaviors impacting caregivers’ and siblings’ ability to care for them?  How are parents’ behaviors, expectations, frustrations, and reactions impacting a child? When parents feel that family interactions and behaviors are problematic, in can be useful for them to evaluate their engagement with their children and critically consider if it is optimal.  Often, youth I meet with in my office share a concern that an important person in their life is not sharing meaningful time with them.  Sometimes, this is a distorted perception that can be addressed in therapy.  Often it is truth.  Fortunately, treatment can improve this scenario.

It’s realistic to expect that kids simply have to do things they don't like or things that are necessary for the family.  In fact, this is useful to help build frustration tolerance and ability to accept delayed gratification.  Sometimes, children benefit from exposure to experiences that they would not choose, but will advance learning and development.  Piano lessons, anyone?  However, children should ideally be afforded the time to engage with their parent in activities the CHILD likes.  Over and over again, I see parents failing to make an effort to engage with a child in a way the child prefers.

Certainly there will be times with teenagers that everything is boring, family members are annoying, and family members’ attempts to foster relationships are shunned.   Sometimes “I don’t care” from a teenager is the closest we get to “yes, I would love to!”  As youth gain maturity and a desire for independence, more time is naturally and appropriately spent with peers; however, most youth thrive when independence is tempered with boundaries, guidance, support, and love from their families.

Giving a teenager options on when and how to spend family time can help.  “I would like to take you out this weekend so we can catch up.  Would you prefer to go to lunch today or breakfast tomorrow?”   Asking a child for ideas on activities to do together can be productive but often overlooked. 

Children who feel alone and bored can find ways to fill this void.  There are peers who will introduce them to marijuana or alcohol, perhaps sex before they are ready.  Youth who are not engaged in meaningful activities within a family can create theories depicting themselves as inadequate or unimportant.  While it is key to focus on homework and tests, service hours, and chores, it is imperative that the value of the relationship is not sacrificed.  Often times, this realization is the most pivotal for families I see in crisis, looking for solutions.

In this busy era of practices, rehearsals, and large homework loads for kids and out-of-town travels, conference calls, and dinner meetings for parents, it can be a challenge to carve out time for leisure activity, let alone a sit-down family meal.  In the Portteus household with four young children, we deal with the daily struggle to manage tasks and support relationships in caring and meaningful ways.

If you are not feeling engaged with your child, it might be a good time to invite them to do something fun… and let them choose!  Families with conflictual or disengaged relationships may also find it useful to evaluate and treat possible depression and address relational problems in therapy.


Andrew Portteus, MD, MPH


The Portteus Psychiatry Group is a family mental health practice that provides diagnostic evaluations and treatment with individual therapy, family therapy and medication management.   To learn more about us, read Dr. Portteus’ blog, or schedule a consultation, visit or call 214-550-3367.

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