High-Strung Daughter Needs Therapy But Won’t Seek Help

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Reader’s Question

My daughter is extremely intellectual and an overachiever. She’s always been rather high-strung. Although she is able to speak or perform on stage in front of large groups of people with slightly less than normal nervousness, she has abnormal trouble being among the masses. She can’t stand social situations that have her butted up against a bunch of other people. At one point, I could see the sweat bead up on her forehead before she started crying and hyperventilating. This occurs any time she is in a crowd. Therefore, she has stopped attending functions with crowds — concerts, school athletics, school dances, etc. If she lived in a larger city with crowded sidewalks, I fear that she would not be able to walk down the street. She doesn’t want to see a counselor about this, but I am wondering if she should.

She is highly opinionated about over-medication and over-diagnosed people, and she doesn’t want to be one of them. When she was seven, her baby sister was in a car accident, and we had her stay with a friend of ours while we were away at a Children’s Hospital. When we came back, the teacher said that she thought my daughter had ADD due to her inattention, and we put her on meds (Ritalin, Adderall) after seeing a physician and a counselor. We discovered later through a second opinion that she had more than likely suffered depression. Thus, my daughter refuses to be diagnosed or to see any other counselors despite her reactions to social situations.

I know she needs help, but she is resistant. What can I do?

Psychologist’s Reply

The situation you describe is not all that uncommon, and there are some things you might want to consider.

Many folks who set high standards and expectations tend to apply those standards not only to themselves but to others. Plus, if they struggle with anxiety, they often fear a loss of control (which paradoxically only fuels the anxiety cycle). Some individuals have greater anxiety in situations where they are among the masses, and can experience an even greater fear of loss of control. The term “agoraphobia” has been used to describe such fears, and literally means “fear of the marketplace” (where crowds of people gather).

Individuals who are particularly conscientious or perfectionistic also sometimes tend to worry that their struggles with anxiety might be perceived as character weaknesses. This makes it difficult for them to acknowledge the need for help and to accept assistance.

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Today there are many effective treatments for individuals who suffer from anxiety. But one of the key things to keep in mind when seeking help is the person’s need for a sense of control. So, it’s important to frame the situation as one in which the person’s difficulties are not a sign of personal weakness. It’s also important to stress that therapy is a team effort as well as an inexact science. The person seeking help has to feel that they’re the one ultimately in charge of things, providing information and assessing for themselves the degree of relief they’re getting from treatment efforts. Although there is no magic bullet, the chances for a positive outcome are greater when the person sees themselves not as the “subject” of someone else’s (i.e., professional’s) diagnostic study but as the person in primary control of dealing with an important issue. If they have the assurance they will be listened to and can set their own limits, they’re much more likely to trust the endeavor.

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