Talking To Teens: Expert Tips for Parenting Teenagers

Introduction to Talking to Teens
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Andy Earle: You're listening to Talking to Teens, where we speak with leading experts from a variety of disciplines about the art and science of parenting teenagers. I'm your host, Andy Earl e.

Understanding Self-Hate in Teenagers
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Andy Earle: We're talking today about self hate, self blame, self criticism, self loathing.

People in general, and especially teenagers, can be so hard on ourselves.

For a certain set of people, we start to really internalize these ideas about ourselves that we'll never be good enough.

That we really can't do anything right.

We start to believe that these feelings of hate for ourselves are a core part of who we are and something that will be with us always.

As parents, we want to prevent our teens from developing these core feelings of self hate.

And if they're feeling that way now, we want to help them heal.

Introducing Dr. Blaise Aguirre
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Andy Earle: Today's guest, Dr. Blaise Aguirre, is a professor of psychiatry at Harvard Medical School.

He is the founding medical director of Three East Continuum of Care. And he's the author of the new book, I Hate Myself.

Dr. Aguirre, welcome to the Talking to Teens podcast. I am super excited to speak with you.

Blaise Aguirre: Well, thank you so much for having me. First of all, I'm a little bit envious that you have gotten the book before I have, but I also think this is a topic that parents need to know about.

So, really appreciate you having me on your show.

The Concept of Core Self-Hatred
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Andy Earle: The book is all about self hate and self loathing, which are maybe different things or maybe not. Talk to me about the topic. How did you settle on this as the thing to write about? And where did the idea for this book come from?

Blaise Aguirre: By way of context, I'm at McLean Hospital, and I've been here since 2000. McLean Hospital is well known for the movie Girl Interrupted. A lot of people have seen that's where it took place. And my area of interest has been young people with very self destructive thoughts and behavior.

So suicidal thoughts, a lot of cutting, a lot of toxic relationships. A lot of self destructiveness in their life.

Dialectical Behavior Therapy (DBT) and Its Impact
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Blaise Aguirre: We're certainly seeing a lot of that, in the world these days, especially here in the U. S. I started a program in 2007 using a treatment known as dialectical behavior therapy.

Kind of Zen contemplative mindfulness with Western cognitive behavioral therapy. As a way of reducing these behaviors. So, we don't emphasize medications, and we don't emphasize traditional talk therapy. And, what the research shows is that DBT lowers suicidal behavior and suicide actions.

The concern was that a program that only catered to highly suicidal kids was going to have a lot of suicidal outcomes. But in fact, we found that by applying DBT, we really reduced the risk of suicide in the kids who completed our program, which is really wonderful, because, certainly having experienced the loss of other patients before the time of DBT, how devastating it was for families, and treaters. Even though we reduced the suicide rate markedly, there was still a small group of kids who tragically took their life.

And I wondered what it was about their experience versus other kids who were suicidal who didn't take their lives, that made a difference.

Identifying and Addressing Self-Hatred
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Blaise Aguirre: And when I reviewed their records and when I started to speak to some of my other patients, the one thing that no treatment addresses is this idea of self hatred.

So there was this small group of kids who had core self hatred, that even if they were going to school, and even if they were listening to their parents, and maybe they were not using as many drugs, etc. This core self hatred persisted. And therapy never addresses that. And we don't even ask about it.

And so, I wanted to reduce that element of suffering in people with core self hatred. I started collecting stories, patient histories. And I started to work with them. I saw the ways in which trying to target self hatred Worked in all the ways in which it didn't work. And, as people started to really heal from self hatred, I just thought, like, we need to get this out. Both so that clinicians know what to do and help parents, give them some ideas of how to help their kids who may be beginning to show some signs of self hatred.

Andy Earle: Wow. You talk about it being a small group of people that were showing signs of this core self hatred, but isn't this common? Don't we all, all kinds, I think of multiple times a day when I hear people saying things like, ah, I'm so stupid. I always do stuff like that. I'm such a klutz. I hate that I do that.

So, uh, talk to me about that. What's the difference between that? Is that what you're talking about here?

Blaise Aguirre: Yeah, it's a great question. And actually, even though the book is really targeting core self hatred, there are many related concepts: self criticism, self disgust, perfectionism, people pleasing behavior.

So there's a sort of a self dissatisfaction that comes with it. But let's imagine that you decided to go skydiving. So you went skydiving and it was fun, or it wasn't fun. But you then said, you know what, I really didn't like it.

I'm not going to go and do that again. Or I'm going to go and hang out with these people at a party. And you go there, you have fun, or you don't like them. And you say, I'm not going to do that. But you recognize that those experiences are separate from you. And so when you say, I've done this stupid thing, then there's a thing that you've done that's outside of you that's stupid.

And then you can say, all right, I get it. I'm not going to do that thing again, or I'm going to try to think about other ways to do it. But it would be as if core self hatred were your liver. It's like, it doesn't matter where you go, it's always with you. And so for people with core self hatred, it's integrated into their sense of who they are.

So it's not as if you say, well, I'm going to go to the party, or I'm not going to go, or I'm not going to do that thing again. It's like, no matter where I go, this self hatred is with me, and it is part of who I am. And there's lots of ways in which we identify whether it's gender, race, ethnicity, sexual orientation, whatever it is, and you just say, well, that's just part of who I am.

So, it's part of just like that core sense of self, that gets integrated into the DNA of the human, or at least that's what they perceive.

Andy Earle: And it feels permanent and unchangeable.

Blaise Aguirre: Yeah. In the same way that many other aspects of core self.

Andy Earle: You write on page 29 that often when you initially meet people with self hatred and ask how they're doing, they say, fine. But in the majority of cases, fine is the furthest from how they're feeling.

Wow. I think a lot of parents relate to that, asking your kids how they're doing and just hearing fine. If that's the case and someone might be experiencing these really intense feelings of self hatred, but if you ask them about it, they're just going to tell you they're doing fine. Not a big deal.

What do we do as someone who's maybe trying to have a conversation with a teenager and wonder if they're experiencing some of these feelings?

Parental Approaches to Teen Self-Criticism
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Andy Earle: How do we get past that "I'm fine" barrier.

Blaise Aguirre: Yeah, you know, and I see that a lot in the work that I do with teens that people just say they're fine.

Often people are fine, so I don't want to pathologize the word fine. When people are fine, they're just fine. But there's a dissonance that happens if your kid 98 percent of the time goes off to school, comes back, is grumpy, they need some food, they eat, and they go to their room, they're doing their homework, they're on their social media, they go out and do whatever they do. That is their natural state.

And they would probably say that they're doing fine. But what happens if you start to see changes in behavior where they start to be overly self critical, overly self judgmental, you start to see behavior where there's a lot of people pleasing. There's a lot of perfectionism.

There's a lot of dissatisfaction, with the self, And, you know, and it's insidious because it's sort of, you know, like, I could have done better on a test. Well, maybe that's true. But now the reason I'm not doing better on a test isn't because I didn't study enough. It's because I'm stupid because I'm lazy, you know, so that they start to program their minds, their brains with self critical words.

What parents tend to do is to challenge whatever concept the child, brings like no one will ever love me. That's ridiculous. Of course, people are going to love you.

Andy Earle: That's not true. Look at how many people. No, you did great in that other subject. You're really smart at something.

Blaise Aguirre: Exactly. Exactly. I understand that, I'm a father of four children. I understand the desire to give them a pat on the shoulder. Now, there are many kids for whom that would work. People who have more than one child will often notice that a technique that they use with one kid works differently than a technique they use with another kid.

One characteristic of the group of kids that I'm talking about is that all of them are highly sensitive people. With my two younger kids, if I say something like. They were playing soccer. They fell down and said, you know, get your ass off the ground and go chase the ball or whatever it is.

They would just do that. And it would be fine. Maybe my older children would say, why are you being so mean? Why are you being so critical?

Andy Earle: Stop yelling at me.

Blaise Aguirre: Why are you being so horrible? I'm doing the same thing. But, you know, I think was it Gabor Mate who said no two children are raised by the same two parents.

The children are different, and you yourself are different as a parent, depending on the child that you're interacting with. But when you have a highly sensitive child, and they perceive criticism, it's sort of like taking a magnifying glass to that experience and amplifying it so that it doesn't just be like, hey, you know, you should have studied harder. What they do is they take that statement and it's, you should have studied harder because you're not like your brother, who's much smarter than you are because you are lazy, because you're good for nothing.

They're adding their own editorializing to whatever experience they're having and they're amplifying it. Simply saying, no, you're not stupid or anything like that. You're not going to say you are stupid either. You're just going to say, Hey, listen, what's going on? You want to have a discussion with them about the self critical statement.

Tell me what's going on. Rather than either rejecting them or saying, or simplifying the solution. Like all you need to do is be like your brother. Or study harder.

Andy Earle: I hear a lot of parents complaining about the behavior that they see from their teenagers. My teenagers talks back to me, doesn't respect me. So ungrateful, takes things for granted. All these different things. And I found it interesting. On page 60, you have an exercise, and you say to pay attention to the behavior you tolerate from others.

You are teaching them how to treat you. Are you teaching them that it's okay to act toward you in the way that they do?

It got me thinking to these parent teen dynamics and how we might be if that behavior is occurring and your kid is treating you in a way that you don't like, how could we examine that further and start to notice where we might be enabling that or teaching them that that's okay.

Blaise Aguirre: So, my 4 kids, one is studying AI, the other one is going to law school. My oldest boy became a social worker. And my daughter works in service industry.

And my son and I, my social worker son and I, went to Vegas just to hike through the desert and I was like, hey, was there ever anything that I taught you that made sense?

He says, I don't remember so much of what you told me. I really don't, but I remember how you made me feel. And I felt listened to. And I think that what happens is, my dad's 90, like he's told me a million things. I don't remember any of it. My mom, I remember just how I felt good when I was with her.

I felt that we could talk. But I don't remember what specifically she said. Maybe I've got one or two statements. And we forget that we too were adolescent at one point and probably behaved in similar sorts of ways with our parents.

Children rarely feel good about talking back to their parents and being disrespectful. I'll hear parents say, Oh, they're so disrespectful. And so they often don't feel that way. But when the child doesn't know what to do, they start to escalate the behavior. Especially children who are highly sensitive. Parents say, go clean your room, go clean your room, stop nagging, I told you I was going to do it later, back and forth.

And now, there's a lot of back talk. So then what happens is the parent becomes more punitive. They say, now you lose your car privileges or whatever it is. And what happens is it creates a state of conflict. Rather than sitting down together and just saying, look, we've made this issue about cleaning up your room such a big thing between us and I don't want to fight with you and you don't want to fight with me.

And so, what's going on? Are there things that I'm doing that are annoying you? Are there ways in which we can solve this problem together? Maybe it's not a priority of yours, but is there a way to listen? Because everything makes sense from a human being's point of view.

How a person sees the world makes sense from their point of view. So rather than saying, you need to change your point of view, it's like, tell me about your point of view. If I say to you, living in San Francisco is ridiculous, you're gonna have an earthquake or something. Boston's much better.

And you say, wow, it's really cold over there. It's like, you know, 20 degrees out right now. I don't want to be living in the cold. Okay, you got a point of view. I've got a point of view. We don't have to fight about it. So tell me how you get there.

If I'm being disrespectful to you, and you're tolerating that, and I'm continuing to do the behavior that I do, maybe that's just how I'm going to continue to treat you. For a parent to then continue to do what they do that allows for that behavior to persist does the parent a disservice and does the child a disservice. And there's no modeling of more healthy, effective interaction.

And I just think putting everything down and saying, hey, come on, this is really hurting us. This is really hurting our relationship. What's going on? And also, the parent may be doing stuff that isn't effective. But you're much more likely to get it if you can open your mind and your heart before you open your mouth.

Andy Earle: Doesn't need to escalate things further, or be more disciplinary, or make them respect me, we need to reset this pattern somehow and reconnect with the child in a different way.

Blaise Aguirre: Something you said is just absolutely critical. The dysregulated brain cannot think.

So, if you're interested in Plato, and then we're standing outside your house discussing Plato, and then all of a sudden it goes up in fire, and I say, hey, wait a second, I want to talk about the allegory of the, and you're like, what are you talking about?

My house is on fire! Thinking narrows during emotionally escalated state. And so, what I'm saying is not only you're not listening to me, I'm going to punish you, which escalates things further.

The best way to shut down thinking is to escalate emotions and often these things just escalate emotions and what you want is to get thinking back online.

You've got to regulate before you can reflect. So the idea is to settle things down before we can have a discussion.

Andy Earle: I like what you're saying about your son and, walking through the desert and reflecting on your parenting journey. He can't really remember specific things that you talked about, but he just says, I feel like I was listened to. Like I was being heard. And that's so important for any parent child relationship.

The Importance of Validation
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Andy Earle: You talk in your book a decent amount about invalidation, which I found really interesting, because I think that so often kids are trying to share things with us and we're invalidating their statements or their experience in different ways.

Without necessarily trying to. It creates that feeling where they're not being listened to, or they don't feel like they're being seen. What does that look like? Or what are some of those things that we do maybe unconsciously that could invalidate things that our teen is trying to share with us?

And how could we not do that?

Blaise Aguirre: Did you just ask me if I treat girls differently from boys, is that what you just asked me?

Andy Earle: No.

Blaise Aguirre: Wait, what happened, really? That's not what you asked me. What happens when I misattribute or interpret what you've said? What happened when I asked you that question?

You were like, what?

Andy Earle: Yeah.

Blaise Aguirre: It was surprising to you that I asked you that question, because it had nothing to do with what you were asking. So what happens is, it creates confusion between us. And if I persist and I say, no, that's not what you said is that, that I went for a walk with my son in the desert, but I should have gone for a walk with my daughter.

That's what you're telling me. No, I didn't tell you that. No, you did. So we get into it. The invalidation rejects the other person's experience. It minimizes the other person's experience. It sort of says, well, okay, I get it that you're not doing very well in math but, you should study harder, you should do more math problems or something like that.

It makes the solution seemingly simple. And it tells people that they shouldn't be feeling the way that they're feeling. When that's the way that they're feeling. Now, the problem is, if I keep telling you that things are easier than they should be, or that you shouldn't be feeling the way that you do, but you're a young child and you're a sensitive child, the message that you're getting is that either you're flawed in some way, because you are feeling the way that you're feeling. Or that you need to try harder. Or that you're just wrong. You're simply wrong and what you need to do is shut up. But if you think about people who eat peanut butter and enjoy it.

But if somebody is allergic to peanut butter, they're going to have a big reaction to that and then maybe even die. Just saying, hey, listen, all your other siblings can eat peanut butter. You should be able to do so as well. Is the metaphorical equivalence of invalidation?

And so rather than getting to that, even if you think that that's true, even if you think that they're making a very big deal over the fact that they broke up with a boyfriend of only three weeks, and it's the end of the world, even if you think that that is true, the fact is that they are making a big deal over it.

And before you get to any problem solving or solutions, it's like, hey, tell me what's going on for you. Why is this so painful? Help me understand that. Which is much more validating than, look, the guy was a jerk. You should just get over it,

Andy Earle: You're only dating for a month.

It's not that big a deal.

Blaise Aguirre: Exactly. Calm down. Yeah. And you know, actually I had a kid who was a valedictorian of a school and she was dating this kid who was getting arrested all the time for selling drugs. Eventually they broke up and the dad was overjoyed. We had a family meeting and she was so upset.

The dad said, like, why are you so upset? The guy was a jerk. He was selling drugs. He was getting arrested all the time. So I said, well, your kid's the valedictorian of the school, and she's dating this guy. So, are you telling me that she's not intelligent? That she can't discern?

And she said, yeah, well that's what's so confusing. Like, she's such a smart kid. Like, why would she date the guy? And I said, well, she's sitting right there. Why don't you ask her? And she said, Dad, you know, for so many years I've dated people who were so hurtful to me. Yeah, this guy did stuff that I didn't like, but he listened to me.

Whenever I was struggling, I could pick up the phone and call him and he'd be there. I didn't have boyfriends like that. No, I didn't like some aspects, but I really needed that.

What I'm saying is that behind a person's experience, there's a truth that they're experiencing and when the dad understood that, it allowed for a more harmonious relationship.

So that's the part of it. That's so key in validation, is that, when you're getting into a fight with your kid, you just got to stop and listen and say, Hey, I'm not understanding this, what's going on? But with an open mind, not just like, well, help me understand why drinking so much was so good for you last night. Cause then the kids are sarcasm raiders, they'll pick up on it very, very quickly.

Andy Earle: You don't really care. You don't really want to know.

Blaise Aguirre: Exactly.

Andy Earle: It's like completely writing off their experience as not valid.

It doesn't matter. Why are they so worked up about this? It's not a big deal.

Blaise Aguirre: Exactly. And it's a big deal for whom it's a big deal. And like, parents also have things, you know, they're a big deal to them. And what if somebody rejected those things?

Conclusion and Final Thoughts
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Andy Earle: Dr. Aguirre, thank you so much for coming on the show today and, sharing your experiences, your wisdom, and, the ideas from your book. It's been enlightening and fascinating.

Blaise Aguirre: Thank you so much for having me.

I've regulated. I'm less envious now that you've got a copy. There's no comparison. I'll get mine at some point. Thank you for the insightful questions, for your care for teens and families, for bringing topics that are less common to their ears and, appreciate it tremendously.

Andy Earle: I highly encourage people to check out a copy of the book. It's called I Hate Myself, Overcome Self Loathing, and Realize Why You're Wrong About You.

Blaise Aguirre: And you know, the other thing is that Jewel wrote the foreword, and she's a good friend of mine, and she is not only an incredible musician, but she's gifted in the field of mental health.

She has a foundation where she works with kids and she has done remarkable stuff.

Andy Earle: It's a powerful forward. Yeah, she really did a great job on that.

Where can we send people to find out more about you what you're doing and follow updates from you?

Blaise Aguirre: I hate myself book dot com. The work that I do day to day is at McCain hospital, which is a part of the Harvard teaching system. And it's the number 3, the word East dot org.

Andy Earle: Thank you. Thanks again for coming on the show.

We're here today with Dr. Blaise Aguirre talking about self hate in teenagers, and we're not done yet. Here's a look at what's coming up in the second half of the show.

Blaise Aguirre: If you have a terrible toothache and I keep giving you painkillers, you might have a much bigger problem later on, an infection, something that is brewing, but I've masked the pain. In order to get people to change, you have to understand where they are in the first place. A child isn't born hating himself in the same way that you weren't born speaking English. You're born with a capacity to experience. And then the early experiences determine which way you'll go.

Andy Earle: People with self hate feel it's a core, unchangeable part of who they are. And a big part of the work is dismantling that belief or convincing them that it can change.

Blaise Aguirre: The only person to ever compare yourself to is yourself. You less effective and you more effective. You less compassionate to yourself and you more compassionate to yourself. Why should I get advice from people who are unhappy? If your advice is working, you wouldn't be unhappy.

Andy Earle: Want to hear the full interview? Sign up for a subscription today. It's completely affordable and your membership supports the work we do here at Talking to Teens. You can now sign up directly through Apple Podcasts. Thanks for listening, and we'll see you next time.