Teenagers are experiencing anxiety and depression at higher rates than previous generations. The COVID-19 pandemic exponentially increased these rates. However, getting teens to talk about their feelings can be challenging for both parents and clinicians. In her new book Behind Closed Doors: A Guide for Parents and Teens to Navigate Through Life’s Toughest Issues, Jessica L. Peck, DNP, APRN, CPNP-PC, CNE, CNL, FAANP, uses her more than 20 years of experience as a pediatric nurse practitioner (NP) to help clinicians and parents strengthen connections and better communicate with teens.
Dr Peck offers teaching points gleaned from the examination room where she has treated teens with mental illnesses such as suicide attempts, self-harm wounds, and emotional trauma from cyberbullying, sexting, and pornography addictions. Dr Peck is a clinical professor at the Baylor University Louise Herrington School of Nursing, past president of the National Association of Pediatric Nurse Practitioners (NAPNAP), and a mother to 4 teenagers.
Q: What are the key takeaway messages from Behind Closed Doors?
Dr Peck: I hope that people will take away 3 things from this book: health, help, and hope. We need to remember that healthy relationships are not perfect. Perfection is not the standard we’re trying to attain, whether that be our physical health, mental health, or relational health. I want people to know what physical health and healthy relationships look like for teenagers.
I also want people to take away help. This book is very practical. It is not a self-help book that will just change your perspective. It is a Jumanji-style adventure with a lot of practical applications in it. I describe ways to take what I’m saying in the clinic and translate that health advice into strategies to improve communications with teenagers at home.
And the third thing is hope. In a world where we are inundated with bad news coming to us at the speed of a smartphone, I want people to find hope in healthy relationships and to know that it’s not all bad news. There is good news in the world and there are wonderful things about parenting teens. I’m a parent of 4 teens aged 19, 17, 15, and 13 years. When I mention this in conversation, I’ll usually get sympathetic head tilts or jokes, but really jokes are what we use to hide pain. I want parents and clinicians to address that pain in a way that reduces stigma and shame and helps connect families to hope.
I started writing this book as a girl with broken family relationships of my own. I started as a mom of a teen in perpetual conflict. During this journey, I integrated my guide on the side at drnursemama.com, my professor brain, my hands-on nursing experience, and my heart as a mom to walk alongside families. In March 2020, I looked back and reflected on that journey, and saw what was facing teens currently during the COVID-19 pandemic and what was to come. I knew it was going to get worse and that parents were going to need help and hope, and I had a unique skill set to leverage to be able to meet them where they were.
I recognized if I was going to say that we needed to leave stigma and shame behind that I had to model that first. And so hopefully that’s what I’ve done.
Q: Can you give an example of practical information provided in your book?
Dr Peck: No teen ever comes into my clinic and says, “I’m not sleeping very well and I’m not eating very well” or “I think I might be depressed because I’m sexting.” That just doesn’t happen. But they do come in and ask “Do I have the flu?” or “Do I have mono?” From there we can start discussing potential psychosocial stressors. I want to prompt families and clinicians to look for early signs of mental health issues in teenagers and to know when to call a health care provider or refer teens for help.
I created the love your team communication model, which has 4 steps:
- Listen with your face
- Offer open-ended questions
- Validate their emotions
- Explore next steps together
This approach is all about building a bridge for the teen to walk across. You can’t lecture your way to leverage behavioral change or argue your way into a relationship. You really have to start by listening and asking questions instead of lecturing or offering advice. For example, you can say “this seems upsetting” or “I can see that you are worried about this” to help teens name and claim their emotions. Exploring next steps together is inviting them in to create a pathway forward to help develop coping skills and to reason through things rather than telling them what to do or punishing them. They need to be empowered to take charge of their health.
Q: In your book, you note that teens do want to talk to their parents but don’t know how. Can you elaborate on this?
Dr Peck: It is a misconception that kids don’t want to talk to their parents. Often parents will say “they don’t care what I have to say”, “I can’t get their face out of their smartphone”, or “they care much more about what their friends think” but that is just not true. A teen’s mind is like a police scanner and is monitoring conversations going on in the background at home and listening intently for things that their parents are saying about them. Their mind tunes in and they listen very carefully. And, most importantly, they believe what their parents say about them. So when their parents describe them in negative terms like lazy, they generalize those behavioral struggles into a character trait and it deeply imprints how they think about themselves.
Also, parents need to stop expecting instant gratification. Even my kids will say “I don’t need to hear this” and give me resistance during conversations. Instead, I think of the conversation as opening a door so that they can later come back to me with questions. So often I meet patients whose parents never open the door and the teens say “I can never talk to my parents about that. It would be just too embarrassing.” What they are really saying is “I care about what my parents think about me and I don’t want them to know that I did this.”
Q: How did your expertise as a pediatric NP aid you in writing this book?
Dr Peck: Each chapter is divided into 3 sections, the first of which is what happens behind the clinic door. This is where I leverage my expertise as an NP to offer real-life clinical scenarios in which I’ve helped teenagers with conditions such as depression, anxiety, self-harming, and eating disorders. As an NP, I often meet families at a point of crisis they never saw coming. My goal is to reduce the stigma around mental health conditions. We all have secrets and we need to find a trusted practitioner to help us through them. Nurses are ranked the most trusted profession and are ideal to share problems with.
Q: What can NP and PA readers learn from this book in terms of clinical practice?
Dr Peck: Integrating mental health into the medical curriculum is a slow process. However, the current mental health crisis has unfolded at warp speed. In my book, NPs and PAs will find a concise guide to the most recent scientific literature on mental health management in teens. In a nutshell, this book is a clinical update on mental health threats and how they are impacting teens today.
One thing that surprised me most about [writing this book] is meeting other health care providers where they are as people. I’ve had so many clinicians reach out to me and express the positive impact the book has had on their personal life. Health care providers are not immune to personal trauma, mental health struggles, or to any of the other struggles that are in this book. And sometimes we as providers [are] our own worst patients.
We make sure our patients get enough to eat, get enough sleep, and reach out when they have early signs of mental health conditions. But we’re not doing that for ourselves. Providers have reached out to say that this book helped them cross that divide to realize that they need to take their own advice. And that can be a really hard place to be in. However, it is not the moment that broke you, it’s the moment that you start to heal.
Q: Do you have any tips for NPs and PAs on writing a book?
Dr Peck: This book writing journey has been terrixciting — it’s terrifying and exciting at the same time. Nursing voices are underrepresented in media and authorship despite being the most trusted profession. As parents are home hurting, dealing with the mental health repercussions of the COVID-19 pandemic, what better voice to come alongside them than the voice of a nurse.
To future NP and PA authors, I say take the leap. Just do it. Dream big and think about ways that we can reach families and patients. It takes a lot of blood, sweat, and tears. One of the most difficult things has been stepping outside of my professional persona and being vulnerable and that is really what’s resonated with people.
Lebrun-Harris LA, Ghandour RM, Kogan MD, et al. Five-year trends in US children’s health and well-being, 2016-2020. JAMA Pediatr. 2022;176(7):e220056. doi:10.1001/jamapediatrics.2022.0056
Peck J. Behind Closed Doors: A Guide for Parents and Teens to Navigate Through Life’s Toughest Issue. HarperCollins, 2022.