Expert: Joel Simon - 12/18/2011

Question
I will try and make this short.  Son, 22, has a history of issues.  Generally he's very normal and a pleasant to be around but due to some unfortunate circumstances and his "issues" things have been a bit stressful around here and I am going bonkers.  He lives at home and is taking a break from college.  He was working a lot and it made him happy - busy and making money.

Issues:  Son was diagnosed this past summer with bipolar 2 after being hospitalized for suicidal ideation because his girlfriend broke up with him.  He also has a drinking problem.  About 3 weeks ago he came staggering in our house at 3:30 AM after setting off the car alarm.  He broke our glass lamp shade and doesn't remember any of it.  Hadn't had a drinking incident since then.  About two weeks ago he came down with severe strep throat and had to have an emergency tonsillectomy and had to be hospitalized until the next day.  The following day he said he felt well enough to play an indoor soccer game.  I wasn't happy with the idea but what could I do?  He ended up blowing out his knee.  For the past week he's been on pain meds and crutches, until a day or so ago and now is badgering and badgering me to give him our car keys.  I made it clear that he won't get the keys until we get the results from his MRI - which isn't due for another week.   I held my ground but he kept yelling at me. So he asks his dad (like our youngest always did - who is an addict) said it was okay but then thought he'd better tell my son he'd have to "check with your mom".  That sounds alright, normally, but we've had this conversation many times and he knows better than to make me out as the "bad guy" because he doesn't agree with me.  My husband and have a very good relationship except when it comes to big issues involving our sons.  He has a bit of passive aggressive stuff going on and it really hurts.  Although he's gotten better ~ this latest incident - with my son saying some awful things to me is overwhelming and hurtful.  I know he's hurting in a big way because he can't work, he can't play sports, and he can't drive.  Maybe his depression has come back because of his circumstances?  He yelled that he just needs to get away from me.  That's why he wants to drive he said.

My question in all this is ~ should we as a couple consider counseling or ~ since this is so infrequent ~ should I just ride the wave?

Answer
Kathy, let me begin with my favorite soapbox: psychiatric diagnosis.  In reality, psychiatric diagnoses are irrelevant and meaningless.  Unlike medical diagnosis which are based (mostly) on concrete evidence - a culture, an MRI, PET Scan, X-ray, blood tests, etc - psychiatric diagnoses are based purely on client and significant others' reports and behaviors.  If you've ever seen the DSM IV-TR, you would see that it contains behavioral descriptions only and that diagnoses are made based upon behavioral criteria.  Also unlike medical diagnoses which lead to a prescriptive action - take this medication, have this procedure, etc - psychiatric diagnoses leads to nothing prescriptive.  At last count, there are something between 300 and 500 different models and theories of psychotherapy.  If you went to a psychoanalyst and said that you carry a diagnosis of major depression, he or she would prescribe a course of therapy very different than if you went to a behavioral therapist.  So, I would not make too many assumptions about the meaning of a bipolar diagnosis.  You've said that your husband and your communication has gotten better over time regarding responding to your son.  I wonder whether you and your husband are doing your best so far in trying to figure out how to parent an adult child.  It may mean that you need together explicitly to figure out how to construct a consistent approach with your son -  I think this is a much better frame than passive aggression (just another irrelevant diagnosis).  For example, saying to your son that he needs to check with his mother is a step in the right direction.  However, saying, "I need to discuss this with Mom and we will let you know what we think" is much better.  In terms of your question, if you and your husband have the ability to communicate together and work these things out, I doubt you will need outside intervention.  If however, you both together need to figure out how to improve your communication, then a couple of sessions with a counselor might be useful.  If you decide on the latter, make sure you choose someone who will attend to your goal and not try to engage you in long-term therapy conversations about problems.  You might want to take a look at www.0to10.net/Therapy  for further information on this.  Hope this helps.  Joel