Our participants experience their teenager’s use of BAs in markedly different ways. We elucidate here two distinct meaning structures of this experience: ‘being gifted relief and hope’ and ‘being robbed of everything you believed in’. For each essential structure, we will first present its full gestalt, then explicate its constituents and their interrelatedness in depth.

Essential meaning structure: being gifted relief and hope

Their teenager using BAs is a blessing in the parent’s experience. In a dangerous world, the parent rests assured that their teenager is safe during BAs. They feel a wave of relief, no longer needing to live their life in a constant state of emergency. The parent is liberated; their autonomy increases along with the teenager’s during BAs. Everyday life begins to feel recognizable and normal for the whole family, bringing back hope for a future. The teenager grows increasingly independent, and the parent trusts them to manage their own health(care). As the teenager steps up, the parent steps down. This transition sometimes feels painful and difficult, yet the parent accepts it as healthy. Being supportive from a distance, the parent increasingly gets to be their own person in relation to their teenager.

Constituents of ‘being gifted relief and hope’

In the essential structure of experiencing BAs as being gifted relief and hope, the following constituents reveal themselves: ‘a sense of safety and containment’, ‘liberation from a hostage situation’, ‘a return to wellbeing’, and ‘catalysts for relational shifts’.

A sense of safety and containment

Having a teenager who self-harms and experiences suicidal thoughts, the parent has been living in fear for their life. The lived world is one full of dangers: the city full of parks where the teenager may run off, of stores selling potentially harmful items, and of people who may have sinister intentions. To some extent, the parent still relates to the world this way during their teenager’s BAs, especially since the teenager is free to come and go. Even so, the parent relates to the BAs as safe for their teenager – uniquely safe, in contrast to the controlled environment during conventional admissions, which is accompanied by a sense of unpredictability, incomprehensibility, and imprisonment.

The BAs also feel safer than the family home. The house is a potential death-trap where locked medicine cabinets may be pried open, cleaning aides may be consumed, and a whole host of everyday objects may have unpredictably sharp edges. The parent feels out of control of their own space, unable to mitigate perils, sometimes helplessly watching as their teenager self-harms. Difficult experiences from the past may also haunt the house, etched into the walls and floors like hidden mines, so that the lived space manifests as even more hazardous, where the parent gets no rest.

From this place, the parent is relieved when the teenager self-admits. The parent knows their teenager will be kept safe during BAs, in a low-stimuli environment where professionals look out for them and tend to their basic needs. Whether there with the teenager or not, the parent feels their teenager is contained in a positive sense: being held, getting to take a break and simply be. The parent feels contained as well, given a cue that they may now, finally, let go of their worries.

Liberation from a hostage situation

Prior to the teenager using BAs, the parent has their temporality constrained by the incessant need to be ready to respond to crisis. This makes for an everyday life jagged by interruptions; the parent suddenly needs to leave work, drop the employment interview, cancel family activities and any personal plans – essentially drop everything to speed to their teenager’s rescue. Life is moving from exception to exception with no sense of continuity or constancy. The rest of the world ceases to exist.

The parent is spatially arrested as well. They stay at home to watch over the teenager, surveilling their every move as their warden. The price to pay for this is high; the parent cannot sleep properly, tend to their bodily needs, go outside or be with others. The house is stripped of its foundational homeliness and takes on an atmosphere of entrapment for both teenager and parent. This feeling lingers during the teenager’s conventional admissions as the parent is detained in the psychiatric unit, forced to breathe down their teenager’s neck against both of their wishes. Even if permitted to go home briefly, the parent remains in lockdown, tensely waiting to be summoned back. Sometimes, this hostage situation extends to their other children, unable to leave the house not knowing when their parent will be back.

The parent may experience their sense of self held hostage, in the strain between parental responsibilities for their sick teenager and other responsibilities, such as work or tending to the needs of siblings. Younger siblings may witness frightening episodes during crisis, older siblings may tackle the teenager in crisis like security guards to protect them, and amidst this turmoil the parent’s heart breaks. Being a good parent, professional, person appears impossible. The parent experiences internal and external blame, guilt, and shame for not doing or being enough.

When the teenager starts using BAs, however, everything changes. The parent regains spatiotemporal agency; they can take off their soldier’s helmet and step down from their exhausting, all-demanding stand-by duty. This liberation marks a return of autonomy and agency for the parent as well as the teenager. The parent is also free to have a dialogue with the teenager about their preferred degree of contact at the psychiatric unit, free to give the teenager room (to decide). The parent’s sense of self (as parent) is relieved from threat and, in accord, tensions within the family dissipate.

A return to wellbeing

The BAs represent a turning point for the parent: before them, life is suspended in space and time; with them, life begins anew. A burden is lifted and the lived body physically de-stresses, shoulders relaxing, lungs inhaling deeply and releasing a sigh. The parent associates their teenager’s BAs with bodily self-care practices, like having a massage.

Little by little, the parent sees the teenager learning to care for their own emotions and needs, in a way they haven’t before. Even if they might still be struggling, the world and life itself begins to feel manageable for teenager and parent. Throughout crises at home, contact with psychiatry and conventional admissions, the whole family has collectively been sharing feelings of anxiety, frustration, despair, and hopelessness. When the teenager uses BAs, instead, the parent feels that the family shares experiences of relief, safety, calm and hopefulness. The siblings go on being children and the parent is more continually and predictably available to them now, getting to spend some treasured quality time with them. The BAs assimilate into and support a familiar family life, bringing back a sense of normalcy that the parent celebrates.

The parent can also return to familiar activities and settings. Going back to work is a huge positive leap, not only in terms of escaping the stress of leave-of-absence and stabilizing the family’s economy, but in terms of gains intimately connected with a sense of a healthy life, like feeling gratitude and meaningfulness when tapping into the roles of the professional and colleague. These identities bring a sense of wholeness to their selfhood and allow them to reconnect with social relations, receive invaluable support from colleagues, take part in other people’s lives and feel like they belong.

Catalysts for relational shifts

Both teenager and parent need to adjust to a new way of thinking. With psychiatry suddenly encouraging the teenager to initiate admissions, and enabling them to choose to admit alone, the parent’s lived experience with the world shifts to one where help is available, and they do not need to be the one to manage everything. These circumstances catalyze a shift in the parent’s lived relation with their teenager. As the teenager starts experimenting with how the BAs might be helpful, the parent gives them space and encouragement.

Stepping back from managing, moderating, and monitoring is challenging, though. Adjusting to a new world order where the teenager is not in imminent danger, the parent finds comfort in the realization that taking a step back is challenging to all parents – and a normal and healthy part of parenting a teenager. Equally normal is the sometimes-painful experience of not being needed as much, not getting to perform the same concrete acts of care anymore. The parent retains their sense of self (as parent) though, adjusting to a new parental role.

The sense of normalcy affords the parent with faith. They choose to trust their teenager, the professionals, and the BA method. They no longer need full insight into the happenings at the psychiatric unit and feel comfortable not being there. Their spatial absence manifests as freedom rather than hindrance, a natural part of a healthy process, and the parent willfully surrenders control and responsibility. The more the parent can let go, the more they get to experience their teenager growing and maturing, gaining self-understanding and self-regulation skills.

The parent attunes to where the teenager needs them to be. They acknowledge the teenager’s capabilities, validate their need for space, mirror their disappointment in the face of setbacks, and encourage them. In place of the previously hierarchical parent-child relationship, a more symmetrical relationship is forming. The parent starts distinguishing the teenager’s needs from wants and preferences and can begin to consider their own as well, taking shape as person-beyond-parent even in relation to the teenager. The BAs provide parent and teenager with time and space to relate differently to each other.

Essential meaning structure: being robbed of everything you believed in

For the parent, in using BAs their teenager is being deprived of their fundamental needs. The parent engages in a tug of war for control where there is no true winning. The physical environment feels like a wasteland, a space submerged in despair and indignity, robbing the parent of hope. The psychiatric staff feel unreliable, inexplicably abandoning the teenager during BA. The parent does not see the purpose of the BAs, they seem like an echoing void where the teenager receives no help. Nothing adds up, nothing makes sense; there seems to be no thought behind anything. The parent is caught in the present, though aching for a future. They expected more from the BAs and psychiatry at large.

Constituents of ‘being robbed of everything you believed in’

In the essential structure of being robbed of everything you believed in, the following constituents reveal themselves: ‘a tug of war for control’, ‘an unworthy wasteland’, ‘abandonment and collapse of authority’, and ‘no sense of purpose and plan’.

A tug of war for control

The teenager’s life has been hanging in the balance for a long time. Under such grave circumstances, the parent expects the psychiatry professionals to remain in control over the teenager at the unit. But the teenager is free to come and go during BA and the staff seem to have no clue about their whereabouts. The parent is given no reason to have faith in the BAs, and in their mind’s eye they are bombarded with dire scenarios of their teenager self-harming or running away. The parent’s lived sense of self is that of a rock, the one dependable thing out there, and they simply cannot take the risk of surrendering control to no-one.

The parent engages in a tug of war versus both the teenager and the healthcare system. While the teenager is happy about their strengthened voice and autonomy, the parent does not trust their teenager to understand their own health and care needs or make wise decisions during BAs. Sometimes the parent is the one to get the teenager (self-)admitted. Sometimes the parent speaks for the teenager during intake meetings, or over the phone in the teenager’s absence. It may be that the teenager actively seeks the parent’s support, but the parent may also feel the need to go over their head in making plans about what is best for them. The parent instinctively cares for their teenager as if they were a younger child.

The tug of war with psychiatry means fighting both people and system. Paradoxically, the parent may authoritatively scold or command the psychiatry professionals, not trusting their judgement, yet insisting that the teenager is safer at the psychiatric unit than at home. But the parent must submit to certain conditions set by the psychiatric system, such as not staying at the unit and not listening in on conversations with professionals if the teenager doesn’t want them to. The parent feels distressed about this loss of insight into the teenager’s admission, not getting to experience first-hand that their teenager is safe. The parent’s lived space of detachment and absence rules them while they make every effort to overrule it. The parent is distinctly not-there, so painfully on the outside physically that they must always remain inside mentally. They frequently call the unit and text their teenager, they worry incessantly, and may even try reaching the teenager’s friends for updates. ‘Winning’ the tug of war changes little of the teenager’s situation, but losing is excruciating.

An unworthy wasteland

When accompanying the teenager to the psychiatric unit, the parent faces an environment conveying scarcity and urgency. Children’s suffering infuses the walls and hovers in the air, subtly yet profoundly weighing down on the parent, making them feel heavy, uneasy, suffocated. The other children admitted are also perceived as threats who may disturb their teenager’s delicate balancing act between health and illness, triggering self-harm or an eating disorder and competing for the attention of busy professionals in a setting plagued by high turnover and chaos. The parent instinctively wants to escape this environment yet may also feel a need to control it.

The room that is the teenager’s intended refuge is like a prison cell or broom closet – a tight, barren, inhospitable and unpleasant space devoid of hope. The teenager may be left with a bare mattress on the floor. The sense of unworthiness oozes from the lived space that is this wasteland. Though the parent may try to improvise curtains from blankets, the spatial inhospitality is difficult to challenge. The devoid setting, in its silence and givenness, has a demonstrative property to it, declaring this is the world you live in now; this is all there is for your child. The parent’s heart sinks.

Abandonment and collapse of authority

Sometimes as the teenager self-admits alone, soon enough the parent starts receiving messages that their teenager feels alone. Maybe they have left the unit, sitting isolated in some diner. It tugs at the parent’s heartstrings to imagine their teenager lonely and abandoned like a street child, especially while feeling poorly. The parent’s instinctive response is to bring them home immediately, and so the why of the teenager’s being there-not-here is actualized. The implicit agreement to temporarily outsource the care of the teenager from parent to professional, is now violated. The parent experiences a relational breach of trust, betrayal, and is filled up with rage. How can the staff simply leave the teenager? How can they not care?

The inaction and passivity of the professionals is interpreted either as incompetence and clumsiness, or as neglect and unforgivable recklessness. It feels deeply unethical, borderline criminal, to leave a suicidal teenager to their own devices. These experiences hollow out the authority of the professionals.

In fact, the nurses and nurse’s aides are not regarded as professionals at all. The parent is more inclined to trust psychiatrists, psychologists, and healthcare counsellors, feeling that they represent real care. The parent is more oriented toward their absence than the presence of other professionals during BA. The contributions of the professionals present are eyed with skepticism, if at all considered. When the parent stays at the unit with the teenager, they sense that the staff consider BA patients less worthy of care, like second-class patients, deprived of their rights. Not feeling taken seriously makes the parent not take the BAs seriously. The professionals’ betrayal is experienced as deeply personal and unrecoverable.

No sense of purpose or plan

The parent feels frustrated as the BAs don’t seem to make any tangible difference in the family’s life. They seem pointless, futile, and impractical, or their short-term helpfulness appears to hinge on coincidence, such as which members of staff happen to be on duty at the time. Their teenager is in a no-man’s-land, a trench where no one will claim them, contained like an object.

The parent grasps for something to believe in, feeling a pressing need to comprehend the overarching purpose with the BAs, get a sense of direction, a plan for their teenager. But the professionals handling the BAs offer no insight into the bigger picture. The parent’s lived time is in a standstill. They are arrested in the present situation, their future a thick fog, ethereal and impossible to see through.

The parent is left feeling that they expected more from the BAs and psychiatry. They have been to war for ages to get their child the healthcare they need. This care should feel like an all-hands-on-deck situation, but the psychiatric system is deceitful and undependable. In the parent’s lived world, the BAs are bookkept along with other disappointments, as a budget alternative to real care for a healthcare system on its knees. Realizing that the glimmer of the BAs was really l’or des fous, the parent feels disillusioned. Certain that their teenager would not survive losing hope, the parent keeps their soldier’s helmet on – they cannot and will not lose this fight.