Psychologist Melissa Nobile of The Kusnacht Practice on treating young people during Covid-19

To mark Mental Health Week, Melissa Nobile, a Psychologist at The Kusnacht Practice, discusses her experiences of offering care to young people during the pandemic

Mental health has become such a ubiquitous phrase in our society that it is almost verging on cliché – all the more reason, then, to explore in detail what we really mean when discuss it. The best way to do that is to talk with someone who really understands it, and deals with these issues on a daily basis. 

Accordingly, I Zoom with Melissa Nobile, a Psychologist at The Kusnacht Practice in Switzerland. Nobile’s academic background is at the University of Geneva and the University of California in Los Angeles; she subsequently acquired additional training and clinical experience in Thailand and Europe.

Nobile’s role at The Kusnacht Practice is particularly relevant for Finito World readers. Nobile is especially engaged in the practice’s Youth Programme, with most of her work conducted with patients between the ages of 13 and 25. 

For parents, this has been an anxious time. It is difficult to unpick pandemic-specific behavioural changes from developments that would probably have been scheduled to happen anyway, with or without Covid-19. Does Nobile have any advice on that score? “As a parent, it’s okay to see just a little change in your child – signs might include a bit more frustration,” Nobile explains. “But if you’re getting to the point where there’s a really concerning change, then you should seek help.”

So how do problems tend to manifest themselves? “We look for areas where day-to-day functioning has altered,” Nobile continues. “It could be that the child is suddenly really scared of going to school. At the beginning of the pandemic particularly, children were scared of losing a parent.”

More generally, the pandemic has been an onslaught on our sense of pleasure in the world – that’s true for young people too. The death tolls reported daily on our news sources chip away at our ability to be joyful. Is there a danger that we’ve become a morbid society? 

Nobile says that the impact of that is especially significant on those who were already vulnerable: “In those who are predisposed to struggle with anxiety that’s obviously a problem. But it hasn’t been confined to those people: it’s also something we’ve seen in CEOs and high achievers.” That’s partly due to the uncertain time scales which are at the centre of what’s been so challenging about the pandemic: “It’s stressful for everybody. Nobody likes uncertainty for too long, as we have a sense of loss of control if we’re unable to plan for the future. A lot of people end up turning off the TV as they can’t take that morbidity.”

The danger, of course, is that a stressed-out CEO, however wealthy, is not going to be stressed out in a bubble – in the family unit, that stress is likely to be catching and affect younger members of the family. The Kusnacht Practice is careful to see the wider picture of what may be causing strain in a young person. “We’re very focussed on the stresses that CEOs are under. It’s the difficulty of having it all on your shoulders. We have to make sure that what the parents are feeling doesn’t spread into the life of the teenager.”

The Kusnacht Practice is a pioneer in the field of ‘individualised treatment’: “Our approach is tailor-made to each young person coming in,” Nobile explains. “In group settings, the patient comes in and has to adapt to the programme and the setting. It doesn’t work for a lot of people. What we do is listen to the person coming in, and examine their specific problems – whether it be a specific symptom, or pandemic struggles, or something else altogether.”

Crucially, this individualised approach is matched by an equally individualised family programme. “We’ll get as many people as possible on site whenever possible – siblings, parents, grandparents, even nannies. They’re going to go back home, and back into the family system, so changing someone without changing the rest of that family system usually doesn’t work.”

Nobile reports an increase in cases where she’s needed to orchestrate a family therapy approach. “I’m doing more and more sessions where I do parental coaching around a situation. This will sound simple in theory but in truth, it’s quite complicated. In some families it’s about going back to really good communication. Uncertainty will give room for people to imagine the worst. What we need is for parents to explain as much as possible – and in words adapted to a child – what is going on. If you don’t do that, a child may construct more catastrophic scenarios than is actually the case.”

Nobile exhibits a profound understanding of her clients: “Children or teens are antennas,” she says. “Given that, it’s important for parents to say: ‘Listen, this is a difficult time but we’re going to be okay’.”

So what can we all do to improve our domestic lives? Nobile advises focusing on specific family rituals so that no member of the family in question is isolated. “It’s important to have that time where you still cook or go for a walk together. That will always be beneficial. I’ve had a lot of teenagers lately where they’ve found experiences in the pandemic which are very enriching. Some have come out thinking, ‘Even when things seem terrible, I’m able to cope with it and I can talk to someone’. Some have built that vital resilience.”

Even so, the long-term picture remains uncertain, and that creates another layer of problems. “There’ll be a minority group for whom difficulties will persevere,” Nobile says. “There’s the young student who maybe acquired a gaming addiction in lockdown – that will take time to treat. Or else there’s those young people whose parents have lost their jobs at this time. In those instances, we’re discussing a more long-term impact.”

Career issues arise again and again, according to Nobile. “During the pandemic, we had a lot of time on our hands. That creates a lot of existential questioning, perhaps among young people who were already predisposed to that anyhow.”

Fortunately, The Kusnacht Practice has a remarkable range of resources at its disposal. Business coaches and mentors and psychotherapists are on site, and Nobile makes sure her clients are able to explore their interests with a view to shaping their future. 

Given The Kusnacht Practice’s rarefied level of treatment, a lot of the young people Nobile sees are dealing with issues related to having successful parents. “If you have a successful parent, what does that mean for you? That’s not always easy to figure out. You might have a lot of resources, and accordingly, a huge number of choices. Paradoxically, that can make you petrified. For every door you’re able to open, you’re going to have to close so many others. That can freeze you in place.”

So how does Nobile manage that? “That’s what psychotherapy is all about, figuring it out in the context of each person’s life story.”  

One might think that returning to the family unit after treatment might be difficult. But Nobile gives a nuanced reply. “It’s a minority of the youth we receive who come to us because they want to. Most of the time the parents in question have been very concerned for a while. But by accepting the need to come here, they’re sending a signal: ‘Yes, I have a problem’.  And admitting the need for help is incompatible with the normal developmental process of youth who strive for independence. After a few days they however usually realise that this is quite a nice place! They can set goals, work out problems they are facing and learn new skills – and find their voice.”

And returning to the family – is that fraught with danger? Nobile doesn’t see it that way. “We like to see it as an opportunity. Ultimately, life is not with us – it has to be back home. But once clients leave us, we provide daily support with virtual sessions with the main therapist and they can always come back for ‘recharge weeks’.”

It has been a difficult year for many, but it creates optimism to find people like Nobile working on the front lines, committed to the healing which all of us may feel we need after the tribulations of 2020 and 2021. 

Nobile was to talking to Christopher Jackson. Go to https://kusnachtpractice.com