Dear Annalisa

I am desperately worried about my teenage granddaughter, who is in a very miserable state. Her self-esteem is at rock bottom, she has no confidence and apparently no hope.

She is a sweet girl who has always been rather shy and quiet but seemed happy. At her primary school, she got good reports, fitted in and had friends. However, she struggled with concentration, particularly regarding written work. This continued into the first two years of secondary education, where she showed ability in art and a particular facility for cooking.

She enjoyed sport until she had an injury. Later, she was involved in Guides and was doing well until, despite successfully undergoing a rigorous weekend away, she failed to get on an overseas trip she had set her heart on. About the same time, she began to develop school phobia and her attendance became erratic.

She managed some GCSE passes but opted to go to college, but gave up after a few months. She was let go from seasonal work in a local shop. Since then, she seems to have spent most of her time at home in her room. She will cook for family occasions and generally join in, but only arrives after she has masked her face in makeup.

The family context is, superficially, very good. My daughter, her mother, is well qualified but has not had a permanent job since she married. My granddaughter’s father works in a caring but inadequately paid occupation. My granddaughter and her younger sibling have, at different times, lived with me (I am widowed and have a sizeable property). But it didn’t work out well as I got angry and upset with her when she refused to go to school. The situation has got to a point where I fear that without professional help her future is bleak. She has had counselling but it has not been consistent. She has told me that she can talk to people she does not know. She has also told me that medication would be a last resort.

She’s your granddaughter, not your daughter, and while I applaud your involvement, where is her mum, your daughter, in all of this?

I contacted Rajni Sharma, a child and adolescent psychotherapist (childpsychotherapy.org.uk), who thought it was “clear how committed you are to your granddaughter and how much you care about her. In contrast, you don’t mention your relationship with your daughter.”

We both feel this is quite key. For one, why are your daughter and her husband not taking charge of this? “There seems to be,” says Sharma, “a muddle between generational roles that may colour your worry.” Is there something unsaid, unfinished, unresolved between you and your daughter that this teenager represents? Thwarted ambitions maybe? Disappointments? Sharma felt your granddaughter sounded like “a girl who is open to new experiences and can cope when some don’t go to plan. I am curious about frustration and protest underneath her misery and a struggle to get outwardly angry.”

Her school refusal would bear this out: a not doing of something, instead, maybe, of getting angry. And maybe she needs to rebel.

I was left wondering how much your granddaughter is the canary in a family situation and whether you are all trying to fix her, because it’s easier than fixing something else? There seemed a lot unsaid in your letter.

“She’s able to pick herself up and she is resourceful,” Sharma points out, “and not conventionally academic.” And that’s OK, isn’t it? There was also something of the “setbacks echoing past disappointments [in your granddaughter’s pursuits, some of which I have edited to avoid identification], that maybe you worry this is the beginning of serious lifelong failures and difficulties.”

But she’s only a teenager. What were you like when you were her age?

Sharma suggests you talk to your daughter and her husband, come up with a strategy to support each other, with them as her parents and you in the supporting granny role – a very valuable position. In supporting her parents, you will be supporting your granddaughter. This leads me to ask: do you trust your daughter’s parenting?

It sounds as if your granddaughter responds well to therapy, and this can identify any underlying low mood or anxiety she may have, but as you say, she needs a more consistent approach. (Go to the “find a therapist page” in the link above). It’s very important that your granddaughter has somewhere that’s all her own to talk. If she then decides, with her therapist, to bring in other family members, then so be it.

You mention self-esteem and confidence. These are built by being listened to, respected, not having feelings minimised and being supported through trial and error. “Being allowed to be yourself and fit into the world,” says Sharma.

This article first appeared in The Guardian Family section on 23 June 2017.