My stepdaughter is very depressed. The family is considering having an intervention, but we are unsure of how to go about it without pushing her over the edge. She is not a talker and keeps things bottled up inside. She is on medication and is seeing a therapist, but we have the feeling that it is not doing much good. We're afraid she is standing too close to the edge and we want to bring her back. Any suggestions on how to go about the intervention? Do we need professional help in this matter?

Desiree

A lot depends on the age of your stepdaughter. If she's under 18, whoever has legal custody of her could (preferably with her knowledge) talk with her therapist about their concerns, and possibly ask for some family therapy sessions in which your fears about her well-being could be raised.

But if she's an adult and is in therapy on her own, she may resent interference from family members ... and, of course, her therapist could not talk to you without her permission. It's a ticklish situation.

One possibility is to let your stepdaughter know of your concern for her, and any questions you might have about the status or usefulness of her therapy. (Any possible questions about or criticisms of her therapy should be handled very carefully, however, as people can become defensive if they feel their therapy is being threatened.) If you and other family members see her as not improving, you could gently ask what her perception of her progress is. It may be that she's struggling with some deep or disturbing issues, but does feel she's progressing. If so, her perception should be honored, even if her pace seems slower than the family would prefer. If she doesn't feel she's making progress, then you might carefully discuss whether a change in treatment might be worth trying. That might mean seeing another therapist (perhaps for a second opinion), changing or discontinuing medication (only under a physician's guidance, however), etc.

If you're concerned about suicide, you can certainly ask her flat out whether that's something she's considering should her situation seem unbearable. (And, of course, let her know of your love and desire to help her find other ways to alleviate her pain.) The truth is, though, that if someone makes up his or her mind to commit suicide, even mental health professionals can't stop them.

I have some concerns about orchestrating a formal "intervention" -- by which I assume you mean a time in which several family members and/or friends confront your stepdaughter with your perception of her problem and urge her to get help, or in this case, make changes in the type of help she's already receiving. Depressed people can be very fragile and self-critical, and may easily feel ganged-up on or shamed in a group setting. Rather than a group intervention, I'd probably recommend that the person she feels closest to and trusts the most talk with her privately and one-on-one.

But it probably wouldn't hurt to have a face-to-face consult with a professional about this issue before proceeding. Even if she's an adult, it might be possible to have some family sessions in which your stepdaughter is involved, and in which your concerns about her well-being are addressed. Or she might be willing to give her own therapist permission to talk with the therapist you consult, so your therapist can guide you and other family members in dealing with her condition.