Dear Tanya

I need advice about coping with my 14-year-old son, who is being treated by Child and Adolescent Mental Health Services (CAMHS) for anxiety. This has manifested itself as a sort of school phobia - his attendance has been poor and has been getting worse since he began secondary school. He has not been back this term. My husband has a chronic illness and hasn't worked since 2003; he stays in bed a lot and doesn't get involved much in family life. Sometimes he has dreadful mood swings that send the family into crisis. I feel that his illness and other difficulties have sent my son spiralling into this state, but I sometimes feel I am drowning in their moods and problems.

However, I'd like advice on how to handle my son. I feel that I have been pandering to his every whim because I am so sorry for him and have the need to protect and comfort him. He is aggressive and moody, often verbally nasty to me. I realise that he is angry, probably with himself. He seems to seek comfort in spending money and, of course, I do not have that. I try to get him to talk and I'm generally calm and easygoing around him. It isn't helping, though, and I don't know if it is the right thing to do. I have two other children who need me too and I wonder if I should tell him that although I realise he is having a difficult time, I will not tolerate the abuse. He stays up all night and eats a lot leaving a terrible mess for me in the morning. Help. Patty

What a complicated and exhausting situation you are in. Your letter reflects how a child's behaviour can often be a product of many underlying problems across the whole family. Although my clinics are mostly for children and young people with emotional, behavioural and psychological difficulties, often their behaviour is merely a symptom of an “unwell” family. This is a very important point because we can make the huge mistake of localising problem behaviour in children, labelling them as the cause of all the stress and unhappiness, when it is the children who are reflecting those problems within the family, of which they are only a part.

You are clearly trapped in a dysfunctional family dynamic and I wonder what would happen if you suddenly couldn't cope any more. Life must feel like a stressful juggling act with everyone's competing needs weighing heavily on you, particularly the needs of your husband and son. Any advice, therefore, must help you to carry on.

First, some thoughts about your husband. You do not specify his illness, but I wonder why he is so incapacitated. It must be dreadful for him to be bedbound, but is this because of his physical illness, or more about his mental state? Certainly the mood swings sound painful for everyone and these must be addressed. It wouldn't be surprising if your husband was depressed - depression can manifest itself in many ways, including withdrawal from life and turbulent moods.

Undoubtedly, your son's anger must, to a degree, reflect the “loss” of his father and his angry, yet absent, presence in the family home. Therefore, to support your son, your husband needs treatment - visit www.depressionalliance.org for more information and talk to your GP.

I wonder whether you have fallen into the classic “carer” role and your husband has slipped through the net in getting the official care that he may need. Informal carers are estimated to save the UK £87 billion a year and usually struggle alone. Look at carersinformation.org.uk there you will find information on national issues, rights, legislation, and other carers' organisations from which you can receive emotional and practical support.

Your husband needs structure and support in his life, whether in the form of rehabilitation so that he can become more active, or help to manage the chronic illness and restore some quality of life. Talk to your GP. Be frank and do not be afraid to show how exhausted and in need of support you are. Spell out how the home circumstances are directly affecting all your children.

With your GP, or via the CAMHS services that you have for your son, contact local social services for an assessment of your husband. You should be provided with advice about benefits and support groups, counselling, additional in-home support and daycare provision for your husband outside the home. Also, you should receive a carer's assessment, which is your own support plan. You cannot, and should not, do this all alone. At www.crossroads.org.uk you will find information about this incredible organisation, which offers tailor-made support to meet the needs of each carer and the person for whom he or she is caring. Do not be afraid to ask for help; you are doing this for your whole family and this does not mean that you have failed.

I am curious about your son's treatment. He certainly needs support with his school refusal, which undoubtedly is underpinned by his unhappiness with the home situation and also his concerns about you and his father. It is not uncommon for school refusers to have an ill parent at home, whom they feel unable to leave. I hope that his treatment encompasses a structured cognitive behaviour therapy (CBT) approach and is in collaboration with the school - it won't work if it is not. It needs a programme built around his return, starting with a small part of each day and building at a steady rate as he learns anxiety management and other coping strategies.

The school counsellor should be involved and it is worth suggesting a mentor/buddy (probably an older boy who lives near by) who can support your son in the school. In addition, the CAMHS team should have community-based outreach services and you should ask for a dedicated worker to support your son going to school each day.

However, your son is also behaving like a teenager and while I understand your instinct to support him, given the way things are at home, the best you can do is to give him clear boundaries. I appreciate that this will be exhausting for you, but some house rules, with clear consequences if they are broken (using the leverage of computer and gaming time), would be a beginning. You don't want to find yourself in the position of having two housebound males raging at you while also being dependent on you. Contact parentlineplus.org.uk for support and advice from other parents in your situation. You can call 0808 8002222, receive e-mail support, or join a telephone parenting group.

Finally, I want to suggest one of my favourite websites: youngminds.org.uk. You and your son can find support and advice here. Its parents' information line is 0800 0182138. It is also important to empower your son to find his own support and he should check out www.get connected.org.uk. It has a helpline and can put him in contact with support services that are designed for his age group.

You need support and must shout from the rooftops to get it. I know that people in your position are often let down by the system. I suggest that you brandish this article as you make your requests and feel free to say that I am keen to write a follow-up article on how you do.

If you have a problem, e-mail Dr Tanya Byron at: drtanyabyron@thetimes.co.uk