Dear Tanya, I am 21 and the youngest in my family by five years — all my older sisters have their own successful careers and two of them have children.

I have supportive, loving, caring parents and they generously provide for us all but I am having major difficulty in finding independence and gaining control of my life. Although I do work part-time there is not enough to cover my social life, travelling expenses or university fees, so I depend on my parents’ support. I still live at home which is near uni and the hospital where I am doing my clinical practice.

Both of my parents are consultants in this hospital so I cannot be sure if friends are befriending me to impress them. I seem only to work hard, with no time for boyfriends. My friends are in a similar situation so it’s impossible to plan holidays and I end up going with family.

I constantly see my parents — on the wards and as soon as I get home where my mum is nagging me about my laundry. Also, if my sister asks me to babysit and I say I can’t, guilt eats me up . How can I gain independence?

Rachel

Independence is an inner not outer state. People can live far away from their parents yet still be emotionally and psychologically tied to them. Of course moving away from home is a symbolic rite of passage into independence and, as your letter highlights, not having done that makes the whole task much more difficult — but not impossible. Nowadays, when being a student is financially burdensome and many graduates are left with crippling loans, your personal circumstances will sound to many like a privilege. I suspect that there are many who are questioning why you are having such a problem here — it’s only a short time in your life and living with your parents will leave you with less financial stress.

There are two things at play: guilt at being so lucky and a struggle over the task of being the last born of successful sisters and the last to leave home.

Your vocation clearly fits your personality — wanting to care for others, to do the best, to make everything better. However, I am struck by your perfectionism — wanting to do the best by everyone and carrying enormous guilt if you somehow fall short of your expectations. This seems to be taking your need to be the eternal carer, whether on the wards or for your sister’s children, too far. Yet some part of you also seems to be a rather cross child who suspects her friends for their motives in friendship and who also, while living at home, continues to be messy and does not do the laundry properly. There is a huge split within you, one that makes you feel uncomfortable.

To begin with, you need to kick back, relax and live life without having to worry about each and every moment. It is clear from your academic history that you are able to do well, so learn to chill out a bit.

Building autonomy comes as we mature and create identity. We have all gone through phases when we have tried to define ourselves through different cultural markers — fashion, music or ideology. This process often involves some experimentation that is more easily done away from family. I see this as the root of your struggle — living at home makes you daughter and youngest child and this really cuts across the freedoms you perceive as necessary for the development of independence.

However, it is not impossible for you to challenge assumptions about you being the baby of the family. Loosening your anxious self-perceptions by challenging your need to please will allow you to enjoy life free from guilt and give you a realistic view of your circumstances.

At the moment you are plagued by negative thoughts: Have I let others down? Am I doing well enough? Do they really like me for me? These beliefs will arise from anxieties built up over the years as you have witnessed your sisters being brilliantly and knowing that you have some tough acts to follow or even to better. For you to be doing all this in the family profession makes any sense of independent success even more difficult.

Also, being the last to leave home places an added burden on you, as you become the one who changes the dynamic of the family for everyone, particularly your parents. This can be tough and lead to anxiety and guilt — emotions you carry in bucket loads.

Your training is tough. I know that from personal experience. Not so tough though, that you can’t also prioritise a bit. Most students find long holidays abroad impossible. Short backpacking breaks are excellent, cost little and break into the grind of training and studying. Study groups, that end with people falling asleep on someone’s floor, are where most do their best learning.

Furthermore, when you are at work you are “in role” as are your parents. You are not their child in that context and should not allow yourself to feel like one. They do their job; you do yours. Medical training is about caring, empathy and selflessness. It is also about grit, determination and, at times, being tough. The combination of these qualities comes from the individual doctor, their training and also the life that they have lived.

You have the former characteristics but need to develop the latter and these will come only with a shift in self-appraisal and with a maturity that extends beyond your current circumstances and leads to a creative, adventurous and more exciting approach to student life.

If you have a family problem, e-mail proftanyabyron@thetimes.co.uk

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