Category: Adolescent DBT

Boston DBT Parent Class: Parenting the Emotionally Extreme Teen

 How did this class help you? Here is the feedback from four parents who took the Spring 2015 class:

 

“To try and react better..To try and anticipate my daughter’s behavior triggers..try to find out what is causing the extremes and deal those triggers… By accepting emotions and where they are coming from; not to deny my emotions but they are there for a reason. To validate how I feel as well as my daughter. To be calmer. “- Parent 1

“To better understand my emotions, and that they have a purpose…To explore that purpose. Better able to identify escalation in my daughter. I’ve learned to buy time, to put some time in between responding to my daughter and others. What was most helpful was the overall impact of the course which has left me better equipped and more curious about DBT.” -Parent 2

“It made me more willing to bit my tongue, take a deep breath, and not focus on ‘fixing things’. Acceptance was important, both dealing with my own emotions and allowing for acceptance of my child’s emotions. Using mindfulness techniques to tone down my level of arousal was also important. Understanding that emotions might be valid but ineffective in some circumstances. I thought the (video content shown in class) outlined some very pragmatic examples and techniques.” -Parent 3

“To be more present with my emotion. To validate how I feel as well as my daughter. To be calmer, to think things through. Being able to listen to others’ experiences. Each class was built on each other. Have learned many skills to be more effective with my daughter.” -Parent 4

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Why does my teenager cut? A brief guide to understanding self-injury in adolescents

First of all, I’m going to say that focusing on the why this behavior occurs is probably not the most effective approach to addressing adolescent self-harm. I’ll give you some reasons why teenagers self-harm in a minute, but the one fallacy that people often have is that if they could explain why behavior occurs, then they would actually have the tools to fix or change it.  More specifically, teenagers who may not understand the behavior themselves can often be put in an awkward situation in which they are forced to explain the unexplainable. If they don’t understand why the behavior is occurring in the first place, they may end up giving inaccurate reasons simply to appease their environment.

Self-harm behaviors likely have something to do with emotional pain. Possibilities include ways to control feelings, ways to control oneself or one’s behavior, ways to increase intensity of feeling (ie, the need to feel “real” or the need to feel “something”), or ways to decrease intensity of feeling (“If I didn’t cut I wouldn’t have been able to tolerate the situation”). Understanding how emotions work and what they do for people may is critical in understanding the role of self-harm behavior. For instance, feelings are functional in that they give useful information about what matters to us, communicate to ourselves and others, and help us become organized and prepare for action. Without feelings we just wouldn’t care.

In adolescence, self-harm behaviors may play a role in identity, communication, and intimacy. Self-harm may be kept very private or it may be made public. It may be an attempt at controlling one’s environment or letting someone else know that the person doing the self-harm cannot be controlled. The function of the behaviors may communicate to oneself (I know I matter, I know what I have to say is important, I can’t stand by and let nothing happen, I am not pleased by the situation, This is my way of making a statement), or to others (Back off, This is too much, I can control your reactions, I know you will be upset and freak out, There is nothing you can do about this, You can’t claim to know me, You think you know everything and you don’t).

Treatments for self-injury are not as simple as publicizing behavior (ie, making sure that others know about it), invading privacy by doing body checks, or just stopping doing it. If there was no benefit to doing it, no one would do it! That’s just simply how it works. Knowing the benefit can help someone to organize an effective solution. Teenagers who can obtain help in identifying, accurately labeling, understanding, and communicating their feelings effectively will have more options for what they can do when the urges to self harm show up. Increasing options, understanding the short and long term consequences of this behavior, and providing alternatives for how to tolerate intense, painful, and negative emotions is certainly one way to start.

It’s important to remember that teenagers also have their own feelings about this behavior. Some are opposed to changing it, some don’t want anyone to know about it, some want everyone to know about it, and some feel really hopeless that they can’t stop doing it. Most have some degree of mixed feelings. Assuming and communicating that a teenager simply doesn’t want to change is probably not going to help solve the situation. While it might be a likely, blaming a teenager for doing it usually only serves to communicate a parent’s frustration.

Similarly so, parents have their own feelings about it and may feel disgusted, hopeless, overwhelmed, inadequate, or guilty. How parents communicate and address painful emotion will also impact the situation; and thinking through the effectiveness and intensity of one’s own responses may be part of the work involved in addressing teen behavior.

I think it is important to consider that the problem of self-harm behavior has solutions. Sometimes providers, teachers, parents, and community react with an abject horror that stirs the pot, gets everyone all worked up, and in some cases emphasizes the solution (self-harm) and not the problem itself. Emotional problem solving is really just that- emotional problem solving. If a person can figure out how to problem solve (ie, address, tolerate, understand, deal with, validate, survive) painful emotions, then their way of solving problems (ie, self-harm) may decrease. Finding effective solutions means having an adequate way to assess and address these behaviors with a skilled professional who understands the role that these behaviors serve.

When individual therapy with adolescents doesn’t work

Individual outpatient therapy with adolescents can sometimes be limited in that

1) It can fall into Question and Answer sessions-losing the spontaneity and flow of a helpful interaction

2) Adolescents have shorter attention spans, and keeping them focused on painful topics on purpose can be, well, painful!

3) Sharing personal information with an adult you don’t know, but were paired up with because your parents are making you, doesn’t always have the desired results.

4) Adolescents aren’t necessarily going to do things differently because an adult is telling them to.

Group therapy has several advantages in that

1) Its members will be able to tell your daughter if they like it, how it is helpful, and what it has done for them.

2)  It is private (no one knows each other outside of the groups) and participation can be minimal (it doesn’t have to be about you all the time).

3) Group members can help each other think things through, make decisions, look at consequences, generate feedback, and put words on experiences in way that an adult provider may not be able to.

4) Talking about peer situations leads to identifying oneself in peer situations- thus what matters is sometimes brought up by someone other than yourself- or an adult, who may not have a clue.

(Hey! I’m not in high school anymore!)

Click here to see more on what group can do for your daughter. 

10 Reasons why you need The Emotional Extremist’s Guide to Handling Cartoon Elephants book this holiday season

1. The Cartoon Elephant book, after being temporarily unavailable through Amazon, is now back on the market. The retail price is $26.95, but sometimes Amazon will let it go for a bit less.

2. Cartoon Elephants approach painful emotions with humor. If there is an elephant in the room in your family, this book is the starting point for approaching avoided conversations. You will recognize yourself and others in this book. There is no finger pointing or blaming.
 
3. Cartoon Elephants is something you can put on your coffee table. Because it is a graphic book with pictures and fun fonts, it is an easy read. The elephants will fit nicely next to big picture books about Africa and Asia.
 
4. The Cartoon Elephant book is being used to teach people in Dialectical Behavior Therapy skills groups about emotions. Loaded with psycho-educational material and teaching points, it cleverly accomplishes the task of making people think they are reading something fun yet giving them something valuable.
 
5. This book is not hard to read. There is no “plugging away” at chapters. If you want to bring something to someone’s attention in a way that is universally applicable, this book will do the trick. You don’t need to have painful emotions to appreciate elephants- you just need to have emotions.
 
6. If you are going to buy someone a self-help book for Christmas, this is safe bet.
Whether they believe it or not, everyone has cartoon elephants. The research proving this to be true is cited in the back of the book.
 
7. This book can be used and re-used, read and re-read. You can share it with family members, friends, or long lost relatives. It won’t go out of style. Emotions, as a rule, will be with you as long as you live.
 
8. You will get some food for thought about how and where you see yourself in relationship to your elephants. This is great for discussion groups, weekend retreats, and writing workshops.
 
9. This book is great for people of all ages. If you’re trying to get your kid to read something important, heavy, and deep, you can give them this book. It won’t take long to read and it is much more fun with illustrations.
 
10. The book will be the perfect introduction for my live series on emotions starting January 20, 2014. Of course you don’t need the book to sign up, but if you have the book you will have a better appreciation for cartoon elephants in general.

 

 

Starting college? Tips for managing social anxiety in new classroom situations.

Is the newness of college stressing you out? Some people have difficulty adapting to college because they suffer from social anxiety, which includes a fear of being scrutinized, judged, or standing out in the crowd. This can lead to avoidance of classes, diminished social contacts, and a slightly more difficult transition from home to college. Here are some tips for handling social anxiety:

1)   Try to find something to focus your attention on when you go to class. In most instances, people who are socially anxious become pre-occupied with self-consciousness. The focus on being scrutinized or judged increases anxiety and becomes the “problem” in and of itself. Fixing your attention on other things will help reduce anxiety by getting your attention away from all the things that might go wrong. Here are some suggestions:

  • Bring candy with a strong sensory component (mint, cinnamon Altoids, black licorice) and focus all your attention on the taste. This may work even better if you have a strong flavor you don’t particularly like- because it will be harder to ignore.
  • Put a hand on your stomach and- when you breathe- focus on bringing the air down into your diaphragm so that the hand on your stomach gently moves up and down.
  • Try to identify as many sounds as you can- and notice where they are coming from. Gently shift your attention to sounds from within the room and outside of the room. See what sounds you can hear that you wouldn’t normally because you aren’t paying attention.

2)   Keep your facial expression soft and your gaze curious. Often when people are anxious they close themselves off to social interactions. Their expression might read: Don’t talk to me. A tight and stiff posture may be how you are communicating your anxiety- even if you don’t intend it. Try to soften your face and smile gently at people you don’t know. Remember, if you aren’t looking for connections and friendships, it’s harder to make them happen- thus increasing your fear of being among strangers.

3)   Don’t skip classes and make it a point to get to class early. Telling yourself “I will go tomorrow” may be setting yourself up for not going at all. The next morning it will be easier to skip because you will feel behind. When you go early, you have the advantage of not walking in late, knowing where the class is, and gently greeting new people who walk in the door. See if you can make it a point to learn people’s names so you can greet them when you see them. Greeting people make them more likely to connect with you- and when you have friends you are no longer among strangers.

4)   If you’ve missed class already, go back. Define a small goal for yourself (ie, sitting through class) and don’t focus on all the information or material that overwhelms you. Instead, make eye contact, focus on your breathing, and sit quietly. Remember that you can solve problems later if you need to- such as meeting with an advisor or the academic support center if you need to change your schedule or drop a class.

Parenting the adolescent, DBT, and dialectical dilemmas: From Miller, Rathus, and Linehan

In 2007, Alec Miller, Jill Rathus, and Marsha Linehan published Dialectical Behavior Therapy with Suicidal Adolescents. In the book, they outline specific dilemmas related to adolescent development. I think their work is quite clever and clearly fits the dialectical theme: Two opposing concepts can both exist at the same time, people can get “stuck” in extreme polarities, one extreme does not negate the existence of the other extreme, a person has to look for the truths in both extremes in order to get unstuck, and the “middle path” is a place where both parents and adolescents to be understood and acknowledged.

The extremes that parents of adolescents can get stuck in include the following: Being too loose vs. being too strict, making light of problem behaviors vs. making too much of typical adolescent behaviors, holding on too tight vs. forcing independence too soon (page 308).

One of the assumptions in DBT is that clients are doing the best they can. This assumption is held for both parents and teenagers. Parents sometimes parent with an intention to give their children what they didn’t have or prevent their children from making the same mistakes they’ve made. The pain of “letting go” and watching their children become more independent, make decisions, and be faced with extreme consequences can be hard. Sometimes parents can get stuck in extreme ends of these dialectical dilemmas because they are trying so hard to be the best parents they know how to be.

Consider your own childhood for a moment.

  • How did you experience your parents (in terms of polarities) as a teenager?
  • Where do you see yourself as a parent now?
  • Where do you think your teenage son or daughter sees you? Where you see yourself and where he/she sees you may be very different.
  • Consider what kinds of things get you to move towards one polarity or another- and what gets you to move closer to the middle.
  • Consider the consequences (including the impact on relationships) of being in the extremes.
  • Consider the necessity of both extremes- and how they can be effective vs. ineffective.