Boston Area Depressed/ Anxious Adolescents: Why Should My Teenager Be In Group?

Teens face many developmental challenges throughout high school. Some of them are normative and stressful, and some of them become bigger than life overnight. Peer relationships can be life or death in terms of social isolation. Teens want to rely less on adults as they become more independent, but sometimes they get in over their heads.

Teens can be fine one moment and in crisis the next. Getting rejected on social media or having a shift in the friendship circle can imminently impact one’s desire and willingness to go to school and focus on schoolwork. Sometimes teens are fine.

And then, suddenly, they are not.

Ongoing group therapy presents a kind of “soft contact” where there are multiple prompts to talk about what is hard to talk about, rehearse ways of dealing with anxiety, and address “the thing” before it becomes a bigger “thing.” Some kids have a way of holding stress within, putting on a mask, and pretending things don’t bother them. Sometimes it is easier to dismiss how isolated one feels than to make a “big deal” out of something that shouldn’t be “all that bad.” One can spend a lot of energy trying to convince oneself that they are “okay” when really, they are not.

Ongoing group provides consistently, familiarity, and a stable peer cohort. If conflicts arise within their school, they can take it outside of school and gather advice about how to address it. Teens that tend to take on everyone else’s problems can be encouraged to consider their own needs, set limits, identify what they can and can not do, figure out their feelings, and communicate more clearly. They can learn to tolerate emotional discomfort more readily, be more prepared when conflicts come up, and stay in conversations that may bring up a lot of emotion. Being socially connected means hanging in there when things are hard- and sometimes being willing to give and receive feedback.

Being in an ongoing peer group creates opportunities for intimacy, growth, open sharing, and a way to hang in there together with people who are really struggling. It means learning how to address the awkward pause after an embarrassing moment, a tearful outburst, a shameful incident, or an expression of pain. It also means having some help for when someone just simply doesn’t know what to say or do.

In general, people tend to share more personal information with people who are familiar, available, and near- and whom they see regularly. When teens are having “a thing” that may “not be a thing” or “may become a thing”, and there is no consistent person to open up to, the “thing” that was “not a thing” can suddenly become a crisis. Teens are on the brink of engaging in risky behavior, relying more on peers and less on parents, and wanting to be independent. Telling mom or dad may seem childish and immature; yet teens need to do things that keep them safe.

Group is different than individual therapy because there are multiple perspectives in the room, peers can “get it” in ways that adults don’t always pay attention to, and there are lots of resources for help, feedback, and validation. Sometimes kids who are shy, self-conscious, and sensitive are missing out on real life connections- and this can keep kids isolated, ashamed, and lonely. While talking to an adult one one may be a source of comfort and relief, ongoing group therapy offers an entirely different context for problem solving and addressing anxiety.

For more information on teen groups, click here.

Why Isn’t My Teenager Honest With Me?

One of the problems teens struggle with is honesty. And it’s not only honesty with one’s parents or authority, but honesty with oneself.

Part of psychological distress comes from hiding the more difficult and disturbing aspects of experience from oneself. While this can sometimes be adaptive, it can become problematic when it comes to drinking, sexting, drug use, teen pregnancy, domestic violence, and other situations teens can sometimes get themselves into.

Being honest about a situation means admitting it is actually happening, admitting it is real, admitting the distress is real, and addressing potential consequences. Not admitting it is real, not asking for help, and not coping with the situation can lead to even more problematic consequences. Addressing something openly- while often difficult- can lead to prevention of further problems.

Admitting to the reality of a situation also may involve admitting to one’s role or part in the situation. Teens can sometimes not be honest because they have a fear of getting into trouble or a fear that it will escalate an intense reaction in the person they tell. They would rather avoid the short-term pain of intense reactions than the long-term problems of the situation. And teenagers are often not thinking about long- term consequences! The double bind is to deal with it all alone. A teenager who is all about gaining independence and relying less on one’s parents may believe that secret keeping is the only way to gain privacy and independence.

If you are a parent and want to increase you teen’s ability to confide in you, consider the following:

What are you doing to invite conversations about difficult topics, and what are you doing to punish conversations about difficult topics?

Are there topics or themes in your own life that are “off topic”? Are there conversations that would be too emotional for you to handle if someone were to ask?

Is the short-term anxiety of “not knowing” something worth avoiding based on the long-term consequences of not having a conversation at all?

What types of things do you “hide” from yourself because if you admitted they were true, you’d have to face the consequences?

If you were being completely honest with yourself, what situations would you have to confront?

What types of things did you keep from your parent/s when you were a teen, and what do you wish could have been different?

Being open about emotionally “forbidden” topics will help create an environment where openness is encouraged. Being more and more comfortable with intense emotions, painful life situations, and one’s own ghosts will help you develop deeper relationships. Avoiding painful life situations can sometimes create more psychological distress than seeing what is in front of you, admitting it exists, and taking steps to address it.

How To Get Yourself To Class: Boston College Students Quick Reference Guide To Not Falling Apart The First Semester

Going to college is a big change that generally involves a brand new environment in an unfamiliar city. In general, making a big move involves figuring out living accommodations, new roommates, scheduling demands, and independence. For some the transition is overwhelming and can result in avoidance, missing classes, staying in one’s dorm, an increase in alcohol use, panic attacks, an inconsistent sleep schedule, and erratic eating habits.

Here are a few tips to help college students make the transition.

  • Make sure you are familiar with the campus. Try to find out the location of everything before you go to your first class. Find your classrooms, know how long it takes to get to different buildings, and if you can, spend a little bit of time in the buildings before your first classes. Unfamiliar situations cause more stress than familiar situations, and getting lost in new crowds in unfamiliar territory can be cause for anxiety. Don’t assume that you will just figure it all out when you get there.
  •  If you are a student who has struggled with depression or anxiety in the past, try to find the college counseling centering and see if you can set up a “check-in” session a week or two after school starts. Not having any plans to ask or get help can make everything worse. Identify your stressors and know what situations will make you likely get into a crisis. If you know any of the college counseling staff, it will be easier to reach out to them when you need them. Counseling centers can help with stress, overwhelm, demanding schedules, irritating roommates, and organization. They usually have an agenda to service as many students as they can accommodate in a given school year.
  • Try to initiate social connections as much as possible. The more people you know personally, the less stressful it will be to go to class. Try finding people who are by themselves or alone. Consider starting conversations that invite people to talk about their stress: “Are you as overwhelmed by this as I am? Are you feeling a bit lost? Because this whole college transition is a lot to take in.” Sometimes it feels good just to be able to acknowledge stress with someone else, even if you think the stress seems small or insignificant. Try to find things that you relate to and that are similar to you. Ask other students how they found and chose this college, if they’ve thought about a major, if it was hard for them to leave home, how they are finding their way around campus, what would make their college experience a positive experience, and what they are doing to help them deal with the transition. They may have some good ideas for you.
  • If you are overwhelmed by your classes and have the urge not to go, consider all the steps that it takes to get to class. If the first step is getting out of bed and brushing your teeth, do the first step. Getting out of bed and brushing your teeth is not a commitment to attend class. After you brush your teeth see if you can make another small commitment, such as getting your books together or getting dressed. Each small commitment can bring you closer to class. If you actually get all the way to the building and end up skipping class, you will at least have gone through the motions of getting yourself around campus. Moving around on campus dressed for class is better than spending the day in bed avoiding everything. Consider the short and long term cost of what you’d have to tolerate to make it through one class, and assess what you would be willing to do. Going to one class doesn’t mean going to all of them. Go to classes you enjoy and see if you can talk to an advisor about cutting back on classes that are too much. Don’t wait until you are failing. Remember that once you start avoiding one class, it will get easier and easier not to go. Don’t let yourself get into that pattern. Avoiding this problem can increase the stress, whereas admitting it is too much and dropping the class is a more proactive way to accept what is too much for you at this time. It doesn’t mean you are a failure and doesn’t mean you can’t take it another time.
  • Plan down time that is not related to school. Because school can be overwhelming, it is important to press the “pause” button by taking “time outs.” This may include a nature walk, a spiritual activity, meditation, exercise, yoga, prayer, a nap. It might also be helpful to plan a time to talk on the phone with parents, friends, or family that know you. Periodic and planned check-ins can provide a sense of stability and relief. College students sometimes underestimate their needs for leisure time and overestimate how much they can accomplish. This inevitably causes stress. Being an adult also means being able to take care of your time and your body.
  • Take care of the basics: Are you finding yourself consuming more sugar, alcohol, marijuana, or caffeine? Sometimes college is a time where you test the limits of your body as you no longer have a family time schedule to stay on track. Insufficient sleep, erratic eating, over-dependence on substances, and having too many commitments often contribute to stress. Panic attacks alone might be reduced by attending to your biological limits (eating more consistently, getting more sleep).
  • Don’t let panic attacks go untreated, because they are treatable. Panic attacks don’t go away by suppressing emotions, drowning them in alcohol, and ignoring what they may be trying to tell you. Panic attacks are often very intense experiences that include hyperventilating, shaking, racing heart, a feeling that you might pass out or die, and feeling like you can’t breathe. They can be extremely debilitating and scary if you’ve never had one. Often they are a red flag to pay attention to something that is causing you distress- more often than not, something that is easier to ignore. Panic attacks can be hard to explain or understand; don’t be afraid to ask for help. Find out what services are available at the college help center your school and use them.

 

Should I Get Back On The Horse? Two Ways To Approach Your Fear That Won’t Work.

If you get thrown off a horse, should you get back on? Some people will suggest that you need to get back on the horse immediately so that you will gain mastery over your fears. If you don’t get back on the horse, then your fear will haunt you the rest of your life.

Is this really true? Here are some ways of approaching fear that isn’t very effective. The first is to fight your fears or treat the situation like a battle zone. It means taking the reins, having control of the situation, bucking up, grinning and bearing it, tightening your muscles, and powering through. It can be coercive and forceful. In some cases it means blinding yourself, dissociating or disconnecting from the fear, or minimizing or reducing the value of what your fear might be trying to tell you. Generally it is doing the thing that you are afraid of as a way to prove yourself or prove your point.

The reason this doesn’t work is because it often means engaging in life as if it is a battle. Staying in the battle field often means getting hurt, risking relationships with others, being coercive, or putting the other on the defensive. Getting back on a high strung or agitated horse to gain mastery over fears is not an effective way to manage fear.

The other ineffective way of handling fear is to completely avoid anything associated with the fear. This means that any mention of the feared object or situation is avoided. Conversations stop, people stop making eye contact, the air becomes stilted and stale, people avoid people, and people avoid a wide range of stimuli that becomes associated with the feared situation. The person may be humiliated that they gone thrown off a horse, so they go out of their way to hide it. While people lead perfectly fulfilled lives without riding horses, the person who can’t drive past a barn, watch a television show with a horse on it, have a conversation about what happened when they were thrown off a horse, or set foot on a farm may find themselves restricted in ways that have nothing to do with riding the horse itself.

Handling fear effectively means being able to approach the situation with a flexible style that involves both challenging oneself, listening to the validity of the fear, being kind to oneself, backing off when things are too overwhelming, identifying smaller steps to approach the fear, and figuring out why the situation/ issue/ activity is important to you.

Fear is a useful emotion in that it provides information about oneself and one’s situation. Fear protects us from danger, gets us out of threatening situations, and helps us cope adaptively. Fear can also be so extreme that it takes over our lives, restricts our ability to do the things that are important to us, or prevents us from having a life- the life we want.

Here are a few questions to help you figure out your fear:

  • What about the situation, event, activity, or relationship is important to you? You may decide not to ride horses ever again, but does this fear bleed over into other areas of life that prevent you from doing what matters? If riding horses is not important to you, and it doesn’t get in the way of your life otherwise, it may not be an issue.
  • What does your experience- and your fear- tell you? Your fear may be telling you that getting back on an agitated horse is indeed a bad idea. So don’t go out and get hurt if it isn’t necessary. If horses aren’t your thing, let it go and move on. Don’t let your humiliation keep you attacking something that isn’t going to service you.
  • If you want to approach your fears, what would be the smallest step? Watching a TV show about horses, visiting a barn, feeding a horse, brushing a horse, walking a horse, and hanging out with horses are all behaviors that don’t include absolute avoidance but don’t force you into a situation that is potentially unsafe. You could also ride a smaller, more mellow horse with the help of a trainer.
  • If you are going to do the smaller steps, don’t white knuckle it. Relax your facial muscles, soften your jaw, breath slowly/ deeply/ evenly, maintain an open body posture, and take in the situation fully. If this feels threatening, do a smaller step- or limit the time you spend doing the activity. For instance, you could watch a TV show about horses for one minute, five minutes, or fifteen minutes. If this doesn’t challenge you, up the ante by going out to a barn. Find your middle ground, back off when you are overwhelmed, give yourself credit for your efforts, treat yourself kindly, and challenge yourself at some point in the future when you are in a better place.

What To Say To Your Suicidal Friend: A Resource Guide For Teens

One of the biggest problems that comes up in my therapy groups has to do with friends who take on the problems of their friends.

Often teens feel burdened, overwhelmed, and stressed when they have friends who talk about suicide, threaten to commit suicide, or end up being hospitalized for psychiatric reasons. Some times kids have problems getting off of social media, getting off the phone, saying no, asking for help, getting adults involved, or recognizing the limits of what they can do. This can interfere with sleep, concentration, homework, and grades.

Group is one unique therapeutic setting where kids who have “been there” can often dish out advice. While sometimes this advice is hard to hear, the value of being in a group increases the probability of being understood. The combination of being understood and of having practical tools for speaking up, asking for help, and setting limits creates options for practical problem solving- especially when it comes to tough conversations with people we care about.

One of the projects I have taken under my wing recently is to write a book on What To Say To Your Suicidal Friend: A Resource Guide for Teens.

Do your teens need more sleep? Feeling assured that friends are safe and having concrete resources to help their friends can reduce anxiety, increase focus and concentration, and help kids perform better in school.

Refer them to group!

Click Here if you want to be notified about the progress and availability of the book.

 

Manchester By The Sea- A Psychologist’s Point Of View On How To Work With Lee

Recently I went to see an excellent movie: Manchester By the Sea. Here are some thoughts I have about how I would work with Lee.

As a provider of clients who experience intense, severe, and painful emotions; Lee really does fit the bill. General questions that I might consider asking include: What would it take to reduce pain, survive loss, and manage or cope in a way that made things better? What would help Lee feel less stuck? What resources or connections could sustain him better, enable him to bear the weight of his pain, or enhance his quality of life? What could him grieve more fully and to get through this crisis? What is he doing that is working, and what is he doing that is not working? Could he be more likable to himself, sustain the burden or his guilt, or have more fulfilling relationships?

One agenda item I have is getting Lee to stop doing things that could potentially make his current situation worse. Often times I have clients who have severe emotional pain and it is so intense and unbearable that they are looking for any distraction to take away the pain. The distractions sometimes have a short-term effect of feeling better, which makes them hard to stop. However, in most cases these distractions can make problems worse- and are not effective long-term strategies to mitigate the severity of what they feel.

So one treatment agenda is to reduce risk taking or crisis-generating behavior. Specifically, Lee tends to get drunk, pick fights, and throw punches. The natural consequences for this behavior can result in serious injury, concussions, brain damage, head injuries, broken jaw, soreness, swelling, or other various medical trauma. Drinking heavily can result in poor decision-making, hangovers, dehydration, and liver damage. Other natural consequences of his behavior include legal problems, court dates, jail time, being seen as a threat in the community, increased relationship conflict, and isolation. Grabbing the gun of an officer might result in unintended harm to other people. Not only would Lee have the current dilemma of living with the intense and painful losses he has suffered, but he would have to address the above consequences in addition to everything he has already gone through.

Some people actually believe Lee’s behavior is justified. They would say that because he is in unbearable pain, he should be able to act the way he does. Or he should be let “off the hook” because his behavior is understandable. I would encourage those people to consider: Would you recommend your closest confident or best friend- who is deeply hurting- do something that could result in head trauma? Liver disease? Incarceration?

Another “justification” for Lee’s behavior is that he has significant guilt and self-hatred and he is trying to punish himself. After all, the law did not punish him enough! What would be an effective punishment, and how long does he need to punish himself for his actions? Are self-inflicted/ high-risk behaviors actually effective in making him feel less guilty? What if a police officer was shot by accident? What type of effective repair work needs to be done? What lifestyle habits could he change to prevent bad things from happening in the future? What would he need to do to redeem himself in the community? And what would it take for members in the community to find forgiveness, employ him, or tolerate him being around?

How would treatment move Lee towards growth, movement, and decreased pain? There are several ways to approach this- the key being a sensitivity and flexibility to what Lee would be able to handle at the time he seeks help. One is a baseline ability to talk about what happened. As he pieces together his story, there may be parts that are difficult to talk about. Avoiding these topics might show up in the form of escaping, not talking about it, dissociating, becoming numb, becoming argumentative, keeping one’s distance, staying detached, avoiding intimate relationships, leaving, drinking, or even picking more fights. The difficulty is that there are multiple reminders (or stimuli) that will show up throughout his life that he may not be able to avoid. These may include:

  • Conversations about young children
  • Seeing a house fire in the news
  • Talking to his ex, Randi
  • Seeing Randi’s newborn
  • Getting news that young children die or are dying
  • Randi saying “I love you”

For instance, what if he is watching the evening news and suddenly there is coverage about a house fire? What if Lee has a building tenant who loses a child to death, and Lee is present when the tenant tries to discuss it with him? What if Randi tries to contact him again or “shows up” in an unexpected manner? Maybe Lee can try to avoid these situations in the short term, but inevitably life, reminders of life, and young children are the life that surrounds us.

Therapy would work on staying present with emotional discomfort when these topics come up; and doing so in the presence of one or more people. That means not attacking, hiding, or getting drunk. It means being willing to experience grief, pain, discomfort, or tears. It means staying in a conversation and having a willingness to tolerate the stuff that seems unbearable. The more Lee does to avoid it, the worse it is going to get.

Healing results when a person’s grief can be managed, survived, and tolerated. Healing is about experiencing, talking about, and coming to terms with what happened in the presence of others. Healing happens when people can forgive themselves and each other and can make changes to prevent bad things from happening in the future.

Healing doesn’t happen when a person is literally “stuck” in blocking out all things reminding them of pain, and lives a life where they are blind and deaf to such triggers; avoiding any stimulus in real life that will inevitably show up at some point.

Healing doesn’t happen when emotions literally control lives, and people can’t engage a full, meaningful, rich, and productive life as a result. Healing doesn’t happen when there is no compassion for self or others, when there is no forgiveness, and when there are no second chances.

 

Are your socially anxious teens surviving school?

Socially anxious adolescents struggle in the presence of others. Some don’t know what to say, some become self-conscious, and some feel as if they have nothing to contribute. Others feel judged and go out of their way to avoid being the center of attention. Simple things like accidently dropping a pencil, asking to use the bathroom, or getting up to throw something in the trash are treated as a crisis. Social anxiety can create problems in other areas of life, including the inability to simply feel at peace with oneself in large groups, classrooms, and school.

The dilemma: Avoidance of social situations can result in isolation, loneliness, despair, depression, increased stress, and suicide risk. Approaching social situations, especially without confidence, can be downright painful. Classes may be skipped and grades may drop.

Individual services for social anxiety is a challenge: The task is to make a connection without overwhelming the individual. Sometimes teens find “therapy” downright painful. Sometimes it “works” for a short period, but teens also need to find their way within their own peer groups.

Groups allow teens to participate passively, contribute without disclosure, and to experiment with finding their voice. It is not all about them all of the time. What a perfect venue for providing a service that is indirect yet direct! While individual services are helpful for solving emotional problems, group services replicate reality more realistically than 1:1 services with an adult. If teens are in places where peers offer spontaneous interactions while brainstorming solutions to conflict and emotional problems, the teen will be exposed to what life could be like if they open up. The increased comfort of speaking up and participating will translate into other peer settings- including school and eventually work.

Feeling comfortable speaking up and finding one’s voice is a powerful thing!

Does your teen have debilitating social anxiety? Please don’t hesitate to contact me…

When Things Fall Apart by Pam Chordron

Here are some paragraphs from this book:

“When the bottom falls out and we can’t find anything to grasp, it hurts a lot. It’s like the Naropa Institute motto, ‘Love of the truth puts you on the spot.” We might have some romantic view of what that means, but when we are nailed with the truth, we suffer. We look in the bathroom mirror, and there we are with our pimples, our aging face, or lack of kindness, our aggression and all that timidity– all that stuff.

This is where the tenderness comes in. When things are shaky and nothing is working, we might realize that we are on the verge of something. We might realize that this is a very honorable and tender place, and tenderness could go either way. We can shut down and feel resentful or we can touch and I met throbbing quality. There is definitely something tender and throbbing about that groundlessness.

Things falling apart as a kind of testing and also a kind of healing. We think that the point is to pass the test or to overcome the problem, but the truth is that things don’t really get solved. They come together and they fall apart. Then they come together again and fall apart again. It’s just like that. The healing comes from letting there be room for all of this to happen: Room for grief, for relief, for misery, for joy.”

(pages 7-8).