Encouraging Teenage Joy

Have you ever had high hopes for an event only to be sorely disappointed? Or perhaps you came with very low expectations and were pleasantly surprised.  Expectations can make or break a holiday season. High expectations for the holidays can steal joy in anyone. On the other hand, can low expectations turn you into Scrooge no one wants to be around? While predicting doom and gloom may not be the solution, it is important to sit down and discuss what is realistic.

As each family member has their own ideas about the season, stress, disappointment, and miscommunication are common joy thieves.  Teenagers may be grieving the magic of holidays as a child, while struggling with more grown up responsibilities. With school out for a couple of weeks, more family interaction can lead to more conflict than yuletide joy. As adults we want to encourage joy, thankfulness, and peace more than ever. In this particularly busy season of the year, how do we encourage teenagers to develop true joy when we struggle to maintain our own joy?

Look out for joy robbers

• People who won’t take no for an answer-- Its okay for you and your family to need down time and not participate in every holiday activity. It may not make you as popular but a hectic schedule is the quickest way to lose your joy. 
• Financial stress—agree and stick to a realistic budget. Don’t forget to factor in extra money for gas, holiday cooking/baking, secret Santa, and decor. 
• Commercialism have you down? Adopt a needy family through your local church, volunteer at a homeless shelter, reach out to the elderly, foster care children, or lonely people in your life. Focusing on other's in need reminds your teen and family of the true values of the season.

Be a joyous role model

• Schedule down time—teenagers often want to be in the middle of all the fun, robbing them of sleep and, sometimes, sanity (we all go crazy without sleep). 
• Keep up your healthy routine: exercise, eat those veggies, fruits, sleep.
• Limit your alcohol use—Let teens know alcohol is not needed to celebrate or find joy (Teens often are peer pressured to use alcohol (and drugs)  more often during the holiday break.).
• Look for joy in the little things: cup of cocoa, child's smile, frost lined country side, a favorite carol, warmth of a fire.

Let go

• Romanticized ideas about holidays and family life lead to let down—let them go; it’s not real anyway.
• Recognize you are human and can only do so much.
• Realize other’s moods and emotions are under their control; ultimately, it is not your job to make other’s happy—that’s their own job.
• Resolve potentially explosive family differences during a better time.

Each day we have is a gift. Recently, I came across this quote: 

"If you have food in your fridge, clothes on your back, a roof over your head, and a place to sleep, you are richer than  75% of the world. If you have money in the bank, your wallet, and some spare change, you are among the top 8% of the world's wealthy. If you woke up this morning with more health than illness, you are more blessed than the million people who will not survive this week. If you have never experienced the danger of battle, the agony of imprisonment, or torture, or the horrible pangs of starvation, you are luckier than 500 million people alive and suffering. If you can read this message, you are more fortunate than 3 billion people in the world who cannot read it at all."

Perspective is every. Enjoy a blessed holiday season. 

Helping Teenagers Cope with Holiday Blues

As long as I have been in the field of mental health, I have observed a significant increase in new clients starting around Halloween and lasting through Valentine's Day. While there are multiple factors contributing to this phenomena (e.g. more rain and clouds, school), a significant source of distress seems to be the holidays. Teenagers can feel this most keenly as they have little power over their circumstances and are old enough to know what expectations the holidays bring. Two huge contributors to holiday gloom are finances and loss.

Finances—Many teenagers are intensely aware of the family's financial situation. If it is hard for caregivers to make ends meet during the year, this is amply magnified during the holidays. They may know they will have food but dread hearing about all the electronic and expensive gifts their peers receive. They may sit quietly in shame, or lie about the reality of the holidays to avoid pity. Often, they won’t share this feeling with anyone because they don’t want their caregivers to feel worse about tight finances than they already do. While it can be character building to recognize the greed of "keeping up with the Joneses", teenagers who get next to nothing during the holidays may feel unimportant or even unloved. 

What can help: Encourage teenagers to pick up holiday jobs, babysitting, yard work to earn some extra money. It empowers them and increases self-esteem. Encourage volunteer work in local homeless shelters. Seeing those who struggle to have a roof , puts our own wants into perspective. Be a listening ear to financial struggles.  Find an organization who can sponsor families with limited income (i.e. your local church, Salvation Army). What other ways have you found to help encourage teenagers when finances are tight at home?

Loss— Loss comes in many forms. For children with divorced parents or foster/adopted children, the holidays result in missing a parent and/or family traditions. For families who have had a loved one die, the holidays highlight that pain deeply. Even for the lonely or isolated teenager, never it is more felt than the time of year we gather together to celebrate the holidays.

What can help:  One of the best ways to help a teenager struggling with loss is asking “What would make it feel like ___________ (holiday of your choice) for you?” Even the opportunity of expressing their desires helps them process the loss. Encourage the teenagers to set aside some time during the holiday to honor their loss through writing a letter to the one they miss, looking at photos, listening to music, or even creating a “loss box” where they can put in something to represent the loss and review it at their leisure. By setting aside time to honor the loss, it helps the teenager regulate their grief; it help to move on with the day rather than trying to push aside thoughts or focusing on the loss all day. Mourning is different for everyone. Allow people to choose how they want to honor their losses. For a lonely or isolated teen, invite them to join in on a holiday activity. Giving a teenager a place to belong is a priceless gift. Regardless of the type of loss, be available to talk to and make sure they know they are important to you. What other ways have you found to support teens experiences loss during the holidays?

The Oyster: Changing Pain to Beauty

Every once in awhile, I run across a story that must be shared. Nancy Davis, Ph.D. creates a story of changing identify from worthlessness to one of value. Its too good not to share.

The Oyster

Once upon a time an oyster lay on the bottom of the bay. Oysters are very rough on the outside and not very colorful. The shell of an oyster is often ground up into small pieces and used to make roads. People and vehicles ride and walk all over roads made out of oyster shells.

This oyster was no different. "I am designed to allow people to walk all over me because I'm just a yucky, ugly oyster," the oyster told herself day after day. "I was created for people to walk on me." The oyster had also heard that people sometimes become poisoned from eating oysters. So she told herself, "I'm really worthless; all I do is make people sick."

Often when oysters are served at restaurants, people remark, "Yuck, oysters are slimy, they're yucky. Why would anyone want such a repulsive thing?" So the oyster would say to herself, "They're right, I'm not worth anything, I'm slimy, people hate me, and I am worthless."

It was not surprising that the oyster was always feeling sad.  "Why couldn't I have been something different? Why couldn't I have been a diamond or a ruby? Why couldn't I have been a sand dollar or have a shell that could be made into earrings? Why, why, why?" the oyster asked, as she thought a lot about what she wasn't. She told herself over and over that she was ugly and awful and slimy and made many people sick.

One day a fisherman threw a net into the bay and caught this oyster in his net. The oyster was even more upset and cried out, "This is exactly what I was afraid of. Now I'm caught and everyone is going to discover just how ugly and repulsive I really am."

The fisherman had a different way of looking at things than the oyster. Finding the oyster in his net, he opened the shell with a knife. From deep within the shell, he pulled out an exquisite white pearl. This discovery surprised the oyster. She had paid no attention to the hard pearl as it grew within her. "Isn't it amazing that you can have something so valuable within you and not even realize it? How could this be?" asked the oyster. "How could I have this beautiful pearl inside me when I am so ugly?"

Because the fisherman had spent his life on the sea, he sensed the oyster didn't understand how a pearl is formed and he began to talk to her. "Long ago, when you were very little, there were things in your life that were very irritating and scary and sad and painful. To deal with this, you began to build a covering around your feelings. You wrapped and wrapped all your pain and sadness to protect yourself. This was really helpful when you were young and the pain was very real. What you did not realize and now you can see, is that you changed this awful pain into a valuable pearl. You found a way to take your pain and sadness, crystallize it and change it into something exquisite. this pearl was within, just waiting to be discovered."

"Wow", cried the oyster, "that's very surprising." Then the fisherman broke away the shell from the outside of the oyster because she didn't need that anymore. He removed the yucky, slimy part because she didn't need that anymore either. Then he polished the pearl allowing the beauty and luster to shine through. The fisherman gave the pearl to his daughter. She wore it on a necklace of gold and prized it dearly.

"Isn't it amazing?" the little pearl remarked to herself.  "I never realized that I am special. I was unaware that deep within there was a pearl waiting to shine like a jewel." As the pearl continued to think about life, she realized the most valuable jewels are often buried and are just waiting to be discovered and polished.

Davis, N.  (1996). Once upon a time...therapeutic stories that teach and heal. Burke, VA: Nancy Davis, Ph.D .

Handling "My therapist said...."

Have you ever had a teenager tell you “My therapist said….” followed by something bizarre, confusing, or conflicting with your values/rules? Even as adults, people will explain a change in behavior referring to a counselor's direction. And it is true counselors may say or ask clients to change thoughts/behaviors/emotions for a variety of reasons. There is an assumption if someone is in counseling, they want life to be different. This only comes with change. But what do you do when the “my therapist said…” statement challenges your values/rules? Without any context, it can be upsetting to have your values/rules challenged by someone who influences your teenager. Typically, therapists do not work to undermine parent’s/caregiver’s authority.

However, with teens, it is not uncommon for context to be excluded when talking about something their counselor said. Other times the original intent has been skewed for a variety of reasons.  Sometimes it is intentional. Other times it is accidental. While still other times, it is truly misunderstood. 

For example: In one session, Mary and I were talking about the importance of expressing her emotions in a safe way. One of the suggestions I offered was a password protected writing program (i.e. Microsoft Word). Later at home, Mary’s parents asked her for her phone password. Mary told her parents "My therapist said I should have privacy on my phone." and refused to comply. Naturally this was confusing for the parents. Mary had chosen to journal on her phone and consequently privacy should extend to her whole phone. Fortunately, the parents asked me about it and I was able to clear up the miscommunication while discussing with Mary alternate places to confidentially express herself (parents should have access to phone passwords with any minor in their care).

If you hear “my therapist said….” from your teenager and what follows does not keep with the family values, please clarify. Start by responding "Hmm...that sounds interesting. Tell me more about that." If what is relayed continues to be conflicting with values/rules even with more context, ask to talk to the counselor. Teenagers discover the therapist may hold a lot of weight with their parents and intentionally mislead them. Other times they may have misinterpreted the counselor’s intent. Teenagers may mistake validation as approval or agreement. To get the most out of the counseling experience for your teenager, good communication and clarification are vital.  

If your teenager will not let you talk to their therapist to clarify, let them know you will be unable to make or support any changes without clarification as it goes against family rules/values.  But, let them know you would be very willing to listen and clarify if you could talk with the therapist for one session or even half of one session. Some teenagers are more willing to agree if they can still be present with the parent and counselor.

Be careful not to bad mouth the counselor or contradict what they have said without clarifying because it undermines your teenagers therapeutic progress. If no resolution or clarification can be attained, respectfully say, "Everyone has a different opinion"  or "I'm not sure how that will work in our home." Don't let the counselors 'advice' become another area of conflict between you and your teenager.

A teacher once told her children’s parents at orientation “I promise not to believe everything they say about you, if you promise not to believe everything they say about me.” While counselors validate and accept what their teenage clients say, they also take it with a grain of salt. People have different perspectives and are entitled to their opinion. This is true with all clients not just adolescent ones. Counselors recognize they often are only seeing one point of view and encourage parental involvement whenever possible to more efficiently resolve the presenting issues. Ultimately, the caregivers/parents make the rules of the household not the counselor. 

The Science Behind Self Injury

Researchers have been studying non suicidal self injury (NSSI) for over 20 years. Only within recent history have they been able to look at the physiological and chemical differences in individuals who engage in self harm. It is an exciting time as the science behind the behavior can help clinicians and doctors learn to more effectively treat self injury. With more knowledge comes more understanding for parents, teachers, youth leaders, and peers who often feel confused and discouraged by the self-injury behavior.

The Brain

In the limbic system, researchers saw a hyper aroused state in those who engage in self harm. As the limbic system involves emotional regulation, in a hyper aroused state the individual is upset and may try to calm down. When the scientists applied a painful stimulus, they hyper aroused state came down. This appears indicative of NSSI as a coping skill for emotional regulation. In other words, the brain supports a common teenage assertion they actually feel better, calmer, release, and/or relief after engaging in the self injurious behavior.

The Altered Chemical Levels

Researchers have also found altered levels of cortisol response. They are uncertain if the behavior causes the altered levels or if the altered levels increase vulnerability for the behavior. Cortisol is associated with stress (Think of the commercials about cortisol/stress keeping us from losing weight.). It makes sense individuals engaging in self injury often have difficulty regulating their internal and environmental stress. We can see it in the altered cortisol levels.

They also found lower levels of endogenous opioids affecting pain perception and addictive behaviors. There have been rumors NSSI can be addictive. If the Endogenous opioid levels are lower, it is possible there is an addictive quality to some severe self harm. Also, if pain perception is altered, there is potential truth in someone who engages in NSSI stating they don't feel the pain of their actions. However, once the behavior no longer exists, the lowered pain perception does return. Others have suggested NSSI may increase serotonin or dopamine levels in the brain creating an addiction but research does not support the hypothesis consistently at this time.

Nutritional Deficiencies

Research has found successful treatment of self injury in increasing the Essential Fatty Acids (found in walnuts, leafy greens, fish, flax seed, etc...) in the diet. People who engage in self injury have lower levels of Essential Fatty Acids. In one research project, the control group was given a placebo while the other group was given Essential Fatty Acids regularly. After 12 weeks, the experimental group saw a marked decrease in depressed feelings and suicidal thoughts in comparison with the control group. Even adding a supplement such as Omega 3 and 6 capsules (fish and flax seed oil) increase the amount of Essential Fatty Acids in the body. I am continually amazed at how important good nutrition is to the overall health of the mind. While improved nutrition may not cure all diseases, increasing Essential Fatty Acids will improve depressed moods and suicidal thoughts based on some of the most current research.

Effective Counseling

Dialectical Behavior Therapy (DBT) is one of the most evidenced based forms of counseling treatment with self injury. Ask your teens counselor if they utilize DBT. If they don't, ask them if they would be willing to learn (by books or trainings). A counselor doesn't need to be a purely DBT clinician to be effective as long as they are familiar with the basic principles and can use DBT when needed to decrease NSSI. You want the counselor to be DBT influenced. Remember, even with the most effective counseling, NSSI is not a short term issue and there is no quick fix. DBT clinicians recommend preparing for 3-12 months before treatment is successful depending on severity, intensity, and duration of the NSSI.

Prevalence

Don't buy into the belief NSSI is increasing. Much of the literature supports a consistency in the prevalence of NSSI since 2005. It is possible we are more aware of the issue as teenagers open up about the historically hidden behavior. In the United States, up to 37% of high school students have engaged in self harm behaviors at least once. For more information on the research check out these websites:
http://www.suicidology-online.com/pdf/SOL-2012-3-24-32.pdf 
http://www.jabfm.org/content/23/2/240.full 
http://www.capmh.com/content/6/1/10

Understanding Self Injury

Often, I’m asked why teenagers engage in self harm. “Isn’t it for attention?” “Aren’t they just copying what they see on TV?” “How can they stand to hurt themselves on purpose?” The behavior of cutting or other forms of self harm seems so far removed from normal human acts it seems unfathomable to many adults. To a parent, teenage self injury can be terrifying. It leaves caregivers feeling helpless, frustrated, and scared. Yet if we look back on history, civilization is full examples of intentional self-harm crossing into many cultures.

As far back as early Greek mythology, Oedipus pierces his eyes with golden broaches in punishment for his behavior. Today's adolescents express self-hatred, engaging in self injury after a perceived failure. One sophomore girl bit her arm so viciously I could still see the bite marks days afterwards. She believed she deserved it after a misunderstanding with a boy she liked. In ancient Greek times, a shamed Spartan leader asked for a knife after being placed in stocks. Grabbing it quickly he proceeded to slice his own shins. Self harm is not a new issue. There were so many women in the late 19^th century pricking themselves with needles, doctors called them the “needle girls”. Contrary to the prevalent belief self-harm is on the rise, recent research indicates it may actually have stabilized in the last five years.

In its infancy, the medical field has promoted the healing powers of self-harm as Hippocrates encouraged blood letting to cleanse the body. Scarification in African tribes was believed to protect oneself from diseases. Early common psychiatric practices, ironically, included the application of hot irons, purging, and cutting in the treatment of ‘hysterical women’.

Christmas Eve 1888, famous painter Van Gogh allegedly partially removed his ear lobe in a fit of rage. Angry self-harming teenager generally do not remove body parts but could relate to being enraged enough to carve on themselves. Even animals will engage in forms of self harm. Bored dog’s will lick until themselves they have an open wound. Stressed parrots over preen cutting their flesh. Agitated primates bite themselves. 

Religion has provoked much self harm. In Germany, Martin Luther, the founder of the protestant movement, for example, beat himself with a whip regularly. Hindu’s Lord Krishna enucleated his eyes to benefit his mind. Australian aborigine shaman candidates  mutilate and scraped their skin to promote their healing powers.

Mourning and grief have been motivators for self-harm In certain African tribes finger amputation is common in mourning; the more of the finger removed indicates the level of closeness to the deceased. In 2012, a large group of Shia Islamics cut themselves with razors commemorating the death of  a beloved leader. Today, loved ones memorialize their losses with tattoos.

Beauty can motivate self injury. Examples include ear piercings to tattoos to foot binding to plastic surgery. Other reasons include increased revenue for beggars and a soldiers quicker route home. Culture does much to dictate attitudes toward self harm, what is acceptable and what is not.  Shame has kept much teenage self injury hidden. While self harm is widespread in world history, it does not minimize the significance of a young person engaging in self injury. It is not a passing phase. As in many of the examples above, it is indicative of deep emotional pain. Consult professional help if you know a young person is hurting him/her self. Dialectical Behavior Therapy  (DBT) has proven highly successful at reducing/eliminating the behavior. Self injury is not resolved quickly but can take 3-12 months of counseling for progress to occur.

See resources below for further help.

http://www.mirror-mirror.org/selfinj.htm
http://www.fortrefuge.com/SelfInjuryBillOfRights.html
http://www.kristalmathis.com
http://www.Portlanddbt.com 

6 Ways How to Help Depressed Teenagers

     One of the biggest challenges adults face working with depressed teenagers is knowing how much to accommodate and how much to hold to expectations. If all rules are accommodated to keep the teenager less depressed he/she may never learn how to cope with the consequences of his/her actions. On the other hand, holding depressed teens to the same expectation as their peers, may result in spiraling failure increasing their depressive symptoms. Watching your teen fail time and time again can be heartbreaking. You want them to succeed. They want to succeed.
     Many adults fall into the trap of waiving their normal rules to avoid conflict or high risk behavior (i.e. cutting, running away). Done out of the best of intention, the teens may appear to stabilize but when confronted with other expectations they quickly deteriorate. Also, reducing expectations for one individual creates resentment and frustration for others in the family, class, or group. On some level, the lowered expectation reinforces the hurting teen's failure. Essentially they get perks from struggling with depression. This is not the message we want to be sending them. How will you know if there has been too much accommodation? Start with measuring your own resentment level. How much have you done v. how much have they done to help themselves out? If you are going to compromise on an expectation, what are they compromising? If you notice you're working harder then he/she is, there is too much accommodation.
     On the other side of the spectrum are adults who continue to expect exactly the same from emotionally troubled teens as they do from all the others. The result for the teen is often failing out of school, always in trouble, increased poor self-esteem and depressive symptoms, and finally, shutting down. These adults try to motivate assuming if the motivation is big  enough the teen will somehow manage to make changes. "If you pass all your classes this year, you can take drivers ed this summer." "If you don't get any more suspensions, I'll buy you that X-box game you have been wanting.". The teen may actually be motivated, get excited, and earnestly throw themselves into the appropriate behavior with vigor. Within a few weeks, sometimes days, he/she has had a failure. He/She may try to hide it or give up again resulting in everyone's disappointment. So what does the adult do? Unfortunately, the adult may try another motivator which ends up in another painful cycle of failing. Finding the balance of support and enabling can be difficult.

How To Help Depressed Teenagers:
1.) Review expectations together (i.e. be honest, all homework turned in). Having it written out limits confusion later.
2.) Put together reasonable short term consequences (no electronics for 24 hours). Too long of consequences reduces effectiveness as the teens learn to adapt without their privileges. Hint: the consequence time doesn't start till you see the behavior you want (for example, if John curses during his 12 hour restriction period for cursing, the time starts over). Let your teen know ahead of time what to expect.
3.) Reward small steps in the right direction so they can see their progress (i.e. a point for every assignment turn in on time or for a day without yelling). The small reward can work toward a bigger motivator (i.e. X-box game, driver's ed, eating out, sleepover). This reduces their discouragement when they make mistakes as they can always try again tomorrow and still have an accumulated amount of points from past successes.
4.) Follow through. Do not shorten the consequence once you have already agreed to a certain amount of time.
5.) Be available to validate emotions and  talk about problem solving. Just remember to still hold accountable for poor behavior. Depression, ADHD, anxiety, and trauma are not excuses for abusive behaviors or a lack of responsibility.
6.) Encourage them to seek help. Most teenagers have access to counselors and doctors through school, faith system, and/or parents. Put the responsibility on them to develop skills to cope while you support them in their process

Finding a balanced approach can be a struggle. Consult with other professionals or supports if needed. You aren't in this alone.

How is mental illness created?

The Month of May is Mental Health Awareness Month. The more neuroscience discovers about brain processing, the more the community is able to understand behaviors. Mental health issues are prevalent in our society and are sometimes linked to violent and unpredictable behavior. The more informed the community is about mental health issues, the more they will be able to help rather than fear it.

“An estimated 26.2% of Americans ages 18 and older suffer from a diagnosable mental disorder in a given year.” Many adult disorders start in their youth. Almost 10% of teenagers (13-18) meet criteria for serious emotional disturbance including but not limited to depression, eating disorders, autism, anxiety, ADHD, and post traumatic stress disorder based on the DSM IV-TR. Based on the 2012 study, girls were more likely to have emotional issues such as depression and anxiety while boys were more likely to have behavioral problems like those associated with ADHD.

Many influences in our culture promote mental illness as a character flaw. One suicidal teenager recently told me “My dad tells me to stop being stupid.” There is this idea if a person just tries hard enough and makes all the right choices, mental illness will be avoidable. “Aren’t most mental issues self-created?” I was asked recently by a respected business man. While motivation and choices do play a part of treatment, a ‘pulling yourself up by the bootstraps’ mentality or blame will not cure mental illness. Rather it increases shame creating an additional barrier to treatment.

Most counselors, psychiatrists, and psychologists agree on two primary explanations for mental illness.

1.)    Genetic—just as we inherit coloring and facial features from our family linage so do inherit predispositions for many disorders such as ADHD, bipolar disorder, major depression, autism, and schizophrenia. Just as doctors request family history for illnesses like heart disease and breast cancer, the family mental health history is just as important in screening for mental health disorders.

2.)    Circumstances—Ongoing abuse, trauma, loss, isolation, and recurrent environmental stressors can trigger mental health illness. The intensity and duration of a situation play directly into the human reaction.  “It is sometime an appropriate response to reality to go insane.” (Phillip Dick) As humans we can only handle so much for so long without help. Take the example of holding out a cup of water. For awhile a person can hold the cup out successfully without it interfering or bothering or bothering he/she. But, if they are expected to hold it out for hours there will be pain and at some point arms will collapse unless support is given. The inability to hold the cup out for long periods of time is not a weakness of character but a limitation as a human being. The same is true cognitively and emotionally. We can only handle so much for so long.

For some, mental illness may be a life long disorder such as asthma or diabetes needing ongoing counseling and/or medication. For others, mental health illness will be a season of life if they are able to gain the tools they need to stabilize. For teenagers, effective treatment encouraged family involvement. Like having the flu or chickenpox, with the right support, mental illness can be treated successfully.

How Do I Improve Teenage Behavior?

One of the alarming red flags in any parenting program, is the assertion only their way is the "right" way. While there are parenting true principles, a guaranteed technique to work for all teenagers all the time is nothing more than an illusion.  If one technique had a 100% guarantee, parents and cultures would have come to a consensus  long ago.  But instead, there are many parenting classes from the infamous Baby Wise  to Attachment Parenting. Theories abound and vary from culture to culture and, in America, from household to household. Many parenting classes do offer important fundamentals such as increased consistency and structure. How do you know which one to choose? Which one is true to your values? Which one(s) will your teenagers respond to the best?

Start by identifying your child's behavior pattern:

The Compliant Teenager
Very little action is needed in order to discipline the compliant teen. He/she responds to a look from across the room. Talking is the best tool to modify behavior. He/she depends on the adult's approval. Disappointing authority is one of the worst possible consequences for the compliant teen. If needed, taking away a privilege or two goes a long way. They may be moody at times, sometimes challenging authority but most of the time can be talked through conflictual situations.

The Independent Teenager
Most teenagers will push the envelope every now and then. They are learning how to be their own person which often translates into pushing against the boundaries set before them. They want to experiment with "adult" behaviors. Teenagers may explore risky behaviors. Using programs like Love and Logic or Total Transformation, parents train teenagers to think responsibly. They are held accountable for their behaviors but also learn decision making skills to cope with what life brings them.


The Challenging Teenager
Teaching a challenging teenager stretches and pushes the adults with whom they come into contact. Every day is a battle, every conversation an argument. Trust is minimal. For teens who insist on pushing every boundary given, authority would benefit from relinquishing the belief they can control behavior. However, they do have control over "the stuff" (aka everything your teen enjoys like their electronics, going out with friends, etc... ). Use this influence consistently and let the teen know how to earn back the privileges. Be up front about how long the consequence will last after he/she has complied. Utilize programs like Parent Project. They are "evidenced based" meaning studies have been researched on caregivers who have used the program strategies and the outcomes have been reliably successful. If needed, work with a counselor or another support since training a challenging teenager can be exhausting. You will need a cheerleader.

Whichever category your teen(s) falls into, know their decisions are their own. While parents, teachers, youth pastors, and other supports have a significant impact on teenagers, they do have a mind of their own. Some make great choices and others do not, no matter how hard we try. The best we can do is to educate ourselves, admit our mistakes, and demonstrate healthy love and boundaries as much as possible. The outcome is up to them.

Gangs in the northwest?

      One of the reasons I moved to a country suburbia neighborhood was for the walking trails. I love to walk and see the local wildlife, the tall NW trees, feel the breeze or the sun on my face. Being part of a fairly new neighborhood, there is always construction going on. As I passed a nearly completed house on my walk recently, I saw graffiti sprayed to the new windows and house siding. Upon closer inspection (becomes I'm curious), I found more recent spray on the side walk and another partially built home. It included pictures of male genitalia, gang symbols, racist comments, and foul language. Initially, I was surprised to find this in my neighborhood and not on the walls of inner city buildings.

      Seeing it reminded me how close we are to active gangs. Did you know local school have banned bandanas because of gang affiliation are identified by certain bandana colors? Did you know gangs from Portland use I-5 to gain access to other youth across state lines and in unsuspecting rural areas? "The U.S. Department of Justice indicate that every state has violent gangs and that there has been a dramatic increase in gang activity in smaller cities, towns and rural areas." Do not make the mistake of believing gangs are for big cities like Chicago, New York, or LA. Denial allows the problem to grow.

Why would teens belong to a gang? They are desperate for a place to belong. Teenagers need to have a sense of community and will get it where ever they can be accepted. For a youth with few safe relationships, who has been abused, who is isolated and/or bullied, a gang becomes the answer to their problems. If you want to gang-proof the teens in your life. Let them know they have a place to belong whether it be in your family, in the youth group, in clubs, Boy/Girl Scouts, choirs, drama, or sports. Help them find a safe place they can find acceptance.  Talk with the teen about consequences of joining a gang such as a criminal record, putting loved ones at risk, personal injury and/or death.

Signs a teen may be involved in a gang

• Skipping School
• Coming home with unexplained expensive items or cash
• Difficulty bonding with family
• Defiant towards all authority figures
• Drug Use
• Out at all hours of the night
• Sudden decline in grades

What to do if your teen is involved in a gang. Remember: The risks are high and the danger is real.

• Educate yourself on the gang signs.
• Minimize the teens idle time. There is truth to a busy teenager doesn't have time to get into trouble.
• Call local law enforcement/juvenile authority and ask about programs for youth connected to gang involvement.
• Call the police when you see graffiti signs, take photos, and cover it up as soon as possible as it attracts other gang members to the area.

For further help check out LAPD Tips and the Youth Booth.

Helping Teens Accept Themselves.

 
   February is National Eating Disorder Awareness month. Honestly, this is not my favorite topic to discuss or blog about, but last weekend I went to a CREDN (Columbia River Eating Disorder Network) work shop. One of the speakers pointed out even professionals, we all bring our inner biases and beliefs about food and our bodies to the table. I can work with alcoholics, drug abusers, depression, anxiety, self-harm without my personal experiences interrupting too much (aka counter-transference). But when we start talking about weight, eating disorders, and body image, all of a sudden, I am very aware of my body, of what I ate that day, and of my own insecurities. Even amongst counseling colleagues "fat shame" is common. "I'm fat." "I'm on the insert latest fad diet here diet." "I keep trying to lose weight." "You look like you've lost weight" said with an approving smile. We rarely hear "I love my body." And if we do, we may resent the speaker. "Why should they be able to be happy with their body when I cannot? What arrogance!"
   Eating disorders are deadly. One of the conference speaker's daughter died of Bulimia one year after the first time she purged. The thought makes me go cold all over. My stomach twists and turns this way and that and I recognize the feeling of helplessness. If you love or have loved someone who has an eating disorder (and statistics indicate you do), you may understand. What can we do to help?
   The conference challenged me to change my thinking and to watch what I say even subtle implications in conversation with others. My goal is to create a space where people know they are valuable regardless of appearance, weight, size, height, or food choices. This environment promotes an atmosphere of healing for those who struggle with their bodies and food. For our little ones who watch our every move, we can role model unconditional acceptance of our own bodies. This is hard but no one ever said it would be easy.
5 Practical Ways to Handle Fat Shame:

1. When someone asks if you have lost weight or praises you for losing weight, try "So you remember me being fatter?" This will discourage their comments.
2. Focus on the underlying feelings: "You sound really unhappy." or "How are you feeling otherwise?"
3. When someone comments on how much they need to lose weight, ignore it and change to another topic. Telling them they don't need to lose weight reinforces their talk. Agreeing with them increases shame. Just as you might ignore and distract an annoying behavior in your child, distract the speaker with another topic like, "How was your weekend?".
4. Put up some boundaries. "That's not a topic I discuss." "I have nothing to say to that." "I prefer not to talk about weight/diets etc..."
5. When someone shames food (i.e. how unhealthy or how many calories etc...), try "It's a insert food of choice, not a genocide." or "How about we just enjoy this?"

Find the approach which works for you. For some humor, even sarcasm can interrupt the cycle. Other's may need a gentler method. Remember 'fat shame' is another form of bullying. Because it is associated with health we may feel it is more acceptable. It's not. Just as we do not judge based on race, we should not judge based on weight. One woman said "God doesn't smile when we eat an apple and cry when we eat cake." Focus on health and listening to your body--not on appearance. Discover what you love about your body.
Spotting an Eating Disorder and What To Do
   Most people who struggle with eating disorders (not just girls), are really good at keeping secrets. Keeping secrets perpetuates the inner, and sometimes family, shame, thus reinforcing the secret keeping. Unlike other mental health issues, many with eating disorders look like they have it all together on the surface. They maintain their responsibilities in jobs and hobbies, have friends, and get good grades--often straight A's. They may be perfectionists. They may exercise excessively, keep track of their food intake obsessively, never eat in front of people, or hide their eating.
   If you are concerned about someone's eating habits, get them help. Working with a doctor, counselor, and nutritionist who are familiar to with eating disorders is imperative for change to occur. Remember, just like physical illness, healing takes time and is a long process. Just like cancer doesn't have a quick fix neither do eating disorders. Those with eating disorders often have a brain chemistry disruption. Ignoring the problem only prolongs it. Connecting them with the right help may very well save their life.
   I want my daughters and sons to love their body, comparing it to no one. I want to train them to listen to their bodies and encourage health. I want them to see people as valuable for who they are rather than having to conform to cultural standards of beauty. I want their definition of beauty to have nothing to do with attraction but to include inner qualities such as grace, kindness, and respect. Is it possible? I don't know but I am determined to work to facilitate the change so my children can love and accept the body God gave them without question.

Further help and inspiration:
"Pretty" video
Eating Issues, Aging, and Women article
SPEAK: Students Promoting Eating Disorder Awareness and Knowledge
Providence Behavior Health Services: Adolescent Eating Disorder Services 503-216-2025 or 800-716-5325
Center for Discovery in Bellevue and Edmonds, WA
Rain Rock in Eugene, OR
Kartini Clinic for Disordered Eating in Portland
Free Eating Disorder Art Therapy Support Group @ A Better Way Counseling Center 503-226-9061 in Portland, OR

Natural Ways To Treat Teenage Mood Disorders Part 2: Sleep

Teenagers are notorious for their poor sleep habits. However, lack of sleep creates mentally ill symptoms. As Leanne Ernster, Preventative Nutritionist, said in my interview, "Sleep is fundamental to life."  Having had her own struggles with chronic insomnia growing up she discussed how to best help teenagers struggling with sleep. Common teenage sleep problems include,

• Having difficulty getting to sleep 
• Waking frequently
• Nightmares
• "Reverse cycling" -- sleep during the day, up most of the night.
• Inability to get up in the morning

For teenagers struggling with sleep, approaching evening will trigger stress as he/she knows another restless night is coming. Leanne shares her story: "I could not sleep. I hated sleep. The thought of going to sleep made me anxious, which [then] made it harder to sleep." While the average teenagers needs between 8.5-10 hours of sleep a night, one report indicated 85% of teenagers do not get enough sleep. Because sleep is so vital to good health, many doctors will prescribe medications to get their patients to sleep at night. Unfortunately, they have side effects, including disturbing dreams and morning grogginess. Also, many parents are hesitant to put their teenagers on medications at this key point in their development. 

Leanne recommends "Start thinking about sleep in the morning." Jump start your waking/sleep schedule with brighter lighting early in the morning and a glass of water to hydrate. Even a hot shower itself boosts serotonin which can encourage wakefulness. Do what you can to reduce the stress in your life often interfering with sleep. Encourage the following habits with your teens:

• Have a consistent bedtime to sync your body's circadian rhythm, not varied over an hour.
• Journaling before bed to release what is on your mind.
• Dim or turn off lighting on TVs, lamps, computer, smart phones, and mp3's to encourage the body's natural production of Melatonin.
• When laying down for bed, take long, deep, slow breaths to calm the brain down. 
• Snuggle or get a massage to create the chemical oxytocin, "the cuddle hormone", helping people relax.
• Warm baths/showers can help the body and brain calm down.
• Eat sleep inducing foods, such as popcorn, before bed.
• Make hot non-caffeinated drinks 1-2 hours before bedtime-- even holding a hot drink can be calming.
• No caffeine after 2 pm.
• No exercise 4 hours before bed (exception is bedtime yoga or light walking).
• Identify disruptions and resolve as much as possible. Need earplugs? earbuds? eye mask? Some people need complete quiet and others need background noise.

Melatonin is the natural hormone our bodies produce to help us fall asleep. It is also sold over the counter in the US. So many people have such positive results using Melatonin, doctors are including it on their list of sleep prescriptions. Leanne warns against using above 3 mg of Melatonin as it can be counterproductive. "It might be helpful to have a Melatonin complex which would also include low doses of other synergistic calmers like GABA, Vitamin B6, and other neurotransmitters that help you slow down."

Having enough sleep improves a teenager's ability to handle stress and do better in school. Lack of sleep increase irritability, difficulty focusing, weight issues, and many more negative side effects. Unfortunately, convincing a teenager to get to sleep can be difficult. Include the professional's encouragement such as doctors, coaches, teachers, and counselors. Keep an eye out for teens who experience days with few to no hours of sleep as it can be a symptom of Bi-Polar Disorder or substance abuse. Consult with a counselor if this is an ongoing issue.

Other resources: Sleep Foundation

Extra Tip: Vitacost.com is an inexpensive, quick access to high quality food and supplements.

Leanne Ernster started and manages Engedi, a nonprofit coffee shop serving healthy smoothies and organic coffee/teas. My personal favorite is their Chai tea bought local from a native Indian now residing in Oregon. She also coaches people through her business Celebrate Nutrition in helping clients make better health choices promoting whole foods. One of her favorite pastimes is creating new healthy recipes. Like Celebrate Nutrition on Facebook and get regular healthy tips for daily living.

Disclaimer: Check with your doctor before making changes to your diet. Neither Leanne Ernster or Kristal Mathis are medical professionals. Please note not all mental health issues are related to diet but it is an important factor for many people.