Why Creativity Works

    Ever wonder about art therapy, or why a client-- teenager or not-- might draw or paint in a counseling session? Curious as to how expressive methods are useful in therapy? For many people, their memories of creativity in school are also coupled with embarrassment and even shame. In elementary school, we start to notice other’s work. We begin to compare our art to theirs. Perhaps we notice their creations reach our ideal more then our own work. As classmates meet art goals we do not, it is not uncommon for us to shut down our creativity. Negative self talk becomes “I’m not creative” or “My brain doesn’t work that way.” Unfortunately, some art teachers can exacerbate these inferiority beliefs through criticism and even ridicule.

   In my work with teenagers, some will flatly refuse to engage in creative work “I’m not good at it.” they tell me. Anxiety can even spike when people are put in a situation where creativity is required. The problem is creativity is a gift people can use not only to express themselves but to help their brain process emotional pain more easily. When we shut down our creative side, we lose an important tool to help ourselves.

    In the past few months I have been pleasantly surprised at how much recent research supports creative expression in both working through difficulties and living whole heartedly. Dr. Eliana Gil, an author of child therapy books, speaker, and counselor for 40+ years, explained how creative work incorporates a different part of our brain than the part where we think about problems or trauma. When we incorporate creativity into our lives, it allows our brains to process these issues more fully. She even encouraged counselors to self care by engaging in expressive art forms to better process their difficult cases at the end of their day. 

    Another popular writer, research, and speaker, Brene Brown, insists one of the key practices of living life fully is regularly engaging in creative works. She writes that internal and external shaming often keeps us from digging in to spending time on artistic endeavors. To fully embrace creativity we have to put away our tendency to compare and judge but practice self acceptance. Brene also warns “Unused creativity is not benign. It metastasizes. It turns into grief, rage, judgement, sorrow, shame.”  What holds us back from accessing our creative side does more harm than good. Abiding by our fear of failing only hurts ourselves.

    Even if the idea of creativity creates a nervous eye twitch, slowly moving towards creativity not only helps ourselves but models it for our teenagers. Let us get young people involved in utilizing this wonderful gift to help them cope with life's many challenges. Here are some ideas to get you started:

1. Identify what you can do for hours on end and lose track of time (no, not TV)—reading, writing, decorating, experiment with baking/cooking, gardening, dancing, editing photo, crafting, playing games with the family, swimming, drawing, painting. (note: play is the sister to creativity)
2. Schedule time in your calendar to regularly engage in these identified activities.
3. Scientific American recommends going new places, eating new foods, listening to new music, and meeting people that are different than us boosts our ability to be creative.

Developing Healthy Family Rules: Trust Part 3

Most researchers of human interactions agree trust is the essence of all healthy relationships. One mistake families unintentionally pass on to their children is the belief that people aren’t trust worthy. “If you want something done right, you need to do it yourself.” Lack of follow through and bringing up past mistakes are the two most common ways families corrode trust. Here are some examples, the concerns, and how to rebuild the trust:

1.)    Dad promised to be at his son’s sporting event but gets caught up at work and doesn’t make it. This is not the first time it has happened.

·         Concerns: Son learns Dad’s pattern of behavior of promising and not following through. He also learns Dad values his work more than his commitment to his son. He learns not to trust Dad’s promises. As he grows older, he may continue this pattern with his own relationships.

·         Solution: Dad apologizes to his son, recognizes his wrong doing, stops making promises he can’t keep, and makes sure he is at the games he says he will be at. Son learns he can trust Dad to do what he says. Son learns it is important to keep promises.

2.)    Mom tells her daughter she is going to get her a new kitten when her grades improve but after the grades improve, she doesn’t get the kitten. When the daughter brings it up, Mom excuses the lack of follow through by blaming her for not cleaning her room.

·         Concerns: By Mom not remembering the kitten on her own, she undermines her own motivational strategy.  By refusing to follow through she has sealed shut motivating her daughter in the future. Her daughter learns mom will say anything to get her to do what she wants and probably won’t follow through. Further, it isn’t even worth talking to her about it because Mom will turn around and blame her. Daughter learns it is ok to misled Mom as Mom has mislead her.

·         Solution: Make no statements you are not fully prepared to follow through on. Follow through on all consequences positive or negative in a timely fashion with no undisclosed strings attached. Daughter learns to trust what mom says and works to keep her word with her mother.

3.)     Parents ground their teenager for three days but “forgets” after one day.

·         Concerns: The teenager learns (and counts on) parent forgetting decided consequences. They may take advantage of it. He/she may expect other authority figures to do the same rather than hold them accountable. The teenager also learns parents won’t follow through with what they say.

·         Solution: Only say what you are willing to do. If a one day consequences is what can be held to, then only say one day. If three days have been decided, figure out ways to remember to hold them to it for three days. This way, the teen learns to trust parents even if he doesn’t like what they are saying.

4.)    Family is in the middle of an argument over chores and parent brings up past mistakes/failures that have nothing to do with the current discussion.

·         Concerns: The teenager learns no mistake is really forgiven and resolved but can be used against him/her at any time. She/he learns it is better no one knows about their own mistakes because others can’t be trusted to be safe with the mistake/failure.

·         Solution: Parents stay on topic to the discussion at hand. If unresolved issues come up, save for a better time to discuss. Try to resolve issues as quickly as possible rather than dragging them on for days, weeks, or even longer. Parents work at full forgiveness and moving on once the issue has been resolved.

Trust is the foundation for all healthy relationships. If we can’t trust our own families, it makes it a lot harder to trust others. Trust takes so much time to build and can be broken in an instant. All parents make mistakes but it is never to late to work at improving. Mental illness, trauma, and substance use are common perpetrators of distrust in families for a variety of reasons. It takes awareness, intention, time, and hard work to build trust within the family. Instilling trust in your family is a great gift. It allows the next generation to live life more wholeheartedly without shame, it improves their ability to connect with people at work, and have lasting intimate relationships. See a professional family therapist to facilitate the process more quickly.

Develop Healthy Family Rules: Encouraging Emotions Part 2

Fostering an environment allowing any emotion (not behavior) creates healthy families. Unfortunately, many times families have an unspoken rule that emotions are not valid OR certain feelings are not acceptable. Being too sad, mad, or even "too happy" is discouraged as dramatic or unimportant. "Pull yourself up by the bootstraps." "Stop crying." "Suck it up." are common expressions perpetuating these myths. Other times only a select emotion is allowed, such as anger. While other feelings are dismissed or invalidated, anger expressions are given free reign. Occasionally, families can develop roles giving only certain family members permission to express a feeling. Traditionally, girls can cry and be sad more and boys can get angry more. Or, perhaps only one family member can express intense emotions. When alcoholism, substance abuse, or mental illness seeps into the family tree, the maladaptive coping skill, suppressed emotion, can influence the generations of families.

When we do not allow our children and teenagers to own their own emotions, we teach them danger in being vulnerable in relationships. A young lady once told me every time she cried her father became angry and walked out of the room. The vulnerability of crying was rejected in what could have been a close relationship between daughter and father. This breaks down family relationships. Researcher Brene Brown says, "Vulnerability is not a weakness. And that myth is profoundly dangerous." Healthier families vulnerably share feelings knowing they will be heard in safety and support. Each family member has a right to their own feeling regardless. This doesn’t mean all behaviors are permissible. This also does not mean all negative emotions must be ‘fixed’ or rescued. Part of a healthy emotional family is the respect and personal ownership of feelings. For example:

Sister is very upset she can't go to her friend's house. She is crying and arguing. Parents can listen and validate her emotion ("That makes sense you are disappointed you can't go to your friend's home.") and still set limits ("Nevertheless, this is the decision made. If there is going to be continued arguing, you will need to go to your room. "). Offering a consolation hug can let her know her sadness is recognized. Stopping the arguing lets her know the behavior is unacceptable. 

Are each of your family members allowed to have their own feelings?

Is anger one of the only acceptable emotions in the house?   

Young people keep their feelings to themselves because they fear grownups will:
a.) ignore them
b.) diminish or respond sarcastically
c.) become more upset than the person sharing
d.) become angry. Almost daily, I hear from families that they cannot communicate feelings out of protection- either for themselves or for others.

To facilitate healthier communication families must be able to share emotions safely. It takes vulnerability to share emotions freely. This not a skill we are born with and may not have learned growing up. Sometimes the only safe place initially, is a counselors office, having a 3^rd party mediate. It is a practiced skill that can be developed. If you are having difficulty identifying feelings, use this chart below to fine tune your own emotional sense. Once you are able to identify your own feelings better, you will be able to help other family members with this as well.

I’m Feeling…                                                                                                 Note: Some feelings overlap.

Happy	Misc	Stressed	Scared	Mad	Sad
Alive Appreciative Awed Blessed Blissful Calm Capable Cheerful Confident Content Delighted Eager Elated Empowered Enchanted Energetic Enthusiastic Excited Flirty Free Fulfilled Full Glad Grateful Gratified High Honored Hopeful Important In Love Infatuated Inspired Joy Justified Loved Loving Lucky Marvelous Optimistic Overjoyed Peaceful Pleased Proud Refreshed Relaxed Relieved Resolved Respected Safe Satisfied Secure Silly Thrilled Tranquil Twitterpated  Validated Valued Wanted Wonderful Zany	Achy Ambivalent Apathetic Attached Avoidant Bored Bold Brave Bubbly Cold Curious Determined Distant Exhausted Fascinated Green Haunted Hot Humble Hungry Hypocritical Impatient Impressed Interested Lethargic Mischievous Nauseated Meek Numb Robotic Sexy Shocked Sick Stifled Stubborn Surprised Tickled Pink Uncomfortable Weary Whiny Zoned Out	Agitated Anxious Apprehensive Awkward Bashful Bulldozed Cautious Conspicuous Flustered Frenzied Nervous Paranoid Self-conscious Shaky Sheepish Shy Smothered Startled Swamped Tense Timid Uneasy Wary Worried Confused Baffled Deceived Disorganized Distracted Divided Doubtful Foggy Indecisive Misled Out of it Overwhelmed Perplexed Preoccupied Skeptical Torn Uncertain	Afraid Alarmed Arrested Betrayed Desperate Dominated Doomed Dread Fearful Frightened Guarded Guilty  Hesitant Horror Inept Inferior Insecure Intimidated Isolated Panic Paralyzed Petrified Powerless Reluctant Reserved Sabotaged Shaken Suspicious Terrified Threatened Tormented Trapped Vulnerable Withdrawn	Angry Annoyed        Appalled Argumentative Belittled Bitter Cheated Coerced Controlled Crabby Cranky Criticized Defensive Disgusted Disrespected Enraged Exasperated Frustrated Fuming Furious Grouchy Grumpy Harassed Hostile Incensed Indignant Infuriated Insulted Irked Irritated Jealous Judged Miffed Obnoxious Offended Outraged Patronized Peeved Pissed Provoked Rage Rebellious Resentful Scorn Seething Sulky Sullen Ticked Upset Used	Abandoned Agonized Alienated Ashamed Blue Broken Bummed Burdened Condemned Contrite Crushed Dead Defeated Dejected Depressed Deprived Deserted Despair Devastated Diminished Disappointed Discouraged Discriminated Disillusioned Dismal Distraught Distressed Disturbed Drained Embarrassed Empty Gloomy Grief Helpless Hopeless Humiliated Hurt Ignored Lifeless Lonely Lost Melancholy Miserable Misunderstood Moody Morose Mournful Pathetic Pessimistic Pity Regret Rejected Shame Slighted Solemn Sorrow Stuck Tearful Unloved Unwanted Victimized

Develop Healthy Family Rules: Talking Part 1

All families have rules. Some rules are spoken or written down, some are unspoken. Perhaps "Be respectful" is on the list of rules posted. "Don't talk to Mom before she's has her cup of coffee in the morning." is a rule everyone may know without having to say it aloud. Rules of families, whether spoken or unspoken, are for the safety of everyone in the home. Sometimes rules are to help family members cope with challenges.

One unspoken rules many families develop to survive is silence. In many families talking about problems, feelings, and dreams are not allowed. Talking becomes against the rules in order to keep the peace. One woman told me if she didn't talk about the problems, they didn't exist. This type of pretense glosses over issues that will otherwise continue to fester until resolved. Over time this rule can be passed down from generation to generation like a genetic disease. Sometimes alcoholism, substance abuse, or mental illness influences the development of this damaging trait. Long term, this maladaptive coping skill negatively effects emotional and relational growth.  

Is your family allowed to talk about problems, emotions, dreams, and passions? Do the adults in the family encourage open communication without negative emotional repercussions? To be clear, this is a separate topic from holding teenagers responsible for their behaviors. Of course, there need to be consequences for behaviors. But, is there room in the family to discuss almost anything? Do we try to protect certain people by not mentioning certain topics? Do we find ourselves blaming the speaker when the receiver becomes angry or upset? 

Talking about challenges and problems is the way people work through them rather than getting stuck. Fred Roger's from PBS's Mr. Roger's Neighborhood once said "When we can talk about our feelings, they become less overwhelming, less upsetting and less scary." The opposite is also true. When we cannot talk about our feelings they become more overwhelming, upsetting and scary. The idea filters to teens that their emotions need to be kept to themselves because the grownups may do one of the following:

1.) Ignore or dismiss feelings expressed. One young lady told me every time she cried, her father walked out of the room. 

2.) Respond sarcastically. Sarcasm can shut down productive conversation quickly. 

3.) Cry and become upset. If the teen has to comfort the parent, why even tell them? The lack of communication stems from a need to protect another family member. 

4.) Become angry. Statements like "I've raised you better than this." or "How could you do this to me?" discourage any open communication. 

To facilitate healthier communication, families must be able to share emotions and thoughts safely. This not a skill we are born with and may not have learned growing up. Initially, the only safe place may be a counselor's office. It can be helpful to have a 3^rd party mediating if discussions become too heated at home. If teens are told they can talk about anything, parents have the responsibility to stay calm in the face of challenging revelations. Nobody ever said it would be easy. If you have trouble staying calm, seek help and support. 

Helping Teenagers Find Solutions

One of the pieces of counseling teenagers is problem solving. Teenagers struggle with many life problems from handling peer conflict to coping with a mentally ill parent. If adults rush to fix the issue, not only do we rob the teenager of the opportunity to find their own answer, we can lose their investment in the solution process.  A good counselor’s goal is to work their way out of a job by teaching clients skills. Counselors teach teenagers how to find solutions to their problems on their own. 

One tool used is the decision making tree (coming from the DBT model of counseling). In this form of counseling, all problems have four possible solutions:

1.)    Fix it-- What can be done to make this issue better?  How can the outcome be influenced? This may include consulting with trusted people, utilizing assertive communication, and making necessary changes to behavior. For example, a client is struggling with fatigue. Improving sleep hygiene, utilizing calming strategies, and even working with a doctor or sleep clinic are all attempts to "fix" the situation. 

2.)    Change how you feel about it--changing our feelings can be tricky but effective. For example, a client gets upset whenever they are yelled at by a parent resulting in worthlessness, depression, and self harm. Changing feelings may include retraining thoughts to put the responsibility of yelling back on the parent rather than self blaming. The client can also practice skills to lower interpersonal reactivity. 

3.)    Radically accept-- Have you ever gone to an unavoidable lecture with lowered expectations only to be pleasantly surprised afterward  it didn't bother you as much as you expected? Accepting a situation fully, minimizes distress. If clients are able to radically accept a difficult life circumstance, they get through it much easier. Trying to change what we have no control over leads to increased frustration, anxiety, and depression 

4.)    Stay miserable-- While this may not seem like an option, many times clients can choose to stay miserable. Often times clients aren't motivated enough to use one of the previous three solutions. There is something to be said for comfortable misery and it is a choice to stay there. 

Helping teenagers utilize these tools empowers them to sort out their own problems. Practice these skills in your own life as a role model and you empower their futures. These skills are not innate but need to be taught and practiced regularly.

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.