Getting the most out of therapy for children and teens part II: Making therapy a good experience

Last month, I provided tips on how to find a therapist for your child or teen that feels like a good fit for both of you. It’s important that your child feels heard and connects with the therapist. It’s just as important for you to trust the therapist to fully understand your child’s mental health challenges and to address their needs. As I said last time, the way therapists treat a child versus a teen looks different in process. However, the outcome should be the same regardless of age. You should notice progress in terms of the way your child feels, copes with stress, or feels confident and resilient. The goal of this blog is to help guide parents as their child begins therapy, so they have an optimal experience. 

1. Refrain from asking your child specific questions about their therapy. To build trust with the therapist, confidentiality is critical. The child must have a safe space to talk freely and believe the information stays in therapy. Failure to keep privacy a priority may result in them feeling uncomfortable and being less vulnerable.

2. Encourage your child to give therapy a real chance. Some of my young clients ask to go to therapy, while others are brought by their parents. If you put your child in therapy because you are concerned about their emotional well-being, but they do not want to go, you must encourage them to give therapy a real try. Sometimes parents bring their child a couple of times and give up because they say the child isn’t connecting. While connection is important, it does take more than a couple of sessions for some children and teens to establish it. If, after several sessions, they still resist going, ask them to talk with you about their concerns. Suggest they let the therapist know it isn’t working to see how they will respond. Sometimes, the first therapist turns out not to be the best fit, but reassure your child there are lots of choices and that you want to work together to help them find a good fit.

3. Set realistic expectations for your child’s therapy. You may have taken your child to therapy because you had concerns about their anxiety or depression. Or perhaps you took them to therapy because they were being disobedient and disrespectful at home. Be careful about expecting the therapist to address behaviors that you find unacceptable. The role of therapy is to help the individual who is in it learn how to process emotions and develop coping skills. While that work often changes behavior in positive ways, it does not guarantee the child’s behavior or choices will reflect what you desire for them. If they become more emotionally stable and well-adjusted through the course of therapy, that is what matters the most. They may then be in a better place to discuss problems in their relationship with you, which may lead to family therapy with someone who specializes in helping families communicate and resolve conflict.

4. Be available to talk to your child about therapy and to their therapist. While it isn’t a good idea to ask your child specifically what they discuss, it is appropriate to let them know you are available to help them process what they are talking about in therapy or what they are learning in terms of coping strategies. Let them know you want to support them. Many therapists will reach out to parents to periodically have a session focused on educating them on how to be supportive of their child’s work and therapy, as I do. But if the therapist doesn’t reach out, initiate a phone call or schedule an appointment to talk with them.

5. Celebrate your child’s progress. As you notice your child coping better with stress, managing their anxiety, and demonstrating greater confidence, let them know. Ask them how they are feeling and validate their feelings around how they are coping. Talk with them about what they think is needed. If they say they don’t want to talk about it right now, let it be and perhaps it will build trust so they will come to you later. You can still let them know you are on their side and that you are proud of them.

Therapy will be most effective for your child or teen if they know they are in the driver’s seat. If they don’t feel the weight of your expectations, they will have the freedom to talk through their struggles. With their therapist, they can develop effective tools for managing life‘s challenges and becoming more resilient. You can partner with them and be a source of support, but they must own the process. 

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Getting the most out of therapy for children and teens Part 1: Starting Therapy

May is #MentalHealthAwarenessMonth, and May 1-7 was #ChildrensMentalHealthWeek. So this is the perfect opportunity to talk about therapy for children and teens. The American Academy of Pediatrics has declared a mental health crisis for children and adolescents. Within the past year, the need for therapy for this population has become much greater than the number of available therapists and psychiatrists. That is a crisis in itself; however, not one that is easily resolved. If you are a parent who has been fortunate enough to find a therapist for your child, you have accomplished an important step in addressing their mental health challenges, but now the work really begins. 

I often hear similar stories from parents: “My child didn’t like being in therapy,“ or “the therapist just played with my child. Their behavior didn’t change at home or at school.” I’ve also had parents who, after a few sessions, declare they don’t think therapy is working, and they’re going to stop for now. 

Unfortunately these responses often reflect a disconnect between parental expectations, child understanding, and therapeutic reality. For example, I’ve had some young clients who have barely said a word the entire session, but I have worked hard to engage them in a conversation or an activity. As children or teens enter therapy, it’s important to have a conversation about what therapy looks like for kids, what makes it successful, and how parents can support their child or teen as they enter therapy. 

This blog offers suggestions for ways to maximize therapy for children and teens.

But first, I need to clarify that children have different needs in therapy than teenagers. While the long term goal of improving their mental health is the same, the journey together looks quite different. Parents must adjust their expectations of what they will be told and how much they will be involved in therapy for an adolescent as opposed to a younger child. This is because adolescence is its own stage of development, where they are achieving greater independence from their parents and forming their identity. The psychological term is “individuation,” and it’s critical for parents to allow their teen the opportunity to explore their sense of self. 

Talking to parents about this sometimes compromises their confidence in me as a provider because that’s not what many parents want to hear. Parents become anxious about the choices that their teenager will make, which is understandable. I’m not suggesting they resort to free range parenting because that is another extreme on the parenting continuum. I am suggesting that parents form good boundaries with their teenagers, allowing them to have space and privacy. Proactive discussions around safety are important, as are opportunities to hold space for teens when they want to talk to their parents about what’s on their mind. But asking them what goes on in their therapy and expecting the therapist to give substantive details violates therapeutic trust and often significantly decreases the teenager’s willingness to go to therapy. 

On the other hand, younger children benefit from more involvement from their parents in supporting their therapy. This does not mean the therapist divulges the details of conversations with the child, because trust in the therapeutic relationship is still important. However, younger children may need additional practice with coping skills learned in therapy at home, which the parents can reinforce. They may need parents to read books with them, for example, about how to manage anxiety or help practicing strategies for calming down when their big feelings result in emotional meltdowns.    

Therefore, the suggestions below will be executed differently, depending on your child’s age, and the modifications appropriate for adolescence are indicated. 

1. Talk to your kids about therapy before you take them. I can’t tell you how many times I’ve had a child say in my office that they had no idea they were coming. Their parents told them they were taking them to see a special teacher or doctor. It’s important to be honest with them because if you are uncomfortable with mental health professionals, they observe your discomfort. Talk with them about your concerns by saying things like “I am worried about how sad you’ve been feeling,” or “I know that you’ve been struggling lately.” Many children and teens now go to their parents asking for therapy. If your child has requested this, do your best to honor their request and to look for a therapist who is a good fit together.

2. Allow your child or teen to have input in choosing a therapist, and choose a therapist that you trust. Do your research when investigating therapists. Many people who have not previously been in therapy default to looking at a list of providers in-network with their insurance panel. While I understand that some people have financial constraints that do not allow them to go out of network, I would not recommend this being the only step to choosing someone to work with your child. The therapeutic relationship and the ability of your child to connect with the therapist will make the difference between them building rapport and trust. My practice does a parent intake first, so the parents can ask as many questions as they want, and I can gather background regarding the situation. We can both decide if it’s a good fit, and then I meet the child. I do recommend that children have input: for instance, if they really dislike meeting with the therapist. But I also think they should give it a few sessions before deciding. Many kids are understandably uncomfortable going to therapy because it’s not an experience they’re familiar with. So sometimes it’s the discomfort with being there at all rather than the therapist. Giving it a few sessions will allow time for rapport to build, or not. Ultimately, you and your child should trust the therapist if you continue working together.

3. Talk about goals with the therapist. If you are taking a child under the age of 12 to therapy, the parent intake is a great opportunity to explain to the therapist what your concerns are and what your child has expressed. Some children talk openly about their feelings while others do not, but they internalize their emotions and begin to withdraw. Be specific and detailed with the therapist about what you have observed and what others have observed. You should in turn get a good understanding of how the therapist plans to address the issues. Some therapists use play therapy to work with younger children and often with teens as well through video games. If this isn’t something that you’re comfortable with, you need to be honest with yourself and with them about it. Allow the therapist the opportunity to educate you about how they use this modality, because you may change your mind if you initially are skeptical. If you are taking a teenager to therapy, let them join the intake session, and you can both ask questions and get a sense of how they would work with your teen. Your teen will feel included as part of the process, and they are more likely to trust the therapist if they are part of the process from the start.

4. Develop realistic expectations of therapy with the therapist. Talk directly with your child’s therapist about what you hope to accomplish. For example, taking your teen to therapy and expecting the therapist to address behavioral issues at home is not a realistic expectation if your teenager doesn’t see that as the priority. If they are anxious, depressed, or having problems with peers, they may want to focus their therapy on that. Therapists can’t take the same role as parents, in terms of telling kids what is right and wrong and directing their behavior. Family therapy may improve communication between kids and their parents, but that is separate from your child’s individual therapy and should not overlap with the same provider.

5. Understand what kind of therapy your child needs and who is best to provide it. Beyond forming a trusting relationship with your child, some therapists specialize in children with anxiety, some have expert knowledge in ADHD, and some specialize in trauma. When you are doing your research, look for providers who are knowledgeable in areas of concern to your child. If you aren’t sure why your child is struggling, starting with a psychological evaluation might be wise. Those are conducted by psychologists who have expertise in thoroughly investigating the underlying sources of emotional distress and difficulty functioning in every day life. Having a clear and comprehensive understanding of why children struggle will allow them to get the help they need faster. This process can also identify the types of therapy that would most benefit your child and help create an active plan.

The common factor in the above suggestions is to do your research in finding the right fit to address your children’s mental health struggles; ask questions of potential therapists; find someone with whom your child connects; and build your own trust with therapist so that you feel comfortable taking their advice and learning from their insight. Your confidence and comfort level in the care that your child receives are central factors to a successful outcome in their treatment.      

We’ll pick up here next month to discuss ways parents can support their child once their therapy has gotten off to a good start.                                                          

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How psychological evaluations clarify complex diagnoses in adults

If you’ve ever gone to therapy for help with symptoms of anxiety, depression, or other mental health conditions, you may have had a clinical intake interview. Most psychologists and therapists conduct a more formal, structured clinical interview the first time they meet with new clients. This is to try to figure out what factors are contributing to the emotional distress and the symptoms that the client experiences. They probably also asked you about your background, your family, the kind of childhood that you had, or what your experience was like in school. Gathering this kind of information is important because it helps us get to know our clients before we start giving advice. 

While the initial interview is necessary, and often very helpful, sometimes it is not enough to reveal the underlying reasons why my clients are struggling. Sometimes, clients present as very complex, having multiple challenges getting through every day life, struggling to find and stay in healthy relationships, and feeling like their life isn’t meaningful. Human beings are complex, after all, so it makes sense that we can’t pinpoint the source of their problems right away. Even after meeting with some clients several times, I still feel like there are missing pieces. Perhaps the client isn’t thinking of everything important they need to tell me. Or they may have challenges they aren’t even fully aware of. Therefore, an intake interview and a few therapy sessions is still insufficient to fully understand the complexities.

In recent years, there have been several mental health conditions that have become publicized through social media and pop culture. Celebrities are often quick to identify themselves this way, which can be affirming for people who have similar struggles. Seeing all this, we can convince ourselves that we have a condition, but getting an evaluation from a qualified mental health provider is the best route to understanding ourselves and to getting effective treatment when appropriate. While many people genuinely struggle with these issues, it’s necessary for clinicians to do more than just validate peoples feelings about whether or not the condition exists. 

Conducting psychological evaluations based on the clinician’s training and empirical research data is key to ensuring that people do not get inaccurately diagnosed. Psychological testing removes the guess work from the early treatment stage by clearly identifying the nature and extent of the presenting problems. The evaluation involves not only a clinical interview, but the administration of of tests that ask many specific questions, investigate thought processes and emotions, and gather important information that does not appear from merely talking to clients.

Below are two of the more common diagnoses we read about. If you are concerned that you might have one of these conditions, psychological testing can help determine your diagnosis and make sure that you’re investing in the correct treatment.

ADHD Among Adults

There has been an increase in the number of adults diagnosed with ADHD in the last decade who were not previously diagnosed earlier in life. While it is certainly possible for ADHD to occur without being detected in high functioning persons who have done reasonably well academically, or who may have had the inattentive subtype that did not result in disruptive behavior, there are many reasons why adults struggle to concentrate. A psychological evaluation can tease out other factors that affect the ability to sustain attention and function effectively at work and in every day life. Anxiety disorders, depression, and substance use are just a few factors that can affect a person’s attention and that should be investigated before deciding that ADHD is the culprit.

PTSD

It’s hard to get through reading the news without finding an article about trauma or the impact of traumatic events. It is certainly true that we live in a world where bad things happen all the time, and we want to understand how traumatic events affect people differently. Not everyone responds to trauma in the same way, and psychological evaluations do a thorough job of identifying how intensely someone has been impacted by their experiences. Research suggests that people are often misdiagnosed with conditions such as bipolar disorder when in fact trauma is behind their behavioral changes in mood fluctuations. But PTSD and bipolar disorder are treated radically differently both medically and psychologically. Thus, ruling out the incorrect diagnosis is critical.

Although psychological evaluations can be expensive and time consuming, the money and time saved in treatment later are well worth the cost of the outset. My practice offers these kinds of evaluations. Please feel free to inquire for more information, using the contact form on this website.

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Five ways parents can support their child’s mental health

Last year, the American Academy of Pediatrics declared a mental health crisis for children and adolescents in the United States. The crisis emerged during the COVID-19 pandemic due to the social isolation children experienced as a result of required quarantines, virtual school, and other necessary restrictions. Additionally, the anxiety that everyone experienced was especially hard on children and teens. Rates of depression and suicide among youth rose sharply within the last three years. Parents who have sought the help of a mental health professional have often found long waiting lists to get an appointment. Parents are also experiencing their own mental health challenges, and it can be difficult to imagine how they can support their child during uncertain times when there is no clear end to the pandemic, or its consequences, in sight. However, there are some things parents can do to support their children’s mental health that can also strengthen the parent-child relationship. While these strategies are certainly not a substitute for professional treatment, they can still be helpful.

Talk to your children, at their level, about what’s going on in the world 

Children are perceptive, even at a young age. They know that what has been happening isn’t typical. They also need to know that everyone is struggling right now in some way. Talking openly about common stressors during this time will help them feel less alone. Talking about your own feelings, at least at a basic level, will normalize their feelings. This will allow them to also talk more openly and to share their concerns. Obviously, you will share more specifically with an older child or a teen than a young child. But regardless of their age, you can find a way to let them know that it’s okay to not be okay right now.

Validate their feelings, even if you don’t understand their experience

I often hear parents say that their child is blowing things out of proportion, being dramatic, or making a big deal out of nothing. Saying these things to your child or even assuming you are correct in these thoughts is never a good idea. We don’t know what another person experiences, and just because we do not also see things the way they do does not mean that their feelings are invalid. We want to communicate to them that their feelings matter, and we want to create a trusting relationship with them by listening to what they have to say. If you can’t understand why they feel as they do, express concern about their feelings of anxiety, sadness, loneliness, anger, or any other feeling they may identify. Telling someone their feelings aren’t real will shut them down and close off any hope you have of a trusting relationship where they confide in you.

Refrain from giving advice unless asked for it

This is especially true if you haven’t taken the time to listen to what they have to say. If you don’t understand their feelings, giving advice will not feel helpful to them. A lot of situations that currently provoke anxiety do not have a concrete solution. Most children and teens want to feel comforted and safe, rather than hearing specific ways they can change their circumstances. If you build trust with them, there may be a time they come to you seeking advice, and then you can talk with them about their goals and what they would like to change or accomplish. 

The only exception to this guidance is if you learn they are self harming. In that case, it’s important to let them know that concrete steps must be taken to keep them safe and to help them learn healthy ways to respond to their emotional reactions. If you’re on a waitlist to see a mental health professional and your child is self harming, remove objects they could easily access to hurt themselves, make yourself available to talk to them when they feel the urges, and make sure they are not alone when the risk of self harm seems eminent. If they threaten self harm, or you see physical evidence that it has happened, take them to the emergency room. They are crying for help, and you must take them seriously. 

Avoid reassuring your child that everything will be okay. Instead, investigate what they would like to be different or what they think would help ease their anxiety

It’s so tempting to tell people who are in emotional pain that everything is going to be okay, that things will get better, or that things will soon change. While this certainly can be true, people who are trapped in negative thought cycles—feeling depressed, anxious, or hopeless—may not see the light at the end of the tunnel. Instead, ask them questions about what has led to their feelings of discouragement. If they verbalize many different fears, frustrations, or disappointments, ask them if they can identify what would help them feel better. For example, if they are feeling anxious about interacting with people now that they are back in school, are there specific ways that others can support them? They may not have any ideas at that moment, but it opens up the conversation for the future. While I do not recommend giving specific advice, you can share resources with them that you may find, such as online videos or articles, or children’s books about these issues. Depending on how old they are, you can read with them about how to reduce their anxiety. There are several children’s books that have activities kids can do to learn how to think differently about their worries. (You can check out the resource list on my website.) Take the team approach of “let’s work together“ to figure this out instead of giving trite reassurances they don’t believe or specific advice that may not be helpful.

Spend time with children that doesn’t involve specific tasks

Quality time with children is important because it builds the parent-child relationship through emotional connection. They start to see you as a real source of emotional support, rather than the person who drives them to school or put limits on their screen time. Taking them out for ice cream or a movie, or even a walk on the trails, provides an opportunity for lots of conversations about different things. If your child resists your ideas about going out together, ask them what they would like to do with you. Maybe you start out by sitting with them on the couch watching a movie of their choice, or even being in the same room together while they play. Starting the ritual of spending quality time with them when they are younger will make them less resistant to it as they approach adolescence.

The theme of these suggestions involves building emotional connection between parents and children. They are more likely to come to you if they trust that you aren’t going to brush them off, invalidate their feelings, or quickly reassure them that it will get better. Following these suggestions doesn’t mean that your child’s mental health issues will go away, but it does mean that they will trust you to be present with them during these challenging times, and they may come to you first instead of seeking support from social media, TikTok, or other precarious sources of information. 

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Developing a plan for good mental health in 2022

You don’t have to look far to find news articles about the mental health crisis in the United States right now. And now that we’ve moved into the new year, there are a lot of articles giving advice about how to take care of our mental health in 2022. While it’s good that there’s attention being given to mental health, a lot of people get stuck when the advice doesn’t feel practical or seems hard to apply. 

But there are simple, practical ways to address our personal mental health, most of them involving prevention and early intervention. Learning how to recognize the signs that we are experiencing anxiety and depression before it becomes an emergency is key. There is hope when we feel like we have some control over how to handle the stress in our lives. We can’t control how long the consequences of the pandemic will loom, or the way that others handle their circumstances. But there is a lot that we can do to manage difficult emotions and take care of ourselves and our mental health.

Allow yourself to have negative thoughts and feelings

While we don’t want to live in a negative state of mind, it’s natural to think negatively sometimes, to feel sad, or to be angry. When it feels like the world is falling apart around us, it would be more unusual to try to convince ourselves that everything is OK. Tell yourself it’s OK to feel down, shed some tears, and be honest with yourself about how you’re feeling. That’s the first step toward positive change.

Do small, good things for yourself

We hear a lot about self-care these days. It can feel overwhelming to think about what that means and how to accomplish it when there is so much going on. But self-care doesn’t have to be a grand gesture that takes a lot of time or costs a lot of money. It can be something as simple as giving ourselves quiet space to clear our heads, drinking some water, or taking a short walk. Self-care also includes taking care of ourselves in relationships. So stepping away from a difficult conversation or seeking out a trusted friend for support can be a great way to be good to yourself. Taking care of ourselves isn’t selfish, it’s necessary, because if we can’t take care of ourselves it will be much harder to take care of others. 

Look for purpose in every day life

Feeling like our life has purpose and meaning can have a positive impact on our emotional well-being. Helping others can be very rewarding, but we don’t always have time to volunteer for a cause. There are lots of ways to provide support. It could be lending an ear to someone who is upset, taking groceries to an elderly neighbor, or shoveling their sidewalks when it snows. It could be making a delicious meal for your own family or friends. But helping other people reminds us that we are all in this together and we all need help right now.

Be thoughtful about what kinds of commitments you make

Don’t put too much stuff on your plate right now. Even if you’re a very active person, now is not the time to overcommit because there are a lot of things that could happen unexpectedly, like illness or closures. Be mindful of what you say yes to and chose things that you really care about. Avoid making casual commitments.    

Stay focused on the present

Find enjoyable or positive aspects of each day. You might identify something good that happened, even if it’s talking to a friend or drinking a good cup of coffee. Try to recognize and savor those moments of pleasure and positivity. When you do look ahead, focus on what’s happening right now and in the near future because those are the things you can control and plan for. In these uncertain times, it can be more encouraging to plan for shorter durations rather than guessing what things will look like a year from now. 

The most important thing is to remember that you can proactively influence your mental health. Practicing these strategies will help you exert some control over how you’re feeling and allow you to feel more hopeful and positive. 

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blog originally posted on psychologytoday.com

FIVE MYTHS OF THERAPY DISPELLED

In the last year, largely due to the ongoing pandemic, more people have sought support and treatment through psychotherapy. Most of my colleagues are booked solid, with a waitlist, and those of us who are still taking clients have limited availability. The fact that more people are seeking professional help for mental health challenges is good news. Deciding to start therapy is a big step, but I consider it equally, if not more important, that people understand therapy so they can commit to the process. There’s a lot of misinformation out there about what it means to be in therapy and what therapy involves. Allow me to dispel some of those myths and provide a more accurate description of what therapy looks like in the real world.

Myth 1: Therapists force you to talk about your past

While some types of therapy are more insight oriented, meaning that you have the opportunity to discuss your past and connect events and relationships to current problems, not all therapy takes this approach. If you are struggling emotionally and seeking help with current circumstances, it’s possible to find a therapist who can help you focus on the here and now. Cognitive-behavior therapy focuses on reframing thoughts and linking thoughts, feelings, and actions. This type of therapy is particularly useful for persons struggling with anxiety, life stress, and coping with difficult circumstances or relationships.

Myth 2: Therapy just means you’re talking to someone and they listen

It is true that therapists provide a safe space for people to talk about what they are going through. But therapy offers much more than talking. Evidence-based approaches, with scientific research behind their effectiveness, provide strategies to help clients feel empowered to improve their own mental health. Many modern approaches also include helping clients learn to get better control over their emotions, so they feel more balanced and capable of making good choices. Another important goal is to help clients break cycles of behavior that contribute to negative thoughts and feelings, and that affect the quality of their relationships.

Myth 3: Therapy is supposed to make you feel better

Although one of the goals might be to have more positive thoughts and feelings, going to therapy doesn’t always make you feel better right away. Sometimes, early on, people report feeling worse after therapy sessions. This may be because they discussed hard circumstances, loss of a relationship, or other events that produced sadness and discouragement. It’s not until clients express feelings and learn strategies for managing intense emotions that they begin to feel better. Therapy is its own journey, rather than a linear progression to better mental health.

Myth 4: Only people with serious problems should go to therapy      

People pursue therapy for any number of reasons. It’s not necessary to experience serious mental health conditions to seek therapeutic support. If you find a therapist with whom you connect well and you’re able to open up about your experiences, therapy can be beneficial to most people at some point in their lives. It’s intended to be an opportunity to self-examine your feelings and behavior, to explore patterns in relationships that you might want to change, or to grow personally as you transition to a new stage in life. In addition, going to therapy to self-explore or to address mild stressors can prevent problems from developing into greater emotional distress that disrupts every day life. 

Myth 5: Therapy is too expensive

On a more practical note, let’s talk about the cost of therapy. It isn’t true that therapy is not covered by insurance or that it’s cost prohibitive. Many insurance carriers do cover a portion of the cost. Some providers are in network with the major carriers like Blue Cross or Aetna. Providers who do not file claims will still help you with paperwork that you can file on your own if you have out of network benefits. More importantly, you must ask yourself what is the cost of not going to therapy if you are struggling with anxiety, depression, or other significant challenges that are disrupting your quality of life. Therapy can be a form of self-care like no other.   

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Feeling lonely? Find the Friendships You Want

Prior to the pandemic, loneliness was a significant problem among Americans. Following over a year of quarantine and isolation, loneliness has become its own epidemic. As we grow into adulthood, and we form our routines of going to work, coming home, and starting all over again, there isn’t much time left to socialize during the week. And if we don’t have families or partners, the time between Friday evening and Monday morning can feel like an eternity. So, being at home for months on end, only leaving for important appointments and short errands, has taken its toll on many people. I don’t want to limit our discussion of loneliness, however, to those who live alone. It’s possible to live in a house with other humans and feel very lonely. Loneliness is a state of mind, an emotion that makes us feel left out, rejected, and longing for connection. This blog is a discussion about how to combat loneliness by finding connection, whatever our lives look like in terms of physical living conditions.

The first thing to understand about loneliness is that no one is immune to it. People can look like they have it all together, perhaps they are even in a relationship, or they seem to be surrounded by friends, and still be lonely. Loneliness is broadly defined as feeling absence of emotional connection and meaningful relationships. Feeling lonely originates from being disconnected from others, not feeling heard or understood, longing for others to invite them or include them, and desire to be missed when they’re not around. This means that simply being in the presence of others will not take away feelings of loneliness. Instead we have to cultivate meaningful connections.

Many people have a hard time connecting with others. For some, it stems from social anxiety: not knowing what to say or how to sustain conversations. For others, it’s about avoiding the possibility of rejection. Still others have a hard time meeting new people. Here are some suggestions that can help no matter what your struggle to find connection may be.

1. Think about how you most enjoy and appreciate connecting with others. The key is to develop friendships with people who not only share your interests, but who have similar values about friendship. For instance, if you are an introvert who enjoys meaningful conversations, going to happy hours might not help you feel connected. But if you’re an extrovert who loves being around people with a high energy level, you may want to pursue group gatherings so that you have a lot of choices with whom to converse.

2. Although connecting with people in person has its advantages, sometimes it’s not practical. In that case, calling friends on the phone to have a conversation may feel more emotionally rewarding than simply texting or messaging through social media. All of these formats have their own advantages, so mixing up the forms of communication may help you feel more connected.

3. Don’t put pressure on yourself to find connection the way that other people do. Going to parties and group gatherings is not everyone’s forte. Often, people say they leave larger gatherings feeling lonelier than when they arrived. So, if that describes you, choose ways of connecting that improve your mood rather than those that make you feel like you’re missing out on something.

4. If you feel like you don’t know where to meet friends, you’re not alone. It’s hard to make friends as a working adult. Recognize that it isn’t just about you and that it is a larger problem with the way our culture is structured. Then, think about joining a community that matches your interests. Churches or religious communities, book clubs, exercise classes, or other types of clubs may be a good start. Conversations in these spaces originate around common interests, which can feel less intimidating. Even though we know that having common interests isn’t enough to develop a strong connection to others, it’s a good start.

5. Do things that you enjoy, even if you do them alone. Feeling good and enjoying life can put you in a good place to recognize potential friendships. If you’re feeling down and you have lower energy, it might be harder to recognize opportunities when they arise. So, do what you love, and share your interests and passions with others.

6. Consider volunteering. If there’s an interest or call that excites you, taking the opportunity to join others who share it may spark meaningful conversation and connection. Helping others can feel rewarding in its own right, and it provides a sense of purpose that can give us energy.

The key in managing loneliness is to understand that it’s a bigger problem than our individual feelings. Then, we can feel less ashamed, and we can feel more confident in finding community and companionship that we genuinely love.

This has been reposted from my Psychology Today blog: https://www.psychologytoday.com/us/blog/trial-triumph/202110/feeling-lonely-find-the-friendships-you-want

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If therapy isn’t working, consider these things

For the past 12 months, Mindful Solutions LLC has gotten a steady stream of new referrals. The COVID-19 pandemic, the need to quarantine, and the incredible amount of conflict and stress in the world have created a second pandemic: the mental health pandemic. The good news is that people are seeking professional support as they struggle with social isolation, troubled relationships, anger, depression, and anxiety. However, some people will struggle with therapy when it doesn’t meet their expectations. Many people have sought out therapy for the first time, so they may be unsure of what to expect and have ideas about therapy that are different from its reality. They are desperately seeking help, but they experience disappointment when therapy doesn’t solve their problems. The purpose of this blog is to help guide those who may not know what to expect or who may have already been disappointed, so they can make the most of their time in therapy and get the results they seek.

Once you have found a therapist who you think might be a good fit, it’s still important to set realistic expectations. Even if you connect well and there’s good communication between you and your therapist, it’s important to remember that you want to set goals early in your time together. For example, if you are mostly looking for someone to talk to you in a safe space, and you aren’t seeking advice, you must tell your therapist so they don’t give unsolicited advice that you may not find useful. If you are seeking a directive approach, talk to your therapist about specifics. Some therapists are really great at giving concrete coping strategies and helping you come up with an action plan. You can be in the driver’s seat of your therapy if that’s what you want, or tell your therapist that you want them to provide guidance to you based on the information you give to them about your presenting problems.

You may have gone to therapy for several weeks and tried some of the strategies suggested. Perhaps they are not working yet, or maybe you haven’t tried them frequently. Change takes time, and if you are seeking therapy as a means of changing your behavior or patterns in relationships, remember that the most effective changes take place gradually and with practice. Don’t give up because you’ve tried mindfulness meditation twice and you didn’t like it, for example. Or that conversation you had with your friend based on your therapist’s feedback didn’t go so well. Give yourself credit for trying something different and go back to therapy and discuss those setbacks with your therapist.

Therapy can provide a time for developing concrete strategies to manage your life, but it can be so much more. One of my favorite parts of therapy is when clients reflect on their experiences and gain insight into the ways in which they prevent themselves from changing and moving forward. If you embrace introspection, therapy will help you grow emotionally. You are the greatest agent of change in your own life, and therapy is the space in which you can create change, or explore why that is difficult. The therapist can help you with your process, but you must be engaged in that process. 

Difficulty being vulnerable can be another obstacle to effective therapy. It’s understandable that it’s hard to open up right away to a new person. Even though therapy is designed as a safe space where anything can be shared, some people have a hard time being forthcoming, which makes it harder to build a relationship with the therapist. To make it easier, think ahead of time about what you would like to discuss and go to your sessions with material to cover. While a therapist can help guide the conversation, the therapy is for you, so you want to focus on things that are important in your life, and only you know the best content to bring in with you. Thinking about what you have discussed after the session is also critical because therapy is a process that involves more than just sitting in session for 45 minutes. It requires thoughtful consideration all the days between your sessions.         

Before you quit therapy, or change therapists, talk about your feelings about how therapy is going so far. Most therapists will welcome the feedback, and they will appreciate the opportunity to help you get from therapy what you seek. When this happens, therapy is much more satisfying for both the client and the therapist.

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Starting off strong: strategies for managing anxiety in a new school year

Soon students will head back to school, many of them for the first time in person since March 2020. Although students, and their parents, may be excited about the return to in-person instruction, they are also experiencing high levels of anxiety as the first day approaches. 

I’ve heard various reasons for the anxiety, which are all understandable. Some students haven’t seen most of their peers face-to-face in 18 months. That dynamic will feel awkward. Others have gotten used to virtual learning, and even though it was an adjustment at first, they made it work and now feel comfortable with it. Still others feel like getting back into the routine of being at school all day will be challenging.

Additionally, Virginia is requiring masks in K-12, so school won’t be like it was before. It could be hard to wear a mask for eight hours, except for eating lunch. And since children under 12 can’t be vaccinated, some parents are concerned about their children’s vulnerability to COVID-19, especially with the new Delta variant surging. 

With lots of good reasons to be anxious, it’s hard to envision how to manage anxiety around so much uncertainty. However, attempting to do so will assure a good start to the school year and an easier transition to the current version of normal. This blog discusses some strategies to consider, and some ways of thinking about how to approach the uncertainty with courage and confidence. 

Validate feelings of anxiety

It’s completely understandable to feel anxious because our hopes of normalcy have been thwarted. It seemed like things were improving, and now there are new threats of a more contagious mutation of the virus, combined with breakthrough infections for vaccinated persons. Vaccinated adults removed their masks earlier this year, but now we’re being told we should wear them anyway. In addition to health concerns and Covid fatigue, we are all stepping lightly back into any semblance of normalcy because we don’t know what’s coming next. Feelings of anxiety can arise around returning to a group, social awkwardness, or fear of let down once we are back in the situation we thought we wanted to resume. Remind yourself and your children that it’s not abnormal.

Teach your children about self-care

Children are never too young to start learning about how to care for their needs. It’s also a good opportunity for parents to use self-care as well. Self-care means everything from eating a good breakfast,  to getting a good nights sleep, to saying no to some thing they are offered that they don’t want to do. Perhaps in their world it looks like being honest about what they’re comfortable with and knowing when they feel overwhelmed. For example, some of their peers remove their masks on the playground and your child doesn’t want to, so they keep wearing their mask. Or their peers excitedly play together after not seeing each other for a while, but your child feels overstimulated and anxious around a larger group of students, so they decide to do something else. Teaching them to be comfortable setting boundaries can be tough, but it’s a good lesson to start learning young.

Make home a safe space

After being back at school for seven or eight hours a day, some students may come home feeling exhausted, physically and emotionally. Resist the urge to ask them a lot of questions about their day, but offer them space to talk about how things are going if that would be helpful. Let them have some downtime after the school day, so they can reset after constant stimulation. Give them permission to feel mixed emotions about going back to school. Let home be their haven to reboot and get ready for the next day.

Incorporate mindfulness into the day

Pick a mindfulness app appropriate for children and engage them in some guided meditations to help them cope with stress, reduce anxiety, and get a good nights sleep. My personal favorite app for kids and teens is Smiling Mind, but there are many options to choose from. Set aside 10 or 15 minutes each evening or before bedtime just to sit with your child and do a guided meditation. Often, people get bored or distracted when they are learning how to do mindfulness meditations. But be patient, and be patient with your child. Starting to form this habit will be good for both of you.

Monitor negative thoughts, and help your child

Negative thoughts are a normal part of the brain’s process. We are all capable of them, and we all have them. It isn’t necessary to try to push them away. But too many negative thoughts, overtime, can be destructive to a person’s resilience. Help your child practice identifying negative thoughts, acknowledging that they are only thoughts and they don’t have the ability to predict the future. We can limit the power of negative thinking by acknowledging it, then letting it go. While negative thoughts help us understand how we are feeling, we don’t want to assume they are true. In fact, we want to remember they are often the product of nothing more than being tired or having a bad day.

None of us knows how the next school year will unfold. There’s a lot of uncertainty in the world right now, but if we acknowledge what we can control, that will help us deal with the uncertainty. We can control what we are thinking and how it makes us feel. We can take good care of ourselves, and we can allow ourselves to have hope for a positive future. 

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Unpacking What We Mean When We Talk About Trauma

“ Trauma“ has become a very significant term, not only in the mental health profession but also in the broader culture. Within the past decade, numerous books, podcasts, and blogs have emerged with trauma as their focus. Celebrities have spoken out about their own traumatic experiences, and many individuals have openly told their stories of how traumatic events have changed their lives for better or worse. It is both promising and hopeful that as a culture we are striving to better understand what trauma is, how it affects our body and brain, and how we can heal from the impact and move forward.

However, as these conversations have become more common, we have started to use the word more broadly than is supported by its clinical application. In everyday speech “traumatic” has become a synonym for “bad” or “upsetting.” The purpose of this blog is to define trauma, clarify what distinguishes it from other negative events, and explain why it’s important to do so.

Webster defines trauma as “a disordered psychic or emotional state resulting from severe mental or emotional stress, or physical injury.“ Other definitions that I have recently read add that trauma occurs in situations where the person feels threatened or they cannot escape from the event. From a vocabulary standpoint, most sources agree that a traumatic event is both severe and inescapable. Recent publications from experts in the field of trauma have convincingly communicated that trauma affects both the body and the brain in an enduring way if it is not addressed through psychological treatment.

Most people have typically heard of three common types of trauma. Combat PTSD is the type of trauma experienced by those in the military who are deployed on assignment and exposed to violence in the midst of warfare. Much has been written and spoken about the impact of combat PTSD long after veterans have returned home. A second type of trauma that is often the subject of dialogue is that which occurs after a rape or sexual assault, or sexual abuse. Sexual trauma has long been a taboo subject, but it has recently come to the forefront as more victims are willing to talk about their experiences. Then, there is the trauma experienced by victims of violent crimes, such as robberies, shootings, and other incidents that may involve more than one victim. These three types of trauma are ones most people have heard about, and they are events that are clearly understood as traumatic.

However, more recently, much more attention has been given to complex trauma which does not involve a single incident but rather is the occurrence of adverse and traumatic events over an extended period of time. An example would be a household in which family members constantly fought, were physically or emotionally abusive toward each other, and engaged in toxic interactions on an ongoing basis. Complex trauma does not have to involve physical abuse; it can involve forms of emotional abuse such as constant ridicule, shaming, manipulation, or neglect within a relationship. It can include the sudden loss of a loved one in a tragic accident, or other shocking and sudden changes in one’s life. Complex trauma generally involves multiple events during which the person is forced to endure harmful or tragic circumstances.

One reason it is so important to understand the various types of trauma is so we can also understand that not everything bad that happens to us is considered trauma. While only we can evaluate the extent to which negative circumstances affect us physically and emotionally, we want to be aware that defining everything that happens to us as trauma could be harmful to our resiliency. It’s important to believe that some of our experiences are escapable. And to effectively process the things which were indeed traumatic, we must separate what we can control from what we cannot. We want to understand what profoundly affects our well-being and emotional stability and what is disappointing or negative, but does not have the same enduring physical and emotional impact. 

Finally, the manner in which we approach trauma informed therapy needs to include evidence-based treatments, as well as the perspective that people can heal from trauma, move forward, and build resilience. We want clients to feel empowered in their healing process, rather than defined by the traumatic events they endured. The goal of the trauma informed approach is to understand how trauma affects current functioning, but it’s not intended to identify the person as permanently damaged. People can derive great strength and courage from what they have overcome, and they can have healthy relationships, successful achievements, and a life full of meaning and joy.

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