Tag Archives: teenagers

Teenagers and Depression

Every year, every month, and every day, many teenagers complain of feeling down, depressed, or sad and some of them just act with immense irritability. You probably knew that. But, how many teens are experiencing symptoms of depression?

Estimates are wide ranging. The National Institute of Mental Health reported that approximately 12.5% of U.S. youth from 12-17 years-old experienced at least one episode of major depressive disorder. That’s a huge number of American teenagers (about 3 million).

Add to that the many more teenagers who complain of feeling depressed or down, but who don’t officially meet the diagnostic criteria for clinical depression. By some estimates, that brings the number to close to 50% of teens who are consistently bothered by sad, bad, and irritable feelings.

If you’re a parent of a teen, it’s easy to feel concerned about your teenager’s emotional health.

You may have questions like the following

  • Is my teenager clinically depressed or just going through the normal emotional ups and downs of adolescence?
  • Should I take my son or daughter to a mental health professional?
  • What about medications? Are any of the antidepressants safe and effective for teenagers?

The answers to these questions are complex. It’s hard to tell whether a teenager is in a normal emotional angst or experiencing something more insidious and chronic. And, the answer to the question about whether antidepressant medications are safe and effective with teens is a solid: “Maybe, but maybe not.”

In the latest Practically Perfect Parenting Podcast, Dr. Sara and I take on the serious topic of teenage depression. There are no laughs or giggles, but you’ll get to hear Sara ask me many questions about teen depression, and you’ll get to hear me try to answer them, which is sort of funny. You’ll hear the answer to my favorite trivia question: “What percent of children “recovered” from their depressive symptoms in the first-ever double-blind, placebo-controlled study of antidepressant medications?” And yes, once again, you’ll hear Sara find a way to mention sex during our podcast.

If you have teenagers yourself, or you know someone who has teenagers, or you’re a helping professional who works with teenagers, this podcast may be of interest or helpful to you. Check it out here on iTunes: https://itunes.apple.com/us/podcast/practically-perfect-parenting-podcast/id1170841304?mt=2

If you listen and like it, please share it, and then do us one little favor—rate the podcast on iTunes. That way Sara and I can keep climbing up the charts in reality—rather than just in our imaginations.

JSF Dance Party

Goodnight, South Carolina

Some days . . . the news is discouraging. Some days . . . evidence piles up suggesting that nearly everyone on the planet is far too greedy and selfish. On those days, I can’t help but wonder how our local, national, and worldwide communities survive. It feels like we’re a hopeless species heading for a cataclysmic end.

Sunset on StillwaterBut then I have a day like yesterday. A day where I had the honor and privilege to spend time hanging out with people who are professional, smart, compassionate, and dedicated to helping children learn, thrive, and get closer to reaching their potentials. I’m sure you know what I mean. If you turn off the media and peek under the surface, you’ll find tons of people “out there” who wake up every day and work tremendously hard to make the world just a little bit better, for everyone.

For me, yesterday’s group was the South Carolina Association of School Psychologists. They were amazing. They were kind. About 110 of them listened to me drone on about doing counseling with students who, due, in part, to the quirky nature of universe, just happen to be living lives in challenging life and school situations. The school psychologists barely blinked. They rarely checked their social media. They asked great questions and made illuminating comments. They were committed to learning, to counseling, to helping the next generation become a better generation.

All day yesterday and into the night I had an interesting question periodically popping up in the back of my mind. Maybe it was because while on my flight to South Carolina, I sat next to a Dean of Students from a small public and rural high school in Wisconsin. Maybe it was because of the SCASP’s members unwavering focus and commitment to education. The question kept nipping at my psyche. It emerged at my lunch with the Chair of the Psychology Department at Winthrop University.  It came up again after my dinner with four exceptionally cool women.

The question: “How did we end up with so many people in government who are anti-education?”

Yesterday, I couldn’t focus in on the answer. I told someone that–even though I’m a psychologist–I don’t understand why people do the things they do. But that was silly. This morning the answer came flowing into my brain like fresh spring Mountain run-off. Of course, of course, of course . . . the answer is the same as it always has been.

The question is about motivation. Lots of people before me figured this out. I even had it figured out before, but, silly me, I forgot. Why do people oppose education when, as John Adams (our second President) said, “Laws for the liberal education of youth, especially for the lower classes of people, are so extremely wise and useful that to a humane and generous mind, no expense for this purpose would be thought extravagant.”

The answer is all about money and power and control and greed and revenge and ignorance. Without these motivations, nearly everyone has a “humane and generous mind” and believes deeply in funding public education.

Thanks to all the members of the South Carolina Association of School Psychologists, for giving me hope that more people can be like you, moving past greed and ignorance and toward a more educated and better world.

Good night, South Carolina. It’s been a good day.

 

When Teens Talk Back

Sara P Boy Photos

A big thanks to Rick McLeod for inventing this title for a class he taught many years ago at Families First in Missoula.

For tips on how parents can handle it when teens talk back, listen to the latest episode of the Practically Perfect Parenting Podcast. You can catch it on iTunes: https://itunes.apple.com/us/podcast/practically-perfect-parenting-podcast/id1170841304?mt=2

Or Libsyn: http://practicallyperfectparenting.libsyn.com/

Here’s the blurb for When Teens Talk Back:

In this episode, Dr. Sara decides to consult with Dr. John about her hypothetical “friend’s” teenage and pre-teen boys, who coincidently, happen to be the same ages as Sara’s own children. Other than being a disastrously bad consultant, John ends up complaining about how disrespectful our culture is toward teens. This leads Sara and John to affirm that, instead of lowering the expectation bar for teens, we should re-focus on what’s great about teenage brains. Overall, this turns out to be a celebration of all the great things about teenagers . . . along with a set of guidelines to help parents be positive and firm. Specific techniques discussed include limit-setting, do-overs, methods for helping teenagers calm down, role modeling, and natural, but small consequences.

If you want more info on this topic, check out the re-post below, originally posted on psychotherapy.net

A Short Piece on Disrespecting Teenagers

We have an American cultural norm to disrespect teenagers. For example, it’s probably common knowledge that teens are:
• Naturally difficult
• Not willing to listen to good common sense from adults
• Emotionally unstable
• Impulsively acting without thinking through consequences

Wait. Most of these are good descriptors of Bill O’Reilly. Isn’t he an adult?

Seriously, most television shows, movies, and adult rhetoric dismiss and disrespect teens. It’s not unusual for people to express sympathy to parents of teens. “It’s a hard time . . . I know . . . I hope you’re coping okay.” Stephen Colbert once quipped, “Nobody likes teenagers.” Even Mark Twain had his funny and famous disrespectful quotable quote on teens. Remember:

“When I was a boy of 14, my father was so ignorant I could hardly stand to have the old man around. But when I got to be 21, I was astonished at how much the old man had learned in seven years.”

This is a clever way of suggesting that teens don’t recognize their parents’ wisdom. Although this is partly true, I’m guessing most teens don’t find it especially hilarious. Especially if their parents are treating them in ways that most of us would rather not be treated.

And now the neuroscientists have piled on with their fancy brain images. We have scientific evidence to prove, beyond any doubt, that the brains of teens aren’t fully developed. Those poor pathetic teens; their brains aren’t even fully wired up. How can we expect them to engage in mature and rational behavior? Maybe we should just keep them in cages to prevent them from getting themselves in trouble until their brain wiring matures.

This might be a good idea, but then how do we explain the occasionally immature and irrational behavior and thinking of adults? I mean, I know we’re supposed to be superior and all that, but I have to say that I’ve sometimes seen teens acting mature and adults acting otherwise. How could this be possible when we know—based on fancy brain images—that the adult brain is neurologically all-wired-up and the teen brain is under construction? Personally (and professionally), I think the neuroscience focus on underdeveloped “teen brains” is mostly (but not completely) a form of highly scientifically refined excrement from a male bovine designed to help adults and parents feel better about themselves.

And therein lies my point: I propose that we start treating teens with the respect that we traditionally reserve for ourselves and each other . . . because if we continue to disrespect teenagers and lower our expectations for their mature behavior . . . the more our expectations for teenagers are likely to come true.

John and his sister, Peggy, acting immature even though their brains are completely wired up.

Peg and John Singing at Pat's Wedding

Teaching Teens Better Strategies for Getting What they Want

On Thursday of this week I’ll be at the Hilton Garden Inn in Missoula doing a day-long workshop on how to work effectively with challenging youth and challenging parents. Of course, the first point to make about this is that this entire concept is flawed; it’s flawed because it’s not fair to call youth and parents “challenging” when, in fact, for them, the whole idea of sitting down and talking with a counselor is challenging. It would be equally reasonable to hold a workshop for parents and youth titled, “Working with Challenging Counselors.”

One of the approaches featured during the workshop will be to engage teenagers in using better (healthier and more legal) strategies for getting what they want. Rita and I wrote about this approach in our book, Tough Kids, Cool Counseling. . . and so here’s an excerpt that describes the approach and provides a case example:

INTERPERSONAL CHANGE STRATEGIES

The following techniques focus more specifically on interpersonal behavior patterns.

Teaching “Strategic Skills” to Adolescents
Weiner (1992) described many delinquent or “psychopathic” adolescents as inherently understanding the importance of using strategies to obtain their desired goals (p. 338). Despite this general understanding, disruptive, behavior-disordered adolescents frequently utilize ineffective interpersonal strategies and thereby obtain outcomes opposite to what they desire. For example, increased freedom is commonly identified by adolescents as one of their primary therapy goals. However, attention-deficit and disruptive, behavior-disordered adolescents consistently engage in behaviors that eventually restrict their personal freedom (e.g., curfew violation, disrespect toward parents, illegal behavior). The “strategic skills” intervention is designed to help adolescents understand how their own behavior contributes to their inability to attain personal goals (e.g., perhaps by producing increased limits and restrictions).

The therapist must provide two relationship-based explanations to implement the strategic skills procedure. First, the therapist must directly inform them of a willingness and commitment to assist them in personal goal attainment. For example:

It sounds like you want more freedom in your life. I imagine it’s a drag being 15 and still having all the restrictions you have. I want you to know that I’m willing to work very hard to help you have more freedom. We just have to put our heads together and think of some ways you can get more freedom.

The purpose of this statement is to reduce resistance and distrust. Many, if not most, adolescents expect therapists to side with their parents, teachers, or authority figures. The process of valuing the adolescent’s pursuit of freedom can surprise the adolescent and thereby reduce resistance.

Second, therapists must set clear limits on the type or quality of behaviors they are willing to support and promote. This is because adolescents may try to manipulate therapists into supporting illegal or self-destructive behavior patterns (Weiner, 1992; Wells & Forehand, 1985).

I need to tell you something about what I am willing to help you accomplish. I’ll help you figure out behaviors that are legal and constructive and help you get more freedom. In other words, I won’t support illegal and self-destructive behaviors because in the end, they won’t get you what you want. And there may be times when you and I disagree on what is legal and constructive; we’ll need to talk about those disagreements when and if they arise.

If adolescents respond positively to their therapists’ offer of support and assistance, the door is open to providing feedback about how to engage in freedom-promoting behaviors. Therapists can then tell their clients: “Okay, let’s talk about strategies for how you can get more of what you want out of life.” Subsequent discussions might include the following problem areas that frequently contribute to adolescents’ restrictions: staying out of legal trouble, developing respect and trust in the adolescents’ relationships with parents and authority figures, and analyzing and modifying inaccurate social cognitions. Essentially, therapists have facilitated client motivation and cooperation and can move on to analyzing faulty cognitions, modeling and role-playing strategies, and other effective psycho-therapeutic interventions.

Case example. A 12-year-old boy entered the consulting room in conflict with his father over how many pages he was supposed to read for a specific homework assignment given to him by a teacher whom he “hated.” The boy was disagreeable and nasty in response to his father’s comments; direct discussion of issues while both father and son were present was initially ineffective. Therefore, the father was dismissed. After using distraction strategies and a mood-changing technique (See Chapter 3), the boy was able to focus in a more productive manner on the conflict he was having with his father. The boy indicated that his father was partially correct in his claims about the reading assignment, but that the boy’s “hate” for this particular teacher made him want to resist the assignment.
The individual discussion between the boy and his therapist focused on (a) how the boy’s dislike for the teacher produced a “bad mood,” which subsequently produced his resistance to the assign-ment, (b) how the boy’s bad mood and resistance to the assignment had produced disagreeable behavior toward his dad, and (c) how the boy’s bad mood, resistance to the assignment, and disagreeable behavior had produced a bad mood and disagreeable behavior within the father (who was now resisting the boy’s request that the assignment be modified). Consequently, after the boy’s mood was modified, the boy and therapist were able to brainstorm strategies for helping the father change his mood and become more receptive to the son’s request. With assistance, the boy chose to tell the father “You were right about the assignment . . . “ when his father returned to the room. This “improved” interpersonal strategy (which had been role-played prior to father’s return) had an extremely positive effect on the father. Additionally, the boy was able to introduce a compromise (“I’ll do the assignment if my dad will listen to me without disagreeing when I bitch about how unfair and stupid this teacher is”). In response to his son’s admission “Dad, you’re right,” the father stated (with jaw open): “I don’t know what happened in here when I was gone, but I’ve never seen Donnie change his attitude so quickly.” Donnie and his father successfully negotiated the suggested compromise, and before Donnie left, the therapist pointed out (by whispering to the boy) how quickly he had been able to get his father’s mood to change in a positive direction.

In this case scenario, the therapist helped to modify the son and father’s usual reciprocal negative interactions in a manner similar to one-person family therapy advocated by Szapocznik et al. (1990).

P1030724

A Short Piece on Disrespecting Teenagers

The post below is from psychotherapy.net and so you can view it there too: http://www.psychotherapy.net/blog/title/a-short-piece-on-disrespecting-teenagers

Also, I strongly recommend that you check out psychotherapy.net as a potential go-to resource on all things psychotherapeutic. Their video and streaming collection is awesome and extensive. Go to: http://www.psychotherapy.net/

Okay. Here’s the post:

A Short Piece on Disrespecting Teenagers

We have an American cultural norm to disrespect teenagers. For example, it’s probably common knowledge that teens are:
• Naturally difficult
• Not willing to listen to good common sense from adults
• Emotionally unstable
• Impulsively acting without thinking through consequences

Wait. Most of these are good descriptors of Bill O’Reilly. Isn’t he an adult?

Seriously, most television shows, movies, and adult rhetoric tends toward dismissing and disrespecting teens. It’s not unusual for people to express sympathy to parents of teens. “It’s a hard time . . . I know . . . I hope you’re coping okay.” Just last night Stephen Colbert quipped, “Nobody likes teenagers.” Even Mark Twain had his funny and famous disrespectful quotable quote on teens. Remember:

“When I was a boy of 14, my father was so ignorant I could hardly stand to have the old man around. But when I got to be 21, I was astonished at how much the old man had learned in seven years.”

This is a clever way of suggesting that teens don’t recognize their parents’ wisdom. Although this is partly true, I’m guessing most teens don’t find it especially hilarious. Especially if their parents are treating them in ways that most of us would consider unwise—at least if we were treated similar ways in the workplace.

And now the neuroscientists have piled on with their fancy brain images. We have scientific evidence to prove, beyond any doubt, that the brains of teens aren’t fully developed. Those poor pathetic teens; their brains aren’t even fully wired up. How can we expect them to engage in mature and rational behavior? Maybe we should just keep them in cages to prevent them from getting themselves in trouble until their brain wiring matures.

This might be a good idea, but then how do we explain the occasionally immature and irrational behavior and thinking of adults? I mean, I know we’re supposed to be superior and all that, but I have to say that I’ve sometimes seen teens acting mature and adults acting otherwise. How could this be possible when we know—based on fancy brain images—that the adult brain is neurologically all-wired-up and the teen brain is under construction? Personally (and professionally), I think the neuroscience focus on underdeveloped “teen brains” is mostly (but not completely) a form of highly scientifically refined excrement from a male bovine designed to help adults and parents feel better about themselves.

And therein lies my point: I propose that we start treating teens with the respect that we traditionally reserve for ourselves and each other . . . because if we continue to disrespect teenagers and lower our expectations for their mature behavior . . . the more our expectations are likely to come true.

John and his sister, Peggy, acting immature even though their brains are completely wired up.

Peg and John Singing at Pat's Wedding

How to Listen so Parents will Talk: Strategies for Influencing Parents — DVD filming with Alexander Street Press

This past week I was in Chicago to be filmed doing three 15 minute TED Talk like speeches for Alexander Street Press. The experience was both exciting and anxiety-provoking. . . as it’s rather challenging to deliver a 15 minute piece in a darkish studio to a camera on one take. Shannon Dermer of Governor’s State University was the smooth as silk facilitator who conducted 15 minute interviews after each speech. I was lucky enough to be filming on the same day as Paul Peluso of Florida Atlantic University. Although it was comforting to see that Paul was just as nervous as I was, it was not comforting watching him absolutely nail a perfect 10 of a presentation on Humor in Psychotherapy just a couple hours before it was my turn in front of the camera.

In the end, the filming went well, but of course during the live filming my imperfect memory led me to miss a few “lines” and so I’m posting here, a text version of the How to Listen so Parents will Talk THERAPY talk.Although my goal was to post an audio version, WordPress has thwarted that particular plan for now. . . sorry about that.

How to Talk so Parents will Listen: Strategies for Influencing Parents

When I talk with large groups about parenting, I like to begin with a survey. I ask: “How many of you ARE parents?” Of course, nearly everyone raises his or her hand. Then I ask a follow up: “How many of you WERE children.” At this question some participants laugh and a few raise their hands and others joke that they’re still immature.

“This reason I start with this survey is because if you’re a parent, you know that being a parent is an amazing and gratifying challenge. You also know that it’s 24-7; and you know it doesn’t end when your child turns 18. You’re a parent for life. And if you WERE a child, and all of you were, then you know how important it is to have a parent or caretaker who makes it perfectly clear that YOU ARE LOVED. But there’s more. If you were a child, then you also know how important it is to have a parent who not only loves you, but who is skillful . . . a parent who is dedicated to being the best parent possible.

Plain and simple: PARENTS NEED SKILLS FOR DEALING WITH THEIR CHILDREN IN THE 21ST CENTURY. And learning to be a better parent never stops.

Once upon a time I had a mom come consult with me about her five year old son. She said: “I have a strong-willed son.” My response was to acknowledge that lots of parents have strong-willed children. She said, “No, no, you don’t get it. I have a very strong-willed son, let me tell you about it. Just the other night, I asked him to go upstairs and clean his room and he put his hands on his hips and said, “NO.” So I said in response, “Yeah, yeah. He sounds very strong willed.” And she said, “Wait. There’s more. I asked him to clean his room a second time and he glared and me, and said “NO. YOU WANT A PIECE OF ME?” Then she told me the real problem. The problem was that, in fact, she did want a piece of him at that particular point in time and so she grabbed him and hauled him up the stairs in a way that was inconsistent with the kind of parent she wanted to be.

This is one of the mysteries of parenting. How can you get so angry at a small child whom you love more than anything else in the world?

Parents are a unique population and deserve an approach to counseling that’s designed to address their particular needs. In this talk I’ll mostly be using stories to talk about
a. what parents want for their children
b. what parents need in counseling
c. and how professionals can be effective helpers.

Most parents want some version of the same thing: To raise healthy and happy children who are relatively well-adjusted. But what do parents need in counseling. WHAT WILL HELP THEM GET WHAT THEY WANT?

First, parents need empathic listening. They need this big time. Our American culture puts lots of social pressure on parents . . . It’s implied that parenting should be easy and all parents should want to spend 24-7 with their child in an altered state of parental bliss. But this isn’t reality and so we need empathy for the general scrutiny parents feel in the grocery store, at church, on the playground, and everywhere else.

But they also need listening and specific empathy: like in the situation where the mom wanted to tell me about her 5-year-old son. She had specific information to share and it was really important for me to take time to listen to her unique story about her son who, unfortunately, may have been watching too many Clint Eastwood movies.

Parents come to counseling or parent education feeling simultaneously insecure and indignant. They feel insecure because of the scrutiny they feel from their parents and in-laws and society, but they also feel indignant over the possibility that anyone might have the audacity to tell them how to parent their children. As professionals, we need to be ready to handle both sides of this complex equation.

Another thing parents have taught me over the years is to never start a parenting session by sharing educational information. You should always wait to offer educational advice, even when parents ask you directly for it. When they do ask, let them know that your ideas will be more helpful later once you get to know what’s happening in their family.

This leads us to the second crucial part of what parents need in counseling. They need collaboration. We can’t be experts who tell parents what to do, instead we have to recognize that parents are the experts in the room. They’re the experts on their children, on their family dynamics, and on themselves. If we don’t engage and collaborate with parents, very little of what we offer has any chance of being helpful.

Parents also need validation to counter their possible insecurity. We call this radical acceptance or validation and it involves explicitly and specifically giving parents positive feedback. We do this by affirming, “You sure seem to know your daughter well.” And by saying, “When I listen to how committed you are to helping your son be successful in life, I can’t help but think that he’s lucky to have you as a parent.”

And so we begin with empathic listening and we move to collaboration and we make sure that we offer radical acceptance or validation and we do all this so we can get to the main point: providing parents with specific parenting tips or guidance.

And there are literally TONS of specific parenting tips that professionals can offer parents. Most of the good ones include four basic principles:

First, getting a new attitude – because developing parenting skills requires a courageous attitude to try things out.

The second one involves making a new and improved plan. Because a courageous attitude combined with a poor plan won’t get you much.

Third is to get support when you need it. Parenting in isolation is almost always a bad idea.

Fourth, underlying all tips there should be the foundation of being consistently loving.

I’d like to tell two parenting stories to illustrate all of the preceding ideas.

This first story is about a parenting struggle I had. I share it for two reasons: One is that it’s a great example of the need for parents to make a new plan to handle an old problem. And two, often it’s good to self-disclose—but not too much—when working with parents.

When my youngest child was 5-years-old, she ALSO was a strong-willed child. I vividly recall one particular ugly scene on the porch. It was time for us to leave the house. But we lived in Montana and there was snow and my daughter needed to put her boots on. Funny thing, she was on a different schedule than I was. This created tension and anger in me. And so I got down into her face and I yelled GET YOUR BOOTS ON! And her eyes got big and she did. Later that evening I was talking with my wife and she saw the scene and she said to me, “I know John, that’s not the kind of parent you want to be.” And even though it’s not easy to take feedback from our romantic partners, she was right and so obviously so, that I had no argument” which led me to tell her, “I’m not going to yell at our daughter any more. I am, instead going to whisper, because I learned in a parenting book, that sometimes when you’re angry it’s more effective to whisper than it is to yell. That was my new plan. Of course, like new plans everywhere, it needed tweaking. But it didn’t take long for me to have an opportunity to test it because if there’s anything on the planet that’s predictable, it’s that we’ll all soon have another chance to manage our anger toward our children more constructively.

It was the next day or week and my daughter did not get her boots on and she was not on the same schedule as me and I got down in her face, once again, but I remembered the plan to whisper and I did my best to transform my anger from the historical yell to the contemporary whisper and what happened was that what came out was sort of like the exorcist and I said to my daughter: “GET YOUR BOOTS ON!”

Now. I wasn’t especially proud of that, but she got her boots on.

It was the beginning of a big change for me because I learned I could play the exorcist instead of yelling; then I learned to growl and then I learned to count to three and then I learned a cool technique called Grandma’s rule where you use the formula, WHEN YOU, THEN YOU to set a limit and build in a positive outcome. Like . . . “Honey, when you get your boots on, then you can have your cell phone back.” Very cool.

What I learned from this experience is that I could be more than a one-trick parenting pony. I became the kind of parent who, although far from perfect, was able to set limits that were in my daughter’s best interest.

And what I like the best about this particular story is that daughter is now 26 years-old and she still says the same thing she used to say to me when she was 15 . . . that is, “Dad, one thing I really love about you is you never yell.” What’s cool is that I did yell, but I worked on it, I made a new plan, and now she doesn’t even remember the yelling.

I’d like to finish with one last story about how much parents need people like you to have empathy, collaborate, validate, and offer concrete parenting ideas.

I was working with a 15-year-old boy. His mom was bringing him to counseling because he and his dad weren’t speaking anymore. I hadn’t met the dad, but one day, when I went to the boy’s IEP meeting at school the dad was there. I saw this as a chance to make a connection and get him to come to counseling.

I did a little chit-chatting and sat next to him in the group meeting. Then, at one point, I asked the boy a question: “If you got an A on a test, who would you show first?” He answered, “I’d show my dad, my mom, and my special ed teacher.” This inspired me to turn to his dad and say, “It’s obvious that you’re very important to your son and so I’d like to invite you to come join him and me in counseling.” Dad gave me a glare and pushed my shoulder and began a 2-minute rant about how the school had failed his son. Everyone was stunned and then he turned back to me and said, “I’ll come to counseling. I been to counseling before and I can do it again.”

At that point I wondered if I could take back my offer.

The day the dad drove to counseling he and his son weren’t speaking, so I met with them separately. The son was clear that he would never speak to the dad again, but the dad was open. When I asked if I could offer him some ideas, he said, “Well I tried MY best and that dog don’t hunt, so I can try something else.” I was wishing for subtitles.
I told the dad I wanted him to keep his high standards for his son, but to add three things. First, I asked, do you love your son? The dad said “Yes” and so I told him, “Okay then. I want you to tell him ‘I love you’ every day.” He said, “Usually I leave that to the wife, but I can do that.” Second, I said, “Everyday, I want you to touch your son in a kind and loving way.” He asked, “You mean like give him a hug?” I said, “that would be great” and he responded, “Usually I leave that to the wife too, but I’ll give it a shot.” Third, I said, “Once a week, you should do something fun with your son, but it has to be something that he thinks is fun.” He said back: “That’s no problem. We both like to go four-wheeling, so we’ll do that.”

And they left my office for an hour-long of what I imagine was a silent trip home.

The next afternoon, I got a call from the mom. She was ecstatic. She said, “I don’t know what you did or what you said, but they’re talking again.” And then she added, “This morning, when they were in the kitchen, I was in the other room and I thought I heard them hug and when I saw my son walking down the driveway to head to school, there were tears running down his cheeks.”

This was obviously a mom who was listening and watching very closely.

Things got much better for the 15-year-old after that. He didn’t get straight As, but he stopped getting straight Fs. And I learned two things: First, I learned just how much that boy needed to get reconnected with his father. And second, I learned that sometimes, no matter how gruff parents may seem, what they need is some clear and straightforward advice about how to reconnect with their son or daughter.

My final thoughts about this topic are very simple. I hope you’re inspired enough to acquire the knowledge and skills it takes to work effectively with parents. I know their children will deeply appreciate it.

Thanks for listening.

The book upon which the talk is based is available here on Amazon: http://www.amazon.com/How-Listen-Parents-Will-Talk/dp/1118012968/ref=la_B0030LK6NM_1_9?s=books&ie=UTF8&qid=1402106002&sr=1-9 . . . and here on Wiley: http://www.wiley.com/WileyCDA/WileyTitle/productCd-1118012968.html

Strategies for Parenting Teens

Strategies for Parenting Teens: A Brief Parenting Workshop [This is a handout from an old parenting workshop from way back in my Families First days.]

I. Introduction

II. Opening Stories: Dealing with Yourself First
1. How will you stay calm? The answer to this question is surprisingly simple. Managing emotions doesn’t require years of psychotherapy. It requires the following components.
2. A plan for dealing with your anger/emotions.
3. Rehearsing and practicing of the plan repeatedly, before, during, and after you face situations that trigger your anger.

III. Amazing Parenting Strategies

A. Adopt a New Best Attitude: There is one attitude that, if you’re able to adopt it, will help you respond in a more constructive way to all children. I know it sounds absolutely crazy, but, here it is:

LOOK FORWARD TO THE NEXT TIME YOUR TEEN HAS AN OUTBURST OR TEMPER TANTRUM . . . BECAUSE

1. If you look forward to teen’s outbursts, you’ll be able to deal with them in a more positive and graceful way.
2. If you look forward to teen’s outbursts, you can use them as an opportunity for emotional education.
3. If you look forward to teen’s outbursts, you can use them as an opportunity for greater intimacy. Think about the nightmare analogy.

B. Approach Teens Gently, Empathically, and With The Desire to Comfort Them: Being a teenager sucks. If you recall, your body is in turmoil, everybody is staring at you, and your friends are inconsistent and judgmental. Therefore, we should try to be the sort of parent who is a pillar of strength and support and not a big source of criticism and punishment.

C. Use Boring Punishment: Often we get this backwards and end up yelling at our kids, rather than making the punishment boring. Behavior modification principles suggest that we should be exciting when delivering praise or rewards.

D. Get Curious, Not Furious. Just like in the children’s story about the lion and the mouse, there will almost always be some form of distress under teen’s anger or agitation. As you approach gently, with your new positive attitude, think about what might be underneath your teen’s anger. Is she hurt? Is he upset about not getting what he wants? Is she trying to manipulate you into getting what she wants? Is he just blowing off steam?

E. It IS possible to have both empathy for your teen’s feelings AND to set limits on his/her behavior. For example, you can say, “I can see you’re very upset because you can’t go out tonight.” This statement contains both empathy AND a statement of the limit that you’re setting. Many teens throw tantrums to obtain power and control. Therefore, you should always abide by the following rule:

IF A TEEN IS BEHAVING AGGRESSIVELY OR OBNOXIOUSLY, THE ANSWER IS ALWAYS – NO!

F. Use Encouragement: Praise is a great tool for shaping your teen’s behavior, but try to avoid relying exclusively on praise . . . instead, try using encouragement. For example, after your child handles a difficult situation gracefully, instead of saying, “That was great” try saying, “I noticed you kept your cool.” The magic of encouragement occurs because, by not giving specific praise, you give your child the opportunity to conclude himself or herself that the behavior you noticed was good. And often it’s more important for your child to evaluate his/her own behavior than to always have to look to you for approval or praise. Character feedback is another form of encouragement.

G. Use Grandma’s Rule: This strategy involves using the language, “When You, Then You.” For example, you might say, after having empathy for your child’s upset feelings, “When you calm down, then we can get ready to go to the park.” The key to this strategy is to keep your language perfectly clear.

H. Use Mutual Problem-Solving: Too often parents feel like it’s totally their responsibility to solve their child’s problems. This involves unilateral problem-solving and it doesn’t really teach your teen anything but that she/he should rely on you. Instead, try engaging your child in mutual problem-solving.

IV. Looking to the Future: Four Key Questions

To make sure you’re staying focused and effective, it helps to ask yourself the following four questions (from Choice Theory – William Glasser and Robert Wubbolding).

A. What do you want?
B. What are you doing?
C. Is it working?
D. Should you make a new plan?

For more detailed information on these and other parenting strategies, go to: http://www.amazon.com/How-Listen-Parents-Will-Talk/dp/1118012968/ref=la_B0030LK6NM_1_8?s=books&ie=UTF8&qid=1397876334&sr=1-8

 

 

The Therapist’s Opening Statement (or Question) with Adolescents

           Working with adolescents or teenagers is different from working with adults. In this excerpt from a recently published article with Ty Bequette, we briefly focus on how the opening interaction with an adolescent client might look different than an opening interaction with an adult client. This is from: Sommers-Flanagan, J., & Bequette, T. (2013). The initial interview with adolescents. Journal of Contemporary Psychotherapy, 43(1), 13-22.

            When working with adults, therapists often open with a variation of, “What brings you for counseling” or “How can I be of help” (J. Sommers-Flanagan & Sommers-Flanagan, 2012). These openings are ill-fitted for psychotherapy with adolescents because they assume the presence of insight, motivation, and a desire for help—which may or may not be correct.

Based on clinical experience, we recommend opening statements or questions that are invitations to work together. Adolescent clients may or may not reject the invitation, but because adolescent clients typically did not select their psychotherapist, offering an invitation is a reasonable opening. We recommend invitations that emphasize disclosure, collaboration, and interest and that initiates a process of exploring client goals. For example,

I’d like to start by telling you how I like to work with teenagers. I’m interested in helping you be successful. That’s my goal, to help you be successful in here or out in the world. My goal is to help you accomplish your goals. But there’s a limit on that. My goals are your goals just as long as your goals are legal and healthy.

The messages imbedded in that sample opening include: (a) this is what I am about; (b) I want to work with you; (c) I am interested in you and your success; (d) there are limits regarding what I will help you with. It is very possible for adolescent clients to oppose this opening in one way or another, but no matter how they respond, a message that includes disclosure, collaboration, interest, and limits is a good beginning.

Some adolescent clients will respond to an opening like the preceding with a clear goal statement. We’ve had clients state: “I want to be happier.” Although “I want to be happier” is somewhat general, it is a good beginning for parsing out more specific goals with clients.    Other clients will be less clear or less cooperative in response to the invitation to collaborate. When asked to identify goals, some may say, “I don’t know” while others communicate “I don’t care.”

Concession and redirection are potentially helpful with clients who say they don’t care about therapy or about goal-setting. A concession and redirection response might look like this: “That’s okay. You don’t have to care. How about we just talk for a while about whatever you like to do. I’d be interested in hearing about the things you enjoy if you’re okay telling me.” Again, after conceding that the client does not have to care, the preceding response is an invitation to talk about something less threatening. If adolescent clients are willing to talk about something less threatening, psychotherapists then have a chance to listen well, express empathy, and build the positive emotional bond that A. Freud (1946, p. 31) considered a “prerequisite” to effective therapy with young clients.

Some adolescents may be unclear about limits to which psychotherapists influence and control others outside therapy. They may imbue therapists with greater power and authority than reality confers. Some adolescents may envision their therapist as a savior ready to provide rescue from antagonistic peers or oppressive administrators. Clarification is important:

Before starting, I want to make sure you understand my role. In therapy you and I work together to understand some of the things that might be bugging you and come up with solutions or ideas to try. But, even though I like to think I know everything and can solve any problem, there are limits to my power. For example, let’s say you’re having a conflict with peers. I would work with you to resolve these conflicts, but I’m not the police, and I can’t get them sent to jail or shipped to military school. I can’t get anyone fired, and I can’t help you break any laws. Does that make sense? Do you have any questions for me?

A clear explanation of the therapist’s role and an explanation about counseling process can allay uncertainties and fears about therapy. Inviting questions and allowing time for discussion helps empower adolescent clients, build rapport, and lower resistance.

Hello to the Communities in Schools of North Carolina

Tomorrow I head to Billings to fly to Charlotte, North Carolina to speak at the annual training conference for the Communities in Schools of North Carolina (CIS-NC). CIS-NC is an awesome organization that helps prevent and reduce school drop-outs. I’m honored to be a part of their annual training. You can learn more about CIS-NC at: http://www.cisnc.org/

Attached to this post is the powerpoint presentation for the Wednesday opening session.

NC CIS Warts to Wings Final REV no cartoons

And here’s the one page summary from the opening session.

From Warts to Wings Handout

And here’s the powerpoint for the break-out session on “How to Listen so Parents will Talk”

How to Listen for CIS

And the one page summary for the break-out session.

How to Listen Handout

Tough Kids, Cool Counseling: Dealing with “Resistance” – Part 1

Working with challenging, tough, or naturally resistant youth is one of the most difficult situations a counselor or psychotherapist can face. In this excerpt from chapter 3 of “Tough Kids, Cool Counseling” (published by ACA, 2007), we begin discussing strategies for dealing with this difficult situation. Here’s a link to the Amazon page for this book: http://www.amazon.com/Tough-Kids-Cool-Counseling-User-Friendly/dp/1556202741/ref=la_B0030LK6NM_1_2?ie=UTF8&qid=1370790501&sr=1-2

Chapter 3

Resistance Busters: Quick Solutions and Longer-Term Strategies

As noted in preceding chapters, adolescents are well-known for their general distrust of adults and their striving for autonomy (Erikson, 1963; Saginak, 2003). Despite this distrust and independence-striving, in most cases, by using the strategies and techniques discussed in Chapter 2, counselors can manage resistance and initiate therapy with clients and their parents. However, upon entering a counseling situation, some young people will display extreme, provocative, or puzzling resistance behaviors that require more specialized approaches (Amatea, 1988; Richardson, 2001).

Imagine the following scenario:

You’re an intern scheduled to meet with a 15-year-old girl referred to a community clinic from a local group home. You’ve been in graduate school for about 18 months and so you’re not completely naïve, but because you’re only 23 years old yourself (and you went through a fair bit of emotional turmoil during your teen years), you’re especially excited about the opportunity to help a teenager who is obviously in a challenging life situation.

When you meet your client, Maya, in the waiting room, your enthusiasm begins to wane. Her jet-black and pink fringed hair hangs over her eyes and she reeks of cigarette smoke. When you greet her, she sneers, causing her lip-ring to flip upward. Her eyes (or at least what you can see of them) roll back as if she is disgusted at the sight of you.

Her first spoken words to you are: “This is a fucking waste of my time.”

You’re not sure what to say and so the Carl Rogers voice inside of you says gently, “It sounds like you’re not very happy to be here.”

Maya’s response is to slip into a stony silence, a silence only occasionally broken with deep dramatic sighs. Eventually, when she finally speaks again, she says, “Oh my fucking God. And you’re supposed to help me?  That’s a joke.”

Some teenagers have a special talent for destroying their counselor’s confidence. Not surprisingly, our graduate students, when facing a client like Maya for the first time, are often stunned. They complain of having a blank-mind and not knowing what to say. Other common reactions to the Maya-prototype include overwhelming feelings of inadequacy (usually accompanied by anxiety) or strong impulses to retaliate with anger.

This chapter focuses on strategies and techniques for dealing with some of the most provocative behaviors you’re likely to see in counseling situations. Our belief is that counselors should prepare, plan, and look forward to aggressive resistance from teenage clients or students. Again, we emphasize that aggressive resistance is best viewed as a coping style brought into the counseling situation and directed towards anyone in authority—in Sullivan’s terms, a parataxic distortion (Sullivan, 1953). Therefore, when working with challenging youth, keep one key fact clearly in mind: Your client’s insults, disgust, and aggressive behavior, although aimed at you, have virtually nothing to do with you. There’s no point in taking your client’s comments personally, and in fact, if you can side-step the onslaught, it will provide you with all sorts of important diagnostic and clinical information about your client’s pain and defenses.

Getting Your Buttons Pushed

Despite our great advice about not taking your client’s degrading comments personally, in the real world, we all get our buttons pushed sometimes. A graphic example of counselor over-reaction to provocative client behavior was captured in the feature film, Good Will Hunting (Van Sant, 1997).

As a fan of counseling, you may recall the scene. The main character, Will, played by Matt Damon, is an extremely intelligent but emotionally disturbed young man with mathematical genius. His would-be mentor, in an effort to help Will fulfill his potential, sends him to several different counselors, none of whom are able to help Will. Finally, Will ends up in the office of Sean McGuire, played by Robin Williams.

During his initial session with McGuire, Will is his provocative and nasty self. He eventually, either accidentally, or via great intuition, begins insulting McGuire’s deceased wife and because he is still unresolved about his wife’s premature death, McGuire gets his emotional buttons pushed. The result: the counselor grabs Will around the neck and slams him up against the wall. Of course, McGuire also decides to take on Will as a client and successfully helps Will move forward in his life.

We would like to emphasize two key points related to this excellent example of resistance and countertransference from Good Will Hunting. First, be aware of your emotional buttons, seeking the support and counseling you need to be an effective and ethical counselor. Second, no matter how provocative your young clients may act, avoid using Robin Williams’s “Choking the client” technique.  It may play well in Hollywood, but physical contact with resistant, aggressive, and/or angry clients is highly ill-advised.

If you find you’re having your emotional buttons pushed occasionally by teenage clients or students, consider yourself normal. On the other hand, if the button pushing begins to cause you to contemplate acting on destructive impulses, it’s time to get therapy for yourself, and/or support from a collegial supervision group. Many psychoanalytically-oriented writers have warned about the powerful regressive countransference impulses that young clients can ignite in their counselors (Dass-Brailsford, 2003; Horne, 2001).

Pause for Reflection: How do you usually respond when you get your buttons pushed by someone? Do you instantly feel angry? Or, are you more likely to scrutinize yourself and decide that you really are just an inadequate and worthless piece of furniture? Of course, there’s no “right” response to these questions. The best guideline is to continually work at looking at yourself and your reactions to clients so that you are consistently cultivating your self-awareness.

[End of Pause for Reflection]

To work ethically and professionally with provocative clients requires general skill, personal insight, and a particular knowledge base that includes a range of potentially constructive automatic or formula responses.