Dealing with Self-Harming Behaviors in Teens
Posted by FamilyFirst Psychological Services
An increasingly common topic that I am asked about by parents and school counselors is self-harming behavior among teens. This issue puzzles counselors and frightens parents. It has been estimated that as many as one in five teens have tried self-harming. There isn’t a week that goes by that self-harm does not come up in my therapy office, so it seems to be a useful topic to discuss in this forum.
Self-harm (or self-injury) presents in different ways, but most often it’s cutting. While self-harming individuals do sometimes have suicidal ideation that may or may not accompany the acts of self-harm, most of the time self-injurious behavior such as cutting is not a suicide attempt. So that begs the question: why is this person cutting him or herself? There can be multiple answers to this question. At the most basic level, this is a means of coping with emotions that feel intense, painful, or overwhelming. Occasionally, a young person will try self-cutting out of curiosity. If they find it is not a pleasant or relieving experience, they probably won’t do it again. However, for some people, self-injury is an effective means of dealing with difficult emotional experiences. Self-harming behaviors may signify that an individual is going through a particularly difficult life experience or that he or she suffers from a chronic emotional problem such as depression, traumatic stress, or mood disturbance.
Often individuals who self-harm attempt to conceal the marks they have made. They may wear long-sleeved shirts or lots of bracelets to hide the cuts or scars. Also, they may cut or otherwise injure themselves in places that are typically concealed by clothing, such as the thighs or abdominal area. Sometimes individuals allow others to see the marks or appear to be putting them on display. I have frequently heard this described as “attention-seeking” or “manipulative” behavior. I don’t think it’s useful to construe this behavior in such pejorative terms. In my experience, this is most often the best way the individuals can come up with to communicate their difficulties so they will get help.
So what do you do if you find out your child is self-harming? First, don’t punish them for it and don’t shame them for it. Secondly, don’t make them show you all the marks. DO express concern and try to understand what the underlying feelings are. If your child doesn’t feel comfortable telling you what is going on, offer the opportunity for them to talk with someone else, such as a psychologist, about it.
It is important that teens who turn to self-harm learn more healthy ways of coping with their feelings. Therapy can be very helpful for both the teen and the parents in dealing with this problem. Treatment should focus on containing any actual life-threatening behaviors and helping the individual process and work through the underlying stressors that contribute to the self-harming behaviors. Additionally, family therapy may be needed to address contributing family dynamics. When self-harm is not life-threatening, it is not generally helpful to force the individual to stop self-injuring immediately or to hospitalize the individual for the behavior. A more effective method is to help the teen replace self-harm with other effective coping strategies and to address the actual underlying problems. The process of therapy in these cases can take considerable time, but can be very effective.
Melissa K. Hunt, Ph.D.
Licensed Clinical Psychologist
FamilyFirst Psychological Services
Developing Resiliency for Our Fast-Paced Ever Changing World
Posted by FamilyFirst Psychological Services
We live in an ever-changing world. As soon as we buy a new computer or cellular phone, there is an update. Our environment, our economy, our health, our family situations are frequently in flux. Our children start new schools, get new teachers and coaches, join new social groups, and must navigate new demands from all of these sources. Learning to be resilient, or flexible under the influence of change, is a vital capacity to nurture given our fast-paced, variable world. But how does one go about nurturing the capacity of resilience?
According to Joan Borysenko, Ph.D., there are five key tips for developing resiliency. The first is an acceptance of reality that allows for an optimization of future possibilities. If we are overly optimistic we may not plan for the possibility of change. Being realistic about this possibility provides an opportunity for us to problem solve and be proactive. People who are overly optimistic may actually be protecting themselves from a thought they find intolerable. Resilient people are able to tolerate the difficult “what ifs”, because they believe in their abilities to adapt to new situations, even difficult ones. Appropriate realism does not mean we become fretters, it just means we are open to what may come our way and we believe in our capacity to deal with it.
Nurturing a social network also helps to encourage the development of resiliency. Cultivating allies and mentors to provide support during challenging times enhances our hardiness during these times. Feeling safe and having a deep belief that life is meaningful is a third key to resilience. Feeling safe can include a sense of spirituality or a religious belief, but it can also just mean feeling safe in one’s own ability to handle life’s challenging situations. Having this sense of self-efficacy allows us to navigate life’s winding roads. Resilient people are also highly creative and adaptable. This is the capacity to make lemonade out of lemons. Dr. Borysenko tells the story of looking into a nearly empty refrigerator with three wilted carrots and half an onion, and deciding that you will make a great soup.
Finally, resilient people have taken care of their “physical plant”. They exercise, eat right, and get adequate sleep. They practice mindfulness, being fully aware of the present moment without judgment, to enhance emotion regulation, focus, and the capacity to cope. They are aware of ‘burnout’ and take steps to keep their bodies running optimally.
The brain signature of resilience, according to Dr. Dan Siegel, is a moving toward rather than away from challenging situations. Increasing our capacity to tolerate the moving toward that which is difficult because we believe in our ability to deal with whatever life has in store for us, is what we mean by resilience. And resilience is a critical competence for us to develop as we navigate the 21st century.
Marcia Kaufman, Ph.D.
Licensed Clinical Psychologist
(Portions of this blog were taken from a lecture by Joan Borysenko, Ph.D. at the conference of The National Institute for the Clinical Application of Behavioral Medicine, December, 2011.)
Yes, YOU Are a Model
Posted by FamilyFirst Psychological Services
Ever feel like somebody’s always watching you? If you have children, then I’m assuming the answer is YES! I have heard several stories about parents talking candidly with their spouse only to later hear their child repeat the one phrase from that conversation that should never be repeated. Kids are like little sponges and they seem to absorb everything whether you want them to take it in or not. For those with older children, it might even surprise you to know that your 15-year-old recluse who stays shut up in their room hears and sees more than you realize when it relates to family life. Fortunately and unfortunately, this means that as a parent you are a model, maybe even a supermodel in their eyes.
In most instances, being a model for your children is a no-brainer and most parents readily accept this challenge; however, there are times when parents can sometimes forget that they are models and that their own attitudes and behaviors impact how their children think and act. For example, some parents struggle with controlling their own behavior when angry which, if happens more often than not, can lead to anger management difficulties for their child. In this instance it is important to remember that our children often mimic how we cope with feelings, so if one parent tends to be a yeller then this is modeling that yelling is an acceptable form of expressing one’s anger. If yelling is not acceptable within the family home, then the fact that one parent yells can be quite confusing and frustrating for a child (and adolescent) when they are reprimanded for expressing their anger in the same way.
It can be helpful for parents to sit down together and talk about how they expect their children to act when confronted with a variety of positive and negative situations so that each parent can attempt to model these behaviors themselves. For example, what would you expect from your child when they are disappointed about not making the varsity soccer team? Would you expect them to come home ranting and raving about how the coach does not know anything and that the try-outs were fixed or would you expect them to come home and express their understandable disappointment and frustration in a more productive way. In this instance, it is then important for each parent to think about how they have dealt with disappointment in the past and recognize whether they displayed anger toward their boss after not receiving a promotion at work or whether they came home and openly acknowledged their disappointment and frustration by discussing the situation with their spouse.
The good news is that kids take in our positive moments too! So each time you are polite to a waiter, compliment a friend or constructively resolve a conflict with your partner they soak up those moments too. The more you model how you would like your child to respond to situations, the more probable it is that they will follow your lead and the better you will feel about your parenting. However, remembering that no one is perfect and, therefore, no parent is perfect is also important. You can model a healthy self-acceptance of your own areas that need improvement as a way of helping your child if they tend to beat themselves up after making a mistake. For example, if you lose your temper and end up yelling you can later apologize to your child and let them know what you would have done differently. By doing this you are not only modeling how to acknowledge and apologize when you’ve been wrong, but you are also showing them respect. Now, tilt that chin and go model!
Mary Hill, Ph.D.
Licensed Clinical Psychologist
It’s the Holidays- Time for “No” Thank You Notes
Posted by FamilyFirst Psychological Services
Take a minute to remember how it felt the last time that you were told “no.”
• “No tables left on the deck, but we can seat you in the corner inside.”
• “No, we actually don’t have your size and aren’t getting any more in.”
• “No, we have no more rooms available.”
When is the last time that you thanked someone for telling you, “No?”
• No deck seats and it’s such a beautiful day outside. Thank you very much.
• No more of the style I like in my size? I can’t thank you enough.
• Wow- I won’t be able to stay right in the conference hotel then. Thank you.
People generally hope and expect that things will go their way. They don’t want to do without, lose a chance, or not have their needs not taken seriously. Yet, when our needs aren’t met, it presents an opportunity to grow. We detach from the thought that things must always go right and learn to appreciate times when they do. Being told “no” helps us place aside our pride and our sense of entitlement and focus on experiencing what we know–disappointment is not only inevitable, but also necessary.
It reminds of something we sometimes forget in a world where we have friendships at our keyboard fingertips and extended store hours at our convenience — we are not in control. Not getting your way is good for you. Acceptance strengthens us. It reassures you that you can delay gratification. It slows you down enough to consider how you can manage when life is neither convenient nor comfortable. It helps re-establish clarity between what we want and what we need.
It strengthens our identity as strong, resilient, and resourceful. Being pushed outside our egocentrism zone helps us get in touch with humility and brings the background of others into focus–setting us up to understand, tolerate, and reciprocate. If you receive a holiday present that you didn’t want, something that doesn’t fit or that you can’t use, write a mental “no” thank you note for the reminder that life is about connection, rather than insta-contentment. And the next time you’re told “no,” finish with “thank you.”
Virginia DeRoma, Ph.D.
Licensed Clinical Psychologist
Enjoying the Season by Focusing on the Present
Posted by FamilyFirst Psychological Services
As the holiday season approaches, many of us begin to feel stressed, overwhelmed and exhausted. In the face of shopping lists to work through, travel itineraries to plan, and seemingly endless school functions to attend, we often lose sight of the potential for joy, celebration and re-connection with loved ones that this season is supposed to bring. Thus, the holiday season is an especially good time of year to practice “living in the moment”. Although this advice often sounds trite and worn out, in fact it is based on very sound psychological principles that can help reduce stress, boost your mood and improve your outlook on life.
First, consider the alternatives to “living in the moment”. One alternative is to focus on the past. While there can be some value in reflecting on the past and taking stock (how else would we make New Year’s resolutions?!), too much dwelling on the past can foster feelings of regret and sadness that can in turn promote depression. If you find yourself constantly thinking thoughts that begin with “if only I had…” or “I wish that I could have…” it may be time to try focusing on the present. A second alternative to living in the moment is focusing on the future. Again, there is some value in anticipating what challenges may be ahead of us and planning accordingly. However, a singular focus on the future tends to promote feelings of anxiety and distress, and can lead to feeling overwhelmed and helpless. If you are often playing various possible scenarios over and over (“what if this happens…” “what if that happens….”), consider working more on focusing on the moment that you are in.
This holiday season, try to actively savor something that you might otherwise hurry through. Take a break from your “to do” list and focus on what your senses are telling you about where you are and what is going on around you. Be an objective observer of your environment, and stop to notice what you see, hear, smell, taste and feel. If you are baking treats for a child’s school function, take a few minutes to luxuriate in that smell of fresh-baked holiday goodies. If you are wrapping a gift for your work gift-swap, take time to notice the way that the wrapping paper sparkles and how the ribbons curl just so. Appreciate the warmth of your sweater, the sparkling lights on your neighbor’s porch, and the sweet smell of pine as you pass the display of wreathes outside of the grocery store. If you find yourself becoming overwhelmed with tasks, stop, close your eyes, and breathe. Focus on the fact of your breathing, being sure to breathe deeply into the bottom part of your lungs, engaging your diaphragm. Counting as you breathe will help you to breathe more deeply, and also help you to focus on what you are doing as opposed to what you have to do.
In short, the best way to get more enjoyment out of your holiday season is to focus a bit more on the present moment – and perhaps a bit less on the present(s) on your list.
Kathleen Boykin McElhaney, Ph.D.
Values We Live By: What Are Yours?
Posted by FamilyFirst Psychological Services
It is generally safe to assume that a person has a set of values he or she lives by. When asked, it is probably easy to identify a handful of personal core values. Yet, if pressed, how easy is it to name all the values that define who you are? Do you think your children could name your top three?
More often than not, we assume that not only do we understand what our values are without really needing to think about it, but we also assume our children and others know what those values are too. Just as we teach our children vocabulary to learn and understand new concepts, so too do we need to teach the vocabulary of personal and family values.
So, what are values? They are words, ideas, and standards we live by, that define our person, our family. Values may be taught to us through family tradition, including examples such as integrity, honor, bravery, or education. We learn values from our culture: togetherness, independence, or tradition. Values can come from spiritual means: faith, selflessness, compassion, or forgiveness, or from friends: trust, openness, honesty, and respect. We even have values we learn from our favorite sports team: loyalty, pride, and sportsmanship!
Our personal values define who we are. Values help a person make tough choices, pick their friends, and decide what to do in life, day in, and day out. Take a moment, and ask yourself the following questions. Do you notice any consistent values you rely on; or perhaps, values you were not fully aware you held?
- How do you choose to spend your free time?
- How did you decide on your job/career?
- How do you choose your close friends?
- What are the most important factors you consider when faced with tough choices?
- How do you react/respond when someone wrongs you?
- If someone described you in three words, what words would you hope they choose?
Defining and internalizing a set of personal values is an important part of developing your identity. Values offer a baseline for decision-making, problem solving, and choosing the people with whom you surround yourself. Values are our guideposts in navigating life’s curvy roads. Values help define our families, and help mold our children. As parents, the family values we establish serve as the foundation for the personal values our children adopt.
Throughout their lives, we can teach our children the things we value. As small children, it may be through songs or play. In grade school, it may be through drawings or games. In early and late adolescence, keeping a “values business card” in your pocket may be the way you choose to always remind yourself, and your children, of what is important. Either way, defining family values teaches the vocabulary and the skills needed to develop strong identities and a basis for making healthy decisions and tough choices throughout our children’s lives.
Amie Allain, Ph.D.
Licensed Psychologist
What To Do When You Can’t Do Anything About It
Posted by FamilyFirst Psychological Services
Wishing something would happen but it never does. Wanting someone to do something different, but she never does. Worrying about what someone else thinks of us, getting angry when the rain spoils our cookout, and stressing about what the traffic will be like when we leave work tonight. These are all things we have no control over. And yet, these are the types of situations that we often spend many hours of our day fretting about, causing our lives to be more stressed than they need to be.
Often, when we are stressed, anxious, or feeling down, we are focusing on what we can’t control and, unfortunately, not taking charge of what we actually can control. When we focus on what we cannot control, our anxiety, as well as our feelings of hopelessness and sadness, increase because we are, in fact, creating an impossible situation for ourselves. No matter how talented or intelligent we are, we have no control over the weather, what someone else thinks of us, or what someone else does or says. And when we shine the spotlight on that which we cannot control, we leave all that we can control hiding out in the dark. For example, we can take control by developing a contingency plan or alternate date for our cookout, and by making the best possible behavioral choices for ourselves when interacting with others. Once we have taken control of what we can, it then helps to remind ourselves that this is all we can do, and we will have to let the rest go. If we are successful, we tend to feel more at peace and less stressed and anxious.
Differentiating what we can and can’t control, problem solving when we do have control over a situation or parts of a situation, and letting go when we do not, are vital steps for maintaining a mentally healthy life. Once we have determined which parts of a situation we can and can’t control, we can go through 4 basic problem solving steps to manage what we can control and we can learn strategies for letting go of what we cannot.
When we approach a problem or a dilemma, we first want to define the problem, then think of ALL possible solutions, thirdly, think of the consequences or ramifications for each possible solution, and finally, make the best choice, given our options and the consequences for each option. We can practice slow deep breathing, mindful meditation, yoga, and visual imagery techniques to learn to let go of that which we cannot control. Distracting ourselves with enjoyable activities such as reading, exercise, listening to music, talking to a friend, or snuggling with our loved ones, also works well when we need to let go of what we cannot control.
When feeling especially stressed, ask yourself if you are shining the spotlight on what you can’t control and try to light up what you can control. Often the stressful feeling itself can be a clue that you are focusing on things you have no control over. Learning to differentiate what we can and can’t control, problem solve what we can control, and let go of what we can’t, will help us find a sense of peace, reduce stress and anxiety, and leave us with a greater sense of empowerment in our daily lives.
Marcia Kaufman, Ph.D.
Licensed Clinical Psychologist
Teach Your Child to Fish
Posted by FamilyFirst Psychological Services
There’s an old proverb that says if you give a man a fish, he’ll eat for a day; if you teach a man to fish, he’ll eat for the rest of his life. This saying has tremendous relevance for parenting. As parents of children and teens growing up in an increasingly competitive world, we want to give our kids every advantage we can afford and protect them from every harm we can imagine. It’s tempting to wrap them in bubble wrap before sending them to school. The reality is that we can’t protect our children from every harm and we can’t make life always easy for them—nor should we.
The temptations to over-protect children come from a good place—parents not wanting their children to hurt. But in trying to keep our children safe, we can inadvertently set them up for difficulty. Over-sheltering children teaches kids that the world is a dangerous place to be feared, and this can lead them to be overly cautious and anxious. It also leaves them ill-equipped to handles life’s ups and downs. How will a child learn to stand up, dust herself off, and try again if she never falls off the bicycle? Some kids who are overprotected internalize a sense of inhibition which prevents them from appropriately exploring the world, trying new experiences, and engaging fully in life. Another common secondary effect of over-protecting is an autonomy-seeking teen who rebels against the bubble wrap, exploring the world with wild abandon. Either way, the outcome of over-sheltering children is generally not what parents were aiming for in the first place.
Similarly, over-functioning for our children can lead to undesirable outcomes. In an effort to help our child rise to academic challenges by helping them with every math problem, designing every poster, and coordinating every school project, we may forget that the point of all the homework and projects is that the child learns to do them himself. The key to helping and not handicapping your child is to provide only as much scaffolding as he needs. If your kid looks at his project and says, “Wow, Mom! You did a really good job on this,” then you’ve gone too far. When the job is done your child should feel a sense of accomplishment and have learned or improved skills.
It is important that we teach our children to be independent and resilient. The training we give them as children sets them up to be self-sufficient adults. If we don’t allow them to fail sometimes as kids, they will be rocked by the experience of failing as an adult, when they don’t have the safety net of home to catch them when they fall. Teach your children to fish, and they will be able to provide for themselves as adults.
Melissa K. Hunt, Ph.D.
Licensed Clinical Psychologist
Helping Children Cope with the 10th Anniversary of 9/11
Posted by FamilyFirst Psychological Services
For most people, they will never forget where they were or how they felt in those first few hours and days following the attacks of 9/11. With the ten year anniversary approaching, strong and varied emotions seem to be resurfacing for many individuals. While emotional reactions are expected and completely normal in response to such a horrific event, it is important to consider the impact our reactions as adults are having on our children. The American Psychological Association has an area of their website dedicated to the 9/11 Anniversary and children: http://www.apa.org/helpcenter/september-anniversary.aspx.
On their website, they provide an excellent discussion guide written by Robin H. Gurwitch, Ph.D., for parents and educators about how to best handle discussions concerning the attacks of 9/11 and terrorism. The guide offers a TEACH model which stands for Talk, Express, Act, Connect, and Help, which is only briefly outlined below. Please visit http://www.apa.org/news/press/releases/nick-news.pdf for the full document and for more extensive information.
Talk
Encourage discussion
Ask about any worries or concerns
Listen to what your child tells you
Offer Patience and Empathy
Share your own thoughts and feelings
Express – Understand that everyone reacts to stressful events like 9/11 in individual ways. Also, research has suggested that watching traumatic events on television can be associated with emotional reactions, so even children who weren’t even born or too young to remember the attacks will be witnessing the same visual stimuli that we adults witnessed ten years ago as media attention intensifies over the next few days. Help your child by encouraging them to share their emotions and thoughts, including any spiritual questions, and by monitoring any changes in their behavior or physical condition.
Act – Some children may need to take action so they can feel safe and comfortable. Some actions you and your family can take include:
Establish an Emergency Safety Plan
Encourage Regular Routine During This Emotional Time
Set Realistic Goals Concerning the Future
Keep Health and Wellness in Mind
Connect – By reaching out to others after tragedies, we often feel more connected to each other, which can lead to feeling safer because we begin to see the best in people rather than the worst. Connecting children with various emergency personnel who can educate them about their jobs may help some children feel less stress about their immediate surroundings because they learn there are a wide range of people who are often ready and willing to help.
Help – Helping others often promotes good self-esteem and can empower children. Volunteering is an excellent way for children to get involved in their communities.
One last word on the subject, while it is important to be open and honest with our children it is also important that we protect them; therefore, it is suggested that you monitor your child’s media exposure over the next few days. Also, be sure to let them know that news broadcasts on the television and internet are replaying old footage and that the events are not actually happening in real time.
Mary Kathleen Hill, Ph.D.
Licensed Clinical Psychologist
Should an Eye Exam Be on Your Child’s Back To School List?
Posted by FamilyFirst Psychological Services
Vision plays an important role in successful academic performance. Vision is the ability to understand what one sees, and is a learned process. A large portion of learning happens visually in traditional classroom settings. When I ask parents about their child’s vision I often get responses such as “His routine eye exam was 20/20.” It is important to understand that a routine eye exam only measures how well one can see the eye chart, meaning certain sizes of letters that can be seen at 20 feet. It does NOT detect other vision problems that can interfere with learning. Specifically, a typical routine eye exam can’t detect problems with eye movement control (needed for tracking along lines as one is reading/writing), focusing near (needed for copying from the board), maintaining visual focus (needed to keep up with the material being learned and prevents the eyes from fatiguing), eye teaming (needed for the eyes to work together), and depth perception (needed to accurately judge distances of objects).
It is important to identify the symptoms that could signal a possible vision problem. Some of these are listed below:
• Frequent loss of place when reading
• Takes much longer doing homework than expected
• Skips words or repeats lines when reading out loud
• Has short attention span when reading and doing schoolwork
• Reverses letters such as b’s and d’s
• Omits or substitutes small words like “of” for “for”
• Frequent eye rubbing or blinking when reading or doing schoolwork
• Problems catching or hitting balls
• Clumsiness with physical activities
• Avoids reading
• Complains of eyes being tired easily
• Poor posture when working close
• Complains of blurring or double vision when reading or writing
• Squints when doing near work
• Poor reading comprehension
• Fails to recognize the same word in the next sentence
• Holds books or other homework materials very close when reading/working
Many students’ visual abilities are under-developed and thus not up to the level needed to face the learning demands of classroom situations. If your child has a history of struggling with reading and learning, a comprehensive eye exam by a Developmental Optometrist is warranted.
Such an examination will determine whether poor visual skills are interfering with the learning process. Lastly, the above listed symptoms could also be indicative of other learning challenges that can be assessed in a comprehensive psychoeducational evaluation. Refer to our test services page for more information.
Maria Kanakos, Psy.D.
Licensed Clinical Psychologist
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