Tag Archives: Mental Health

Helping Teens with Their Mental Health

Therapy doesn’t come without resistance, especially when you’re dealing with a teenager.  It can be very difficult to get a teen on board with therapy because there’s usually a lot of defensiveness.  I want to discuss a handful of reasons why teens resist treatment:

1. Social stigma.  Anything associated with therapy or mental health issues is a little bit of a taboo.  Kids worry about people pointing their fingers and saying they’re crazy. 

2. Rebelliousness.  No matter what you suggest, some kids will just go against you because you’re an authority figure to knock heads with. 

3. Poor insight.  Teenagers have a limited capacity to look at themselves honestly or realistically.  They often don’t understand how their behavior or problems are affecting them.

4. Fear.  They’re afraid of being “crazy,” that others will perceive them as such, or that they can’t get better.  They also may be scared to death of having to take a deeper look at themselves or their problems.

5. Embarrassment.  They’re embarrassed that they can’t straighten themselves out, and therefore, accepting help from others can be difficult.

6.    Facing their problems may be too painful or overwhelming. 

7. Misconceptions.  Most teens don’t know how psychotherapy works, and they’re worried about what will happen if they admit to things.  They don’t know that the therapist cannot give their parents the information (therapist-patient laws prohibit that, even with minors).

8. Concealment. They don’t want to admit that they’re hiding something – cutting, abusing drugs, etc.  

9. Holding on.  This is what my book, Bad Childhood – Good Life, is all about.  They’re holding on to the drugs or other habit.  They’ve become so dependent on a way of thinking and behaving that it has become their identity.  They’re scared to death of giving up their self-protective mechanism of hiding from reality because it means they will be stripped naked in their own mind, and that’s pretty scary. 

10. Unworthiness. Some kids get so beaten down and depressed that they don’t feel like they’re worth much or that anyone would care about them. 

So, those are some of the main reasons kids resist treatment.  But the question still remains: How do I get my child to attend therapy?

First off, don’t trap them.  For example, don’t say you’re going to the mall and then drop them off at a therapist’s office.  That doesn’t work well.  There are two really good techniques I have always suggested to parents:

1. Make it a team effort.  Say something like, “You know, you and I have been fighting a lot lately, and there’s just so little happiness in the house.  So, I’m thinking if you and I went into counseling together, maybe a therapist could help us sort all this stuff out and make things better.  You’ll be happier and you’ll be able to do all the things you used to enjoy and probably miss.  I’m not sure how to make things better myself, but a therapist could help us work it out.”  That way it’s not, “You wacked-out kid, I’m putting you in therapy because I can’t stand it anymore.”  Make it about how “we” – you and me – can’t figure it out and that you need to get somebody who can help. 
 
2. Make a definitive statement (e.g. “I’m going to schedule the appointment so we can sort it out together”) and then talk about it in the days before the appointment.  For example, say, “Are you a little nervous about the therapy?  Because I am.”  If you tell your kid that you’re having apprehension about the therapist saying you didn’t do everything right, they are going to look at you and think, “All right, this is more even-steven. It’s not only about me.”  The fact that you are both feeling discomfort will be comforting to them. 

When they start therapy, tell your child you want them to go to four sessions, and then after that, you, your child, and the therapist will discuss if there is more to do.  During the first session, your teen will usually be angry.  I remember I used to have so many kids come in to my office and just sit there and glare at me for an hour: “Is it over yet?!”…”Is it over yet?!”…  The second time they come in, there will typically be a little less anger and more movement toward talking about their pain.  At that point, a good therapist will say, “You know, last week you were pretty angry about having to be here, and I don’t blame you.”  The kid is immediately going to be surprised: “She doesn’t blame me?!”  Being forced to do something you really don’t want to do and open up to a stranger about very painful things (which you really don’t want to do), is hard.  However, a good therapist will make your teen feel like they’re not being forced to do any of that, and instead, simply help them be happier and figure out their parents better.  Slowly but surely, by the third and fourth sessions things will be less forced and more about reducing the pain. 

While your child is in therapy, the family has to be very supportive at home.  They should never ask what happened in therapy – that’s none of their darned business!  Instead, it should be all about subtle reinforcement (e.g. “You seem more creative and relaxed right now, and I think that’s wonderful”).  Remember: a hug and a kiss can go a long way.

Stop Putting Off Your Procrastination Problem

The definition of procrastination is putting off something that was planned or scheduled.  Statistics indicate that most people procrastinate.  At least 20 percent of the population calls themselves chronic procrastinators, and according to some researchers, procrastination has more than quadrupled in the last 30 years. 

I think that more and more people have become accustomed to procrastination in recent years for the same reasons that fewer men are going to college and fewer young adults are becoming autonomous – very little is expected of them anymore.

When we were in the era of responsibility, obligations were taken seriously.  Very few people procrastinated because there were consequences for doing so.  However, people today are hardly ever held accountable for anything, especially teens and young adults.  It used to be that if you had an 8-to-4 job, you arrived at your desk at 8 ready to work; you weren’t stumbling through the door at 9.  A lot of young people don’t get that, and then wonder why they are having such a tough time getting jobs.  It’s not just because of the economy – there is simply a lack of respect for young adults in the business world today because they lack commitment, work ethic, diligence, focus, and pride in what they do.

In addition, advances in technology have come at the cost of reducing many people’s effectiveness.   Between the TV, Facebook, and the latest Blackberrys and iPads, technology is providing people with constant distractions.  And with more lazy, unmotivated people sitting around drooling into screens, it’s no wonder that the procrastination statistics keep going up. 

Another contributing factor is that there isn’t a whole lot of parenting going on anymore.  Fewer and fewer kids are spending time with Mommy and Daddy at the dinner table discussing their day.  Chalk it up to divorce or no parent staying at home, but the outcome is the same: kids get away with murder and there’s no hell to pay.  Parents are failing to teach their kids about obligations and responsibilities.  A hundred years ago, kids got up at 5 a.m. and did a whole heck of a lot of stuff before they went to school.  Nowadays, I have parents calling me up complaining about how they can’t get their kids to get dressed in the morning.  It’s ridiculous. 

As you can see, people are not born procrastinators; they are formed to be that way.  And sadly, when they become chronic procrastinators, the results can be dire.  They often experience financial failure or end up dying younger than they should because they don’t bother to go get tests.

If you have a problem with procrastination, here’s what to do:

People procrastinate for all kinds of reasons, but more often than not, I think procrastination is a kind of passive aggressive behavior: “Screw you!” “I don’t have to!” “I don’t want to!”  “I don’t feel like it!”  So, if you really want to change, stop being hostile and start acting like a responsible person.

Don’t overthink what you have to do or make things too complicated – just get started.  It’s funny how something you were initially dreading can all of sudden become easier once you start it.  If you want an example of this, just listen to some of the people who call in to my program.  They may start off extremely nervous, but once they start talking, all their hesitation goes away.   

If you feel overwhelmed by a big project, break it up into smaller chunks.  Start with the hardest part first and then take a step back.  You’ll likely find that once you’ve finished each smaller task, the bigger project isn’t as difficult as you feared.

If you don’t have the right skills to complete a project, do some research or call someone to help you.  YouTube, for example, has a million useful little videos of people explaining how to do all kinds of stuff.  I learned how to drill certain jewelry pieces I’ve worked on from watching YouTube videos.

If you don’t have the right tools, find out where you can buy or borrow them.

Set realistic goals.  What can you realistically do given your abilities?  Ask someone to help pace you.

If you’re easily distracted by clutter, your phone, or your friends, then block out time dedicated to working on what you need to get done.  I rarely have my cell phone on me.  It certainly frustrates a lot of people who want to get a hold of me at that precise moment, but when I want to sit and deal with something, I cut out the distractions.  One of the things you must do in life is prioritize.  Do what needs to be done first, not what you wish to do.  Always remind yourself of what the highest priority is.
 
If you are a perfectionist (as I tend to be), you need to learn to control your impulse to be perfect.  I remember reading about one culture which purposefully put one tiny mistake in everything they made.  I thought that was so clever – what you do doesn’t always have to be perfect to be an expression of you.

Lastly, if you are afraid of failing or taking responsibility, you need to remember that the greatest failure is sitting there like a lump of protoplasm and not trying.  Failing is an inevitable part of trying, but failing is not an endpoint – not trying is.  Failure is at least a step forward toward success.

Getting yourself organized and putting a stop to your procrastination is pretty simple.  Set a reasonable goal, give yourself a time frame, dump the excuses, and figure out a way to hold yourself accountable. In short, just make it happen.

Getting the Most Out of Therapy

Once I started becoming more “known” from my radio program and books, I had to give up my private practice.  Folks would come in for sessions and expect me to work magic in three and a half minutes.  It became clear to me that I couldn’t be as effective one-on-one anymore.  So instead, I wrote books and did my show because I thought that those were the best ways I could help people.  

However, there are times on my program when I tell callers that they need to do a little more extensive work.  I can give them a jump-start, but they need to pick up where we left off in therapy.

Therapy can be a very complicated process, and there aren’t many therapists who do it well.  When looking for a therapist, there are a few things you need to do.  First, and most importantly, you have to form a relationship with your therapist.  When people call in to my program, they generally have listened to me for a while.  This means that they have already developed a kind of relationship with me in their minds.  When you go into somebody’s office for therapy, it usually takes a while to form that relationship. Without it, there isn’t going to be trust.  Although it seems like I receive instant trust from the people who call in to my show, that’s not really the case.  Most callers have been listening to me for a long time (sometimes 20 years or more), and therefore, the trust part is pretty much all squared away. 

Your clinician also needs to be a good fit for you.  Not every therapist makes the same choices or has the same personality and expertise. For example, when I was involved in private practice, I would not deal with anyone’s insurance companies.  They paid for their sessions, and I signed the insurance papers for them to submit.  I did this because I didn’t want my fights with an insurance company to interfere with our relationship.   

In addition, I believe that your first session should be free and on the phone.  It’s not really a session – it’s simply you asking a lot of questions.  You can always look up somebody’s license and credentials, but you still need to ask them about their expertise.  A lot of people get psychology licenses of various kinds and then claim that they can do anything.  However, there are specific areas of expertise.  Make sure you ask.  If you’re nervous about asking questions, first write them down on a piece of paper.  You may be less afraid to ask them if you put them in writing. 

This process may be uncomfortable, but if you don’t feel safe and comfortable with the therapist at first, you are not likely going to meet your goals with them later. 

Personally, I think that if you are seeking marital therapy, you should ask if the therapist is divorced.  Statistically speaking, when a therapist is divorced, he or she is more permissive of divorce.  And if they’re more permissive of divorce, it may impact how you perceive your marriage.  It’s the same old thing – if other people have done it, we feel like it’s more acceptable.  So, be sure to ask if they’re divorced and for how long.

Also ask about their ethics and how they’ve continued their education.  Once you’re done asking everything you want to ask, repeat this process with three to five more therapists.  See who gets defensive and who answers your questions openly. 

I know it can be intimidating or feel like you’re being impolite, but you must ask questions.  The truth is, your therapist is your hired help.  And if you do hire them, you’ll want to be able to ask them honest questions later, such as, “I don’t understand how this is helping; can you please explain it to me?” 

Nevertheless, you must also remember that the therapist does not assume the entire burden.  Therapy is hard work, and in order to improve, you have to do the work.  It’s the same principle as playing the piano – if you don’t practice, you’re not going to play very well.  You may notice that I often give assignments to callers on my program.   That’s because change doesn’t happen in one session – it happens outside of the session.  It’s an active process.  You can’t expect to go to therapy once a week and then not give it a moment’s thought until the next session.  The sessions are important but so is your effort to reflect on the content of those sessions and apply it on a daily basis. If you don’t make progress, it could very well be your own fault.  As I’ve said many times on the air, “Hey, I’m not going to work harder on your life than you are.” 

Finally, you need to expect that at some point during therapy, things could become extremely painful, uncomfortable, or unpleasant.  There are often blockages you have to work through.  You may start placing some of your past relationship issues on your therapist or treat them as if they were your mother, father, sister, etc.  Sometimes you’ll want to quit therapy or wonder why you’re bothering to spend money to be in pain.   You might even develop a habit of arriving late to sessions as a mechanism of avoidance.  However, when you start freaking out or getting defensive, you absolutely must go back and talk to your therapist about it.  Say, for example, “After opening up to you last time about ___, I became very vulnerable.”  Really good therapists are trained to understand and deal with your concerns.   

To bring it full circle, this is why establishing an initial relationship with your therapist is important – you need to be able to discuss anything and everything.  If you don’t trust your therapist or don’t feel like they believe in you, there will be no change.  You’ll simply reenact the same patterns with them and everybody else.

Bipolar Disorder Is Overdiagnosed

In the over 30 years that I have been around in this profession, I’ve seen fads come and go.  I’ve seen agoraphobia skyrocket in numbers with counseling centers set up to deal with it, and then fade out.  And then every woman who was depressed or anxious had to have been sexually molested as a child and couldn’t remember it.  That came and went, as enough evidence indicated this retrieval of memories can’t be remembered was bogus and mostly produced by the feminist nutcases who had licenses and just told people that was it. 

Now we’re in a different kind of fad…and there are reasons for these fads.  It’s not that people don’t have disorders, but these huge increases are a bit suspect.  Now, today, everybody is bipolar.  Generally speaking, you’ll hear “this person’s bipolar, that person’s bipolar” and these diagnoses are made by somebody in 15 minutes and it’s just a mind-bender. 

To make more money for the drug companies, it seemed every kid was ADD and then ADHD.   According to research in the Archives of General Psychiatry: between 1994 and 2003, there was a 40-fold increase in the diagnoses of bipolar disorder in kidlets.  .  Some people  are saying, “Well, we just have an improved awareness of the diagnosis.” 

No. 

Others feel the diagnosis has been over-sold and is used to describe a lot of angry, explosive kids. 

In Minnesota, spending on powerful antipsychotic drugs to treat bipolar and other disorders in children has risen 17-fold since 2000 and exceeds $6 million annually…that’s just in one state.  The medical community seems to be having a reversal that has few parallels in history.  Psychiatrists are now backing away from this diagnosis.  Thousands of kids have received the diagnosis in error and there are lots of reasons: over-zealous doctors, desperate parents wanting an answer, quirks in the health insurance system and aggressive marketing by drug companies.  Dr. Stephen Setterberg, a child psychiatrist said, “Some of the doctors that got going with that early on, they sort of drank their own Kool-Aid.  They talked themselves into believing that many kids were bipolar. It essentially was a diagnostic fad.” 

The drugs they’re given are serious drugs.  They come with increased risks of obesity, diabetes, muscle spasms and more.  A child psychiatrist with Children’s Hospitals and Clinics of Minnesota said, “A substantial number of those kids, if you take them off the problem medication, those symptoms go away, and then they don’t have bipolar; they just had a medication-induced problem.”  And of course, if you give a kid the wrong diagnosis, you’re not going to get the right treatment.

If it’s bipolar disorder, it’s incurable and you’ve got to drug it so that means alternative therapies like cognitive behavioral therapies and others which have been developed for these angry, impulsive kids aren’t happening. 

Bipolar disorder has a genetic component, and it runs in families, but there’s no brain test or scan to confirm it.  I have always said the first line of defense is to look at the family.  Look at the parents: are they divorcing?  Are they drunk?  Are they violent?  Are they abusive to the kids?  Are they sexually exploitive of the kids?  Do they not pay any attention to the kids and don’t feed them and let them run around?  Kids get angry, impulsive and out of control for all sorts of reasons.  Just drugging them probably misses some of the things that could be dealt with more healthily. 

In 2001 a New York psychiatric hospital examined 120 kids who were sent there because of bipolar disorder.  To the best of their analysis in 2001, barely half might really be bipolar; the rest not. 

Now I always think “follow the money”.  The U.S. Food and Drug Administration issued a “black box” warning in 2004 on antidepressants, noting they carried a heightened risk of child suicide.  Well, that had a chilling effect on antidepressant drug use and pushed doctors toward other treatments — especially the “big gun” antipsychotics.  And so it’s driven by drugs.  The research shows a rise in bipolar diagnoses for kids matches the drug trends.  Follow the money…follow the money. 

No one believes the children mislabeled with bipolar disorder are okay.  They’re not okay.  There’s something wrong.  They have extreme tantrums, and sometimes get violent or harm themselves.  There’s definitely something going on there above and beyond a “phase”.  It, indeed, might be biological, but I don’t think that (and I never thought that) drugs should be the first line of defense.  Dr. Stuart Kaplan, who wrote a book called “Your Child Does Not Have Bipolar Disorder,” believes kids with bipolar diagnoses generally have behavior problems that require therapy, not just drugs. I think it is more benevolent to be patient and see what’s going on in that kid’s life before jumping  to very expensive antipsychotic medication, which precludes any other kind of cognitive therapy.  That’s the story.  These kids have some kind of problem, but just knee-jerk bipolar “give them antipsychotics” is not necessarily the solution at all.