How to be happy for others, even when you’re unhappy

In a recent blog post, I listed 10 qualities of mentally healthy people. One of the qualities that I mentioned was the ability to be happy for other people, whether we are happy or not.  

I completely understand that this is difficult, and it’s something that most of us have struggled with at one time or another. Being happy for other people, though, is good for our own mental health. It takes us out of our own head and allows us to focus on something besides our own thoughts, feelings, and   problems. Being happy for others, and expressing it to them, also grows our relationships. It’s important for others to know that we care about them and their lives, including what gives them joy. Most people want to be happy for others, but sometimes it’s hard, especially if your own life is full of challenges, and your own happiness seems out of reach. 

I chose to write this blog now because I know the holidays can be hard. It’s a time when many people do feel happy, and they love sharing their photos and experiences with their family and friends. Being happy for others can be especially tough at this time of year. Maybe your best friend gets engaged over the holidays and you feel lonely. Or you would like to have children, and you receive a holiday card with a picture of your friends and their children, smiling, and having a great time. It is possible to achieve genuine happiness for others and to become a part of their joy. Here are some suggestions.

Feeling happy for others doesn’t invalidate your own struggles

When we feel sad, anxious, and dissatisfied with the status of our lives, it’s easy to get stuck in those feelings. But it is possible, and mentally healthy, to experience both negative and positive emotions at once. Sharing in the happiness of others doesn’t change our own circumstances or emotions, but it can give us a break from them. Take some time to celebrate the milestones of friends and family, even if you don’t feel celebratory. Most of the time, our loved ones do not expect us to be euphoric over their happiness when we are having a hard time. But we may be surprised at how our mood can change when people we love are doing well.       

Reflect on how things change over time

Spend some time thinking about what others have gone through. Most people are not constantly happy nor do things always work out for them. In fact, feeling happy for the successes and joys of others can remind us that circumstances change. At least some of our friends and family have probably gone through hard times as well. Seeing how the lives of others change over time can be encouraging. The friend who was unemployed now has a new job. The sibling that was single has found a partner that makes them happy. Even though the happy news of others is not about us, the ways that the lives of others change gives us hope for our future. 

Challenge negative thoughts regarding the happiness of others

When it’s been a while since we’ve had happy news to share, it’s easy to get into a negative spiral with our own thoughts. But this makes it harder for us to be happy for others, and it ultimately doesn’t do us any good either. For example, we may think that some people have all of the good luck. Or we may wonder how others are able to get things they want when it feels like our own life is always challenging. Not only do these thoughts prevent us from being happy for others, they keep us stuck with a negative cycle in our own head. We must catch ourselves in this spiral and offer alternatives that are healthier. For instance, we can say things like “my turn is coming“ or “It’s good to see things work out.” Generate thoughts that get your brain out of the spin cycle of negativity. 

Express happiness to your friends out loud

Even if you’re not sure you’re feeling up to it, call your friend to congratulate them for their good news. Send a text to thank someone for the lovely holiday card, even if it reminds you they have a family you don’t have yet. It isn’t necessary to make a grand gesture if you’re not feeling up to it. But a small gesture to let them know that you care about their happiness and well-being will accomplish both the goal of strengthening your relationship and reminding you that good things come to us in time. 

Being happy for others does not and should not take away our own pain and suffering. But it’s important to keep exercising that muscle to keep our emotions balanced and to preserve healthy relationships. 

Photo by Dominic Sansotta on Unsplash

This blog was originally posted on psychologytoday.com on December 9, 2022. https://www.psychologytoday.com/us/blog/trial-triumph/202212/how-be-happy-others-even-when-you-re-unhappy

How to be more resilient: Five ways to bounce back from hard times

Everyone faces adversity during their lifetime. We live in a world full of challenges and obstacles to overcome. Some people face more adversity than others, though, and it can become hard to make sense of these disparities. However, we can shift our focus away from other people towards overcoming our own obstacles and channeling our experiences into personal growth. We can become stronger, and we can refuse to let hard times keep us from reaching our potential in living our best lives. Below are five ways to keep fighting the good fight and build your resilience when the going gets tough.

1. Declare that life is not fair. You probably already realize this. But it’s important to say it out loud and keep it in the forefront of your mind when you’re going through a trial. Some people seem to never struggle, and some people get everything they want. Ruminating on this fact will not help you conquer adversity. It will perpetuate the cycle of negative thinking and lead to a cynical attitude. Accept that life is not fair, but that things often do work out with time and effort.

2. Rethink how you feel about adversity. If you’ve experienced what seems like more than your fair share of adversity, this will be difficult. But thinking about adversity as the means by which you grow stronger, build resilience, and learn how to problem solve will decrease your fear of struggles in the future. If you aren’t afraid of what the future holds because you have the tools and the attitude to boldly face it, it becomes less daunting. You then have the agency to take adversity on with optimism instead of telling yourself you can’t handle it.

3. Collect your resources. Everyone has coping mechanisms that work best for them—people in their circle they can trust to support them, and personal attributes that help them get through dark times. You may not know your own capacity, so give some thought to what your superpowers are. For example, maybe you have a great social support network that you can access, or you make friends easily and can increase your support system. Perhaps you are athletic or physically strong, and that allows you to be healthy and alert. Maybe you have great analytical skills. Everyone has strengths they can access and build on. Finding yours during hard times will improve your self-confidence and empower you.

4. Reflect on past challenges that you have overcome. Remembering how you’ve gotten through difficulties in the past and how you navigated them can be a helpful tool and give you more hope and courage. If you find yourself struggling in ways that you’ve never experienced or to a degree that you haven’t faced before, it can still be helpful to reflect on things that you’ve conquered big or small. You want to remember that you have agency, and that you can persevere.

5. Identify something in your life that is stable/positive. Even during dark times in life, there is almost always something that we can count on. It may be a relationship with a relative, friend, or partner. Perhaps it’s a job that we love. It could be a secure home or living arrangement. Maybe it’s even a hobby that we enjoy. Remind yourself of the things that you can count on when there are a lot of changes going on around you or you are uncertain about the future.

Many of us have gone through circumstances where it feels like the only thing to do is raise the white flag and ask for mercy. You don’t feel like you have an ounce of strength left, and you want to ignore the world and pretend it’s not happening. Remember that most circumstances are temporary, and even if they include a permanent change, you can find the strength and resources to grow and evolve. You’ll never learn how strong and resilient you really are until you face adversity. Instead of hiding under the covers, change your mindset and tell yourself that you’re ready to go.

This blog was originally posted on psychologytoday.com on Nov. 7, 2022.

https://www.psychologytoday.com/us/blog/trial-triumph/202211/5-ways-bounce-back-hard-times

Photo by Kristjan Kotar on Unsplash 

Five Things You Should Know About Depression

Because the prevalence of depression and mood disorders in the United States has risen dramatically since 2020, understanding depression is more important than ever. It is necessary for those who are suffering from depression, and those who love them, to be educated about the symptoms, the best practices for treatment, and how loved ones and their community can support them. Below are five important facts to know about depression.                            

1. Not everyone who is depressed cries or has tearful outbursts. When people hear the word “depression,” the first image that comes to mind is somebody crying and continuously feeling sad. This can be true, but it is not always the case. Research shows that sadness and tearfulness are not necessarily obvious symptoms, especially for men. Many people suffer silently, not expressing their emotions. Others become angry as an outlet for their depression. The way that depression manifests takes many forms.

2. Trying to be positive does not cure depression. If you suffer from depression, or you know someone who does, you may have heard people saying how critical it is to keep a positive attitude, look on the bright side of life, or be grateful for what you have. While these statements are technically true for all of us, they can be incredibly frustrating for somebody who is suffering. Having depression is not like flipping a switch. You can’t get up one day and decide that you don’t have it anymore. Simply deciding to be positive is not the answer, and it will not make depression go away.

3. Depression can lead to physical pain and illness. Depression not only affects our thoughts, feelings, and behaviors, but it also affects our bodies. People with depression can and often do experience chronic physical symptoms such as stomach aches, headaches, bodily aches and pains, and fatigue. In some cases, chronic depression is related to worse outcomes in physical conditions such as heart disease, gastrointestinal conditions, and a compromised immune system. It does not cause these conditions but can affect how well the body tolerates them and responds to medical treatment.

4. Unless you’ve experienced depression yourself, you won’t fully understand its impact. This idea can be very frustrating for those who love and support someone who is depressed. But clinical depression is not the same experience as feeling down, having a bad week or having a negative attitude about life. It’s a mental health condition that can be serious and chronic and affect the person mentally and physically. Mental health treatment is essential for treating depression, rather than merely exercising, eating healthier, or thinking positive thoughts. Sometimes, people who have struggled with depression for decades still believe they should be over it completely and must be doing something wrong. The best thing you can do for yourself or for someone that you love is to understand that depression is a complex condition that requires intervention by a qualified professional.

5. Depression can be successfully treated but won’t be “cured.” The most evidence-based treatment for depression is cognitive therapy. Many people also benefit from medication. Therapy and medication will allow people with depression to function in their daily lives, to return to the activities they used to enjoy, and overall to feel like they’re capable of living the life they hoped to live. But treatment will not make someone permanently symptom free, and it cannot erase the mental and physical effects of being depressed.

Now that you know these five things, if you think you are depressed, you should talk to a mental health professional. If you’re in treatment and expecting to be completely well, talk to your existing provider about how your treatment is going, what you both can do to make it most effective, and understand the potential limits. Consider communicating honestly with those around you about how depression affects you, so people are aware of how intrusive and impactful depression can be.

If you’re loving and supporting people with depression, talk to your loved ones and let them know that you want to understand. Offer compassion without assumptions. Find evidence-based resources, including scholarly articles, to deepen your understanding.

Anyone impacted by depression should be open to learning more about it rather than assuming they know everything.

This blog was originally posted on psychologytoday.com on Nov. 7, 2022.

https://www.psychologytoday.com/us/blog/trial-triumph/202211/5-things-you-should-know-about-depression

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How to Stay Mentally Healthy: A Wellness Checklist

We are living during emotionally challenging times. Recently, there has been widespread discussion of the mental health pandemic. More people are seeking mental health services now, and a shortage of providers is hindering their ability to get the help they need.

I’ve been thinking a lot lately about how we can turn our attention more to prevention and early intervention. There will always be a need for mental health services, and people will need to continue seeking therapy, medication, and other resources to address their emotional challenges. However, I wonder what it would look like if we worked to stay on top of our mental health before it reaches a point where we are in a crisis.

The concept that I am referring to is “mental wellness.” Through mental wellness, we can proactively achieve better mental health and protect ourselves from reaching a crisis point that leads to a breakdown in our emotional and psychological functioning.

Below are some questions to ask yourself, and some steps to take in creating your own mental wellness checklist.

1. Assess how you are feeling right now. There has recently been talk of primary care doctors conducting mental health screenings. But you don’t have to wait until you go to the doctor to find out how you’re feeling. Are you feeling anxious or depressed? If you aren’t sure, Google “What is anxiety?” or “What is depression?” and there will be no shortage of articles and blogs to help you find out (check to make sure the source you're reading is credible). Increase your awareness of what you are feeling and the extent to which it is affecting your functioning. If you decide that you are feeling anxious, for example, rate the severity of your anxiety on a scale from 1 to 10. A lower rating means you are a little bit anxious, and a higher rating indicates greater anxiety.

2. Determine how much your emotional state affects your daily functioning. Sticking with the example of anxiety, does the level of anxiety that you experience prevent you from living your life the way you want? It may affect multiple areas of your life, so make a list of those areas and think about how each area is affected specifically by your anxiety. If there are things that you would be doing, or relationships you might pursue if it weren’t for your anxiety, make note of those, as well. Everyone experiences anxiety sometimes, same for sadness or fatigue. But the extent to which those experiences affect our lives determines whether we need to do something about them. If several areas of your life are affected by how you are feeling, it is time to act. It’s never too soon to reach out to a therapist, but sometimes it’s easier to start by talking to a trusted friend or family member. Then, you can determine if you need more help than friends and family can provide.

3. Identify your sources of social support. A big part of mental wellness is knowing that you have people who love and care about you. There may be people around you that you haven’t thought of that you could talk to, or even invite out for coffee or a meal. If you need to talk to someone about the way you are feeling, and you’re having trouble coming up with who to talk to from your circle of friends and family, it may be time to increase your social support.  If you have trouble finding a confidant, this could be an area to explore with a therapist.             

4. Think about what you are looking forward to in the future. If you don’t have anything planned, maybe it’s time to put something on the calendar. Plan to do an activity that you enjoy, or invite a friend to do something. Having experiences to look forward to on the calendar, as well as taking the concrete steps necessary to make sure that they happen, can make the harder days more bearable.

5. Think about what you need to do to take better care of yourself. Determining how you feel and how it affects your functioning is the first important step. Assessing your resources and social support and identifying things that you look forward to are additional measures on your mental wellness checklist. Once you have addressed those items, you have enough information to figure out what’s missing. Then, figuring out what to do to take better care of yourself might mean filling in the gaps. Improving our self-care looks different for all of us. Sometimes, we need to increase our social support network to feel less alone. Other times, we just need to plan ahead so that we have activities we can enjoy, so the days don’t feel like a blur and we can lead a fuller life. But self-care doesn’t happen automatically: we have to be intentional.

It is possible to proactively create a mental wellness checklist that will allow us to stay on top of our emotions and create better experiences. This does not mean that our mental health will always be optimal, because life throws us a lot of curveballs. However, it does mean that we will recognize sooner that we are struggling and we will have some tools to increase our resilience so that we can live our best lives.

If you get to the end of your mental wellness checklist and there are items that you don’t have and feel like you can’t provide for yourself, then it’s time to seek professional help.

This blog was originally posted on Psychology Today on Friday, September 29, 2022.

Photo by Aaron Burden on Unsplash.

How do I obtain effective treatment for ADHD as an adult?

Attention deficit hyperactivity disorder (ADHD) affects roughly 8% of the US population. While historically it has been diagnosed in childhood or adolescence, a growing number of adults are pursuing diagnosis and treatment. It’s never too late to find out whether or not ADHD explains your difficulty focusing, being organized, struggling to remember things, running late, or losing things. Adults with ADHD can receive treatment just as successfully as children and teens, and the relief that comes with knowing why you struggle can be transformative. But it’s important to know which treatments are most effective because there are differences in how therapy works best when someone struggles with attention.

[Are you considering whether or not getting evaluated for adult ADHD is right for you? Check out “The Reality of Adult ADHD” for more information.]

First, make sure that you are properly evaluated for ADHD. Do not assume that problems with attention, focus, and lack of organization are attributed to ADHD. Rather than asking your primary care doctor to prescribe medication first, schedule an appointment with a psychologist who conducts ADHD evaluations with adults. The evaluation should consist of a thorough clinical interview, cognitive testing to assess performance on tasks that require attention, and collateral data collected from spouses, friends, or other trusted individuals who observe you in every day life. Failure to include any of these variables in an evaluation for adult ADHD means that it’s not complete. There are many reasons why people struggle to focus, including anxiety, depression, the side effects of other medications, a chronic medical condition, or the impact of trauma. Narrowly evaluating attention as though it’s only affected by ADHD neglects the possibility of important contributing factors that may need to be addressed in treatment. Comprehensive adult ADHD evaluations are conducted only by clinical psychologists with training and assessment. You cannot get the same level of assessment done by a primary care doctor or even a psychiatrist.  

[Learn more about the value of psychological evaluations here.]

Once the evaluation has been completed and you receive a diagnosis of ADHD, or ADHD with depression or anxiety, obtain referrals for a physician with experience managing medications for ADHD. Psychologists usually have a list of trusted providers to whom they can refer clients. The options for ADHD medications are more complicated than the Ritalin prescriptions of the past. Your ADHD symptoms may not be effectively addressed with one of the more common medications. You also want to make sure that your dose is adjusted for what your body and brain can handle, so you’re maximizing the positive benefits while minimizing potential side effects.

Once you’ve received the official diagnosis of ADHD, therapy is an integral part of getting the results that you want. Although medication is incredibly helpful in improving attention and focus, behavior change is a critical part of living a more organized life and accomplishing personal and professional goals. Cognitive behavior therapy (CBT) is a type of therapy validated by empirical research that works well in managing ADHD symptoms. Talk therapy, as it is known, is usually not enough to help clients become more efficient and self-confident as they learn how to navigate life with ADHD. Most clients tell me that merely talking about their struggles with a compassionate listener falls short of making necessary changes to modify their behavior. They also say that once they leave the session, they struggle to remember what was discussed, and it’s hard for them to assess tangible progress in therapy.

In contrast, cognitive behavior therapy provides more structure to therapy sessions. The therapist and client set short term goals and there are homework assignments, so the client has tangible achievements in therapy. This helps clients feel empowered, and it gives therapy a purpose. Since one of the symptoms of ADHD is talking a lot and getting off topic more easily, traditional talk therapy does not provide a platform for tangible outcomes. While talking with a therapist to process feelings of grief over time that was lost before the diagnosis of ADHD is important, it’s equally important to come up with a plan so that clients can feel hopeful with their new knowledge of the reason behind their struggles.

Interventions to help adults who is suspect they have ADHD must be comprehensive, to include a psychological evaluation, effective medication management from a competent provider, and therapy that is goal directed. It’s never too late to find out if ADHD has been holding you back. As an adult, you can still develop the tools and strategies to improve your daily functioning and live the life you want. 

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Why shouldn’t I stay angry? Reasons to manage anger for a healthier life

Lately, everyone seems to be angry. We hear it in the lyrics of songs, from the actions of celebrities and politicians, and from citizens frustrated with our government.

Being angry is a way to make our voice heard, to fight for our rights, and to let people know that we cannot be taken for granted. It is a common belief that anger protects us and that it can be our best weapon against being treated poorly. I will admit that being angry is appealing. It feels empowering to communicate to others that you’re angry because we feel like we are taken more seriously. Before we were angry, no one listened. Nobody cared what we had to say until our voice raised and took a forceful tone. Now, people know we mean business.

While the root of our anger is often justified, the actions that follow our emotions can have harmful consequences. That’s what makes anger a tricky tool to use in our relationships with others and in fighting for our rIghts. Often, it seems like a good idea when we are feeling angry to act on it, but later we have regrets. Or, even if we don’t, others let us know how our anger has affected them or our relationship with them. Below are some factors to consider when determining when and how to express your anger. It’s important to remember that anger is not a bad emotion, but depending on the way that it is expressed, it can either result in good outcomes or extensive damage.

Reflect on why you are angry

There are lots of reasons to be angry, both in our personal lives and in the world at large. This does not mean that we have to be angry about them, though. Anger becomes less meaningful when we use it as our reaction to everything we find upsetting. Because anger can be empowering, letting us know when something is not right, either in our world or in society, choosing carefully what to become angry about protects its value. For example, yelling at the barista because they got your beverage wrong may not be worth your anger, whereas getting angry at your partner because they aren’t considering your feelings in a big decision is important to get angry about. When we weaponize our anger over many small things, it becomes our default reaction. Others may not take us seriously because they perceive us as being angry frequently, and we walk around feeling emotionally triggered. Thinking about the best reasons to be angry is what truly gives us power. We are in control of our anger, rather than it being in control of us.

Understand how anger affects you physically and emotionally.

When we are triggered and we become angry, it can happen quickly. Before we know it, we’ve lost control and we are emotionally reactive. Many people say they are exhausted after having an angry outburst, experiencing fatigue, headaches, a racing heart, elevated blood pressure, and higher body temperature. They may also be tearful, feel sad, have regrets about their reaction, or be anxious about what happens next. Understanding how our body and brain respond to intense anger is important for our physical and mental health. There are circumstances in which it is important to acknowledge that something has caused us to be angry and to identify what that is. In those moments, before you react, take note of how you’re feeling physically and identify other thoughts and feelings that you were having. I call this being “mindfully angry,” and it can make the difference between using anger well versus letting anger take control. If you can do this, you may not experience the physical and emotional aftermath of uncontrolled anger.

Understand how your anger affects others

While we all have the right to become angry, and we know that anger is an important emotion to acknowledge, anger that becomes uncontrolled can be toxic not only to you but others around you. It is critical to understand that our emotions are not only about us, but they affect our relationships with others. While others’ opinions of us should not dominate our thoughts, they do matter to the extent that we want healthy relationships. When we are angry with others, we need to think about how to effectively communicate our feelings to maximize our chances of being heard and understood. Too much intense anger often leads to others shutting down and neither wanting to continue to listen to us nor seeking a better understanding of our perspective. 

The bottom line is that we can be attuned to our anger without letting it escalate to a level that affects us physically and emotionally. And we can let others know that we are angry with them without it negatively affecting our relationships. Anger doesn’t have to be intense for us to get our point across, nor does it have to fracture our relationships to resolve our conflict. Anger can be done well when we stay in control.  

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10 Characteristics of Mentally Healthy People

People keep asking me what it means to be mentally healthy. Previously, I have discussed things we can all do to achieve better mental health, but people want to know what it looks like when they get there. While this looks a little different for everyone, there are some common characteristics of people who are maintaining good mental health and building resilience.

10. You wake up every day and feel grateful about something. When you are having a bad day, or a bad week, you can look around you and observe other people being happy. It can be hard, in times of suffering, to acknowledge things you appreciate. But the ability to think of at least one thing for which you are grateful on a daily basis is a sign of resilience. It is a sign that you are driven to appreciate the good things or the good relationships that you have. Acknowledging these can improve your mental health if this is a regular habit.

9. You have something that you look forward to doing or experiencing. Maybe you have an event coming up with friends, or a vacation, or something as simple as a quiet night at home watching a favorite movie. Planning something that you can look forward to and finding some contentment and enjoyment in it is a sign that you are seeking positive experiences, which can decrease anxiety and feelings of depression. 

8. You let go of anger and you do not spend time holding grudges against others who have hurt you. While we have all had tough relationships and conflict in our lives at some point, holding onto it can prevent us from moving on with our lives. It can lead to internalized negative emotions such as anger, sadness, and even loneliness when it prevents us from finding other friendships or relationships. If you can successfully let go of anger and stop thinking about those who have hurt you, you are more likely to have peace in your life and achieve good mental health.

7. You enjoy the simple things in life. People who tend to maintain good mental health can have positive experiences doing simple things, like going for a walk in nature, laughing with friends and loved ones, or listening to good music. You can appreciate every experience even if it’s not exciting or elegant. 

6. You keep trying when the going gets tough. It’s difficult to stay motivated when you’re going through tough circumstances. You start to run out of energy and you lose hope. But people who are mentally healthy can generally keep going when the going gets tough, and sometimes that even makes them more persistent. 

5. You help others around you. The mentally healthiest and most resilient people are not self-focused. Even when your own circumstances are questionable, you continue to reach out to others and provide support as best you can. Depending on what’s going on in your life, you may not be able to do big things to help others, but you are always concerned for others and try to lend a hand. 

4. You take care of yourself. Mentally healthy people care about others, but not to an extent that you no longer maintain good self-care. You make sure your own needs are met because you know this allows you to be more available to help others and to be present in your relationships.

3. You have good boundaries in your relationships. Knowing when to say no, and knowing when to give yourself some space allows people who are mentally healthy to stay that way. It’s possible to be helpful without violating your own sense of space and privacy.

2. You are not envious of what others have. You don’t spend time comparing yourself to others or to what others have. You focus on what you want and what is within your reach.

1. You can be happy for others, even when your own life is challenging. The capacity to be happy for others, and to let them know you are happy for them, is an important aspect of mental health. It means that you can look beyond your own struggle or pain, and you are happy for others regardless of what is going on in your own life. 

Some of these characteristics may seem hard to achieve. Some of us have grown up in families where negativity, conflict, and fear are a constant fixture of life. It’s not always easy to shake those cycles and start our own new habits. Learning to reframe our thinking and be present to enjoy what’s around us are great skills to acquire as we strive for the best mental health.

This blog was original published on the Psychology Today website on June 17, 2022.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Image @mcreynoldsphd using Canvas

How psychological evaluations clarify complex diagnoses in adults

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

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

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

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

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

ADHD Among Adults

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

PTSD

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

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

Photo by David Travis on Unsplash