Adolescents, Teens, Depression & The Warning Signs

By Concentric Counselor Katie Ho, LPC, NCC

At a time in life when the only thing certain is constant change, recognizing and being aware of depression during adolescence can be a challenging feat without the knowledge of warning signs and risk factors. Mental health and the seriousness of depression continue to be topics of conversation following the headlines of national news and tragedies - but an equally, if not more urgent conversation is the one that needs to be started at home. The pressures of adolescence and impact of today’s culture of social media appearances and limited interpersonal connection only reinforce the need for education and awareness on depression. Parents and caregivers can provide their support and intervention through having the skills and knowledge to address their young person’s greatest mental health needs.

The answer to why we should talk about depression with teenagers is becoming more clear as the topic continues to be normalized, de-stigmatized and commonplace in the discussion of healthy emotional development; but the answer of how is where the light could shine a little brighter. How do you initiate a conversation around feelings, emotions and concerns of your child or loved one’s changes in mood and psychological health? How do you create a safe environment that fosters and promotes honest, sometimes uncomfortable dialogue about profound sadness or even thoughts of self-harm or suicide? Many of those answers involve one important action: listening.

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In order to fully understand and be prepared for a conversation around your young person’s mental health, it’s vital to know the warning signs and symptoms involved with depression during adolescence. These characteristics can be different than how they typically manifest in adults, and can oftentimes be mislabeled as expected changes during a new phase of life. It’s important to distinguish between depression and normal sadness. Depression can consume their day-to-day life; interfering with the ability to work, eat, sleep, study and have joy. It can involve feelings of helplessness, hopelessness and worthlessness with little to no relief.

Here are some signs and symptoms of adolescent depression:

● While some individuals may appear sad - many and most appear irritable (unrelenting)
● Negative view of self and/or the world and future
● Withdrawal from family and friends (isolation)
● Anger/Rage
● Overreaction to criticism
● Excessive sleeping
● Significant change in appetite
● Increased reckless or impulsive behaviors
● Substance use or acting out in an attempt to avoid feelings
● Violence
● Running away

If you suspect your teenager is struggling with depression or begins showing signs of concerning behavior, finding the time, the patience and the space is the first step in creating an environment for an honest discussion.

❖ Remember the value in listening over lecturing: initiating a conversation about emotional pain or hardships means being willing to hear their truth without judgment or criticism.
❖ With unconditional love will need to come unconditional support; let them know you’re committed to helping them fully and in a way that respects their experience, choice and voice.
❖ Be gentle, but persistent - if your teenager claims nothing is wrong, but is otherwise unable to explain the concerning observations and behaviors, trust your intuition and consider options for getting them to open up. The most important goal is to get them talking - whether it’s to you or to a reputable third party, give them the resources and options to share with someone they can trust.
❖ Validate their feelings - always. Try to avoid talking them out of their feelings or giving them an alternative perspective in which to view their experience. Acknowledging and communicating that you believe and hear them will foster trust and empathy. In combating adolescent depression, it can be effective to take a holistic approach - making their physical health as much of a priority as their social and emotional health. Encourage movement!

Physical activity can be incorporated in a number of ways, whether it’s a sports team, individual activity, dance class, walking the dog or riding their bike - all movement is good movement! Healthy, balanced eating and limited screen time are essential requirements for anyone’s lifestyle, but particularly those in adolescence. These items can also be partnered with the important aspect of positive interactions with family or loved ones. Sharing a meal or spending quality time can help that young person feel connected and valued.

Should the need for professional help and intervention be determined, be sure to involve your teen in those decisions. Respect their thoughts and opinions, and talk openly about their options for treatment. It may be a struggle for them to feel connected or comfortable talking with a professional, and collaborating with them on identifying someone who could meet their needs may help to bridge that gap. Depression and recovery can feel scary to both parent and child, but having open conversations with clear understandings of love, validation and support can make helping them more manageable so that they can live their most meaningful life.

A Therapist's New Year's Resolution

By Concentric Owner & Counselor Jennifer Larson, LCPC, NCC

In only a few more days, 2017 will come to a close.  It will be a time to think ahead – many will ignite their New Year’s resolutions.  While I may not routinely come up with New Year’s resolutions, I do think about and write down my personal desires and goals throughout the year.  And, I have decided that I will come up with a New Year’s resolution for 2018.  Before I share my resolution, I would like to share part of my roadmap that has led me to this juncture.

As I have engaged in reflection, I found myself returning back to a perpetual theme that would emerge and re-emerge over this past year.  One particular theme is what I will name as the ‘non-self-disclosing' therapist vs. the 'self-disclosing' therapist wrestling match.  I have no idea when the sport of wrestling season begins and ends, but I can tell you this particular wrestling match has persisted season after season. And, my hope for 2018 is the self-disclosing therapist will take the lead and possibly bring the wrestling match to a close someday soon.     

Let’s start back when these 2 wrestlers first met.  Perhaps they were both first introduced way back when, before the days of graduate school as 'non-self-disclosing' me vs. 'self-disclosing' me.  In my formative years, I grappled with how much to disclose and how much not to disclose my vulnerabilities. And if I did, I chose wisely with a very select few.  Some would say this is normal as we need privacy and boundaries while others may offer a difference of opinion.  Now, let’s fast forward to when I enter into graduate school where I am confronted again with choosing and deciding on how much to disclose.  This time it is focused more on me as an emerging therapist, not me personally.  In the earlier stages of education, students learn about various theoretical orientations and the relevance and implications of non-disclosing and disclosing to one’s clients. 

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Just after the start of the millennium, I recall being enthralled with the tug-of-war game that was played during a semester course on ethics.  Our instructor was instrumental in leading the charge on getting all of us graduate students to really explore how to handle ethical dilemmas that can and will mostly likely confront a professional counselor, social worker, or psychologist.  Depending on the topic, some students would sinuously form into 2 teams, tugging and vying for one end (yes, it’s okay to self-disclose to a client; yes, it’s okay to hug certain clients upon closing a session), while the other group pulled and vied in the other direction (no, it’s not okay to self-disclose and hug a client). It was one of my favorite graduate courses as our professor and the course curriculum gave us the space and freedom to think critically and to share our perspectives and beliefs.  Some topics called upon us to unequivocally unite together whereas other topics had students participating in the game of tug-of-war, and well some (ahem) left all of us pooling together in the middle, gray area -- scratching our heads saying, “It just depends, it’s not so black-and-white.”    

Does a therapist merely act as a ‘blank slate’ allowing for one to free associate more easily? Or does a therapist offer some disclosure about their experience and feelings in relation to one’s client (countertransference)?  As therapists, do we divulge some our personal, relatable experiences, such as, “I share the same fear of heights as you do – here are tools that have been helpful to me.”  To disclose or not became even further embedded post graduate school during professional training courses and consultation. And for good reason, this particular topic warrants so much attention in the world of psychotherapy.  I understand the clinical relevance and implications – I get it. 

Over the past 15 years with greater professional and personal life experiences, I have found myself continuing to think about the inquiry of the self-disclosing therapist. At times, I have put forth a tidbit of self-disclosure when I believed it to be ‘clinically appropriate’ or when it simply felt right.  The self-disclosing therapist is not uncommon for some psychotherapists, and it's probably still one of the more debated issues in the field.  Over the past year or so, the inquiry in my mind has expanded beyond the closed doors where therapist-client, supervisor-supervisee, and consultant-consultee relationships are formed, maintained and evolve.  

Questions continue to knock on my door, such as, do I as a therapist share my story (or stories) with others publicly?  Is there value in therapists who choose to open up in a more public forum?  How about us therapists taking our practice even further by exercising vulnerability and using our voice through other outlets?  Are age and credibility in the field some of the salient determinants when choosing to publicly divulge as a professional?  What is too much to self-disclose in written form? Could casting a wider net be detrimental to a therapist’s profession?

While these particular questions have lobbed around in my head for just over a year now; admittedly, they have not been all ‘heady’ taking up rent in my mind.  Sometimes (and many times), I would simply experience this feeling inside of me – near my heart or gut – nudging me to share more and to share with more people.  Stop thinking so much and just take action.  Take the leap and have faith.  Even a call to duty would emerge from within as well.  But why and for what purpose?  The answers didn’t seem readily available to me.  And then over the past few months, it all became clearer.

Earlier in 2017, I learned about On The Table and the #BreakTheSilence initiative by The Kennedy Forum.  I was immediately pulled in as I loved the mission and purpose of this initiative.  Bring people together to give people an opportunity and space to talk about mental health in effort to reduce the stigma that still hovers around and shrouds the already cocoon existence of mental health. The idea is that when more people talk about a topic – in this case mental health and addiction – a positive rippling effect can ensue. 

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The more people talk about mental health…

  • The easier it will be for all of us to talk about it. 
  • Better yet, the easier it will be for all of us to talk about it without feeling shame, crazy, or embarrassment. 
  • The more we will feel safe and free of judgment.

The more people talk about mental health, the more…

  • People will seek out help. 
  • We will honor and view mental health as another facet of humanity and life, just as we do with other areas, such as our physical health. 
  • We will advocate for change across cultures, families, and even within the helping professional field. 
  • Opportunity for positive changes within the health care insurance industry.

The continual, cascading effect.  The more people talk about mental health and addiction…

  • The more we will become intimate and experience love.
  • The more we will be empathic and compassionate.
  • The more we will be more understood and connected.
  • The healthier we will all become and the more lives will be saved.

Who doesn’t want to experience these things for themselves and others? 

Concentric Counseling & Consulting hosted its first On The Table Discussion on May 16, 2017.  The turn out and experience was inspiring and moving. We even shared people’s stories, experiences and solutions for people to read in our blog.  However, the Concentric’s therapists served as hosts and guides – we were not active participants in this discussion.  No self-disclosing.  This is not a terrible thing, but the knocking on my door didn’t go away.  Should we have re-considered actively participating in this dialogue?  Sharing would mean ‘more people’ talked about mental health and addiction, right? 

There have been other initiatives and movements this year, including one of the more recent ones that started in October 2017. The #MeToo movement gained momentum and traction which has given people collective permission to break free of the shackles that have promoted and reinforced silence, inequality, sexual harassment, discrimination, and assault, shame, and for some, the cocoon existence of mental health. The #MeToo movement encouraged women to share their stories in effort to give people permission to break their silence to unite and to bring greater awareness about the prevalence of sexual misconduct.  The more people talk about their experiences and hardships, the same effects will occur as with the more people talk about mental health and addiction.  Movements like these promote the cascade effect which in turn promote movements – a positive feedback loop. 

All of these experiences along my personal roadtrip have touched and impacted me.  And, while I recognize that I am helping people, I have also recognized that choosing (more times than not) the non-self-disclosing therapist may just not be as helpful.  I believe in the importance of using one’s voice, honoring one’s experiences with integrity and respect, and I want to help become a part of the bigger picture.  I want to talk more about mental health and addiction publicly in effort to help achieve with many others a positive cascade effect.  It won’t be easy for me, that I know. Truthfully, I am not quite sure where to start, what I will disclose about and which platforms to traverse.  What I do know is I now have a clearer understanding of the persistent themes that knocked on my door.  My deeper desires and hopes for all by talking about mental health.

So, my New Year’s resolution for 2018 is for me as a therapist is to start leaning in, to become more of a self-disclosing therapist by sharing more publicly some of my own mental health challenges and triumphs.  Happy New Year Everyone! 

Simple Meditation Steps For All Ages

By Concentric Counselor Michelle Taufmann, LCSW

These are the instructions for the basic meditation on the breath that I teach clients. Meditation on the breath is a simple, classic form of meditation that has been used for thousands of years to strengthen one’s focus and ability to sustain full awareness.

First, sit on the floor on a meditation pillow, or in a chair. Sit in a comfortable position with your back straight, but not rigid. If you are sitting in a chair it is best to sit forward with your back away from the back of the chair (rather than leaning back into the chair). You want
to assume a posture that facilitates being alert, yet relaxed. Next, close your eyes, or if you prefer, lower your to a gaze about a foot in front of your feet on the floor. The purpose of closed eyes (or lowered gaze) is to remove visual distractions from the field of perception. Now, take a moment to relax your head, neck, shoulders and arms by rotating them, tensing and releasing them, and/or shaking them out; these parts of the body tend to hold a lot of
tension.

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You are now ready to begin the meditation on the breath. Start by noticing your breath as it comes into and out of your body. The experience of the breath coming into or out of the body is most noticeable in the following areas of the body: at the nostrils (the sensation of the breath going into and out of the nostrils), at the chest (the sensation of the chest rising and falling, and at the abdomen (the sensation of the abdomen rising and falling). Choose one of these areas on which to observe the breath. It usually works best to choose the area of the body where the sensation of breathing is the strongest for you. Now, simply attend to the breath. Think of it as being present to the experience of breathing. Your attention on the
breath should be light; you do not want to concentrate or think about the breath.

Once you have stabilized your attention on your breath, sit in this way for the designated amount of time. Ten minutes is the recommended amount of time for beginners. If you are like most people, you will fairly soon notice that your mind has wandered. When you notice
this, gently let go of the distraction, whether it is a thought, sound, or  internal sensation, and bring your attention back to your breath. Continue in this way, returning your mind to your breath each time you become aware that it has wandered. Remember to do this with
patience and gentleness.

Try not to become frustrated or judge yourself if your attention wanders frequently. Frequent mind-wandering is normal and to be expected, especially for beginners. Becoming frustrated or judging yourself for not being able to sustain attention on the breath is simply further distraction from your meditation practice and should be dropped as quickly and gently as other distractions are dropped during your practice. 

With practice, mediation of the breath will strengthen your focus and ability to sustain full awareness.