teenagers – Page 2 – Licensed Mental Health Counselor

Tragic Romeo And Juliet: Teens Kill Officer Then Themselves

26 Mar 201426 Mar 2014by Torey C. Richards, LMHC

In an article I wrote previously Are You In Tune With Your Teenager, I discussed the importance of parents engaging their teenagers in conversation and actually listening to what they have to say. So many parents simply do not listen to their teens and in this one incident in particular, it proved to be deathly.

Last week, in Windermere, Florida, a very small town just outside of Orlando, 18-year-old Brandon Goode and 17-year-old Alexandria Hollinghurst, two troubled teens in love from Davenport, Florida, decided to run away together. They were both suicidal.

Alexandria seemed to have been suffering from depression while Brandon may have suffered from any number of mental issues (in 2012 his mother called the police reporting that her son had painted his face black and was threatening her with an axe).

Their relationship seemed to be as unstable as the typical teenage relationship, but much more so due to both of their emotional and mental health states. Alexandria’s family didn’t seem to like Brandon too much, and three days before they ran away together, Brandon wrote Alexandria a letter apologizing for the trouble he had caused her with her parents and thought it would be better if they broke it off so he wouldn’t continue to cause her pain.

In that letter which was partially made public, and previous letters, it was obvious that the two were in love and had an intense emotional relationship, even declaring themselves to be engaged. They had thoughts of running away to the west coast of Florida together and sailing a boat to Panama where they would get married and live happily every after. A teenage fantasy that they were determined to either make happy, or die trying.

Brandon Goode and Alexandria Hollinghurst

On the day they ran away together, Brandon left a suicide note that said: “Please don’t be sad, this is what I want now, I get to die peacefully with the woman I love, the woman of my dreams, my fiance (Yes we were engaged!).”

Alexandria had written a suicide note a day earlier, stating to her mother: “If I had stayed another minute I would have painted the walls and stained the carpets with my blood, so you could clean it up,” she wrote in another letter to her mother “you turned a conversation about depression and suicide into something all about you.”

Her mom called the police who were there when Alexandria showed back up at her home. She denied being suicidal and the deputy left. The next day she ran away with Brandon. The two were immediately listed as “missing and endangered” and local and surrounding police officers went looking for them, even spotting them once before they drove off recklessly, only to later encounter Windermere police Officer Robert German as they walked along the side of the road.

Officer German immediately called for assistance, but it was too late. The teens shot and killed the officer before killing themselves.

Could the murder of this officer and the suicide of these two teens have been prevented? I’m almost sure it could have, but it may have taken some type of intervention a long time ago. However, I can’t help, but to wonder what if Alexandria’s mother would have really listened to her when she tried to talk to her about depression and suicide? Would she have been able to save her daughter, get her some help and maybe both her daughter and Officer German and maybe even Brandon would be alive today?

We will never really know, but I definitely think this reinforces the fact that parents really need to listen to their teens, make sure they understand what their teen is trying to say and DO NOT turn their conversation into a lecture or something about the parent. That’s not what your teen needs in that moment. They need you to listen, to be in tune with them and definitely to help support and guide them.

There is a lesson to be learned from every tragedy and I hope this one helps us learn to listen, communicate and pay attention to warning signs before it’s too late.

How Your Teen Gets In Their Own Way And How To Help Them Stop Sabatoging Themselves

11 Nov 2013by Torey C. Richards, LMHC5 Comments

Working with teenagers for as long as I have, I realize that many of them come with various challenges, from emotional and educational challenges to family issues that seem to drag them down. However, in a majority of the cases I’ve worked with, the teens themselves are usually the ones who are getting in their own way of success and happiness.

They often don’t see it that way and will blame their family, their friends, their environment, any and everything, but themselves and it will take many sessions before I am able to help them realize that they themselves are indeed the cause of their problems through self-destructive and self-defeating behaviors and thus are also the answer to their problems.

Most people who have been around adolescence know that many times they get in their own way and do things that are self-defeating or self-destructive. Self-defeating behaviors are behaviors that get in the way of constructive action while self-destructive behavior generally causes some type of harm to the person.

In early adolescence for example, teens often start focusing more on friends, fighting with their parents and other adults as they try to discover their own identity and may end up struggling in school in response to paying more attention to friends than to their grades.

During this time of conflict, (ages 9-13), it is common for certain self-injurious behaviors to start occurring, such as cutting as a way to deal with much of the psychological conflict and pain, especially with teenager girls while teenage boys may do things such as punching walls, getting into fights or destroying property even if it’s their own.

During mid adolescence, ages 13-15, friends are generally ultra important and so is being accepted by your peers. This is the age that teens are going to high school for the first time and can be overwhelmed by the pressure to fit in.

When a teenagers faces feelings of inadequacy about their self-image they may shy away from their peers and develop anxiety issues and/or depression or even self-destructive behaviors such as eating disorders and suicidal thoughts.

During late adolescence, ages 15-18, teenagers may engage in self-defeating behaviors that include more risk taking such as drugs, alcohol, and sex simply for the excitement of it and not considering the dangers that can happen.

This is the age that I worked with the most to either help them stop drinking or using drugs, or to help them with issues surrounding sex including pregnancies, sexually transmitted diseases and even rape.

As someone who has worked with teens for a long time, it can be very frustrating to see a young lady with endless potential, waste it because she wants to be liked by her friends or a boy or she doesn’t like herself. The same rings true for many of the young men I worked with who were more concerned about having a “tough guy” image, than actually doing something positive with their lives.

Parents indeed find this self-defeating and self-destructive behavior frustrating, but what can they do? Often times teenagers are too defensive to actually take and listen to advice from their parents so parents often would bring their children to me and then wonder what it was about me, or what did I say that got through to their teenager that they couldn’t and I would always tell them that they had to practice objective parenting.

They had to work on not telling their teenager what to do and think or what not to do or think, to not judge, but instead simply draw conclusion between their choices and the consequences of their choices in an empathetic and objective way, and then let their teen decide to either continue the behavior or to try something different.

This is often hard for parents to do because they would like to control their teenagers choices, but they can’t. They have to allow their teenager to make their own choices, however, parents can continuously attempt to put healthier and more constructive choices in front of their teenager for them to accept or not to accept.

The more healthy options you place in front of a teen, the more likely they are to accept at least some of them. As a therapist that is what I did. I would know that I wanted a teen to stop doing a particular self-destructive or self-defeating behavior, I would share my observations about what they are doing and what they are getting (or not getting) from their actions and then attempt to continuously give them multiple alternatives in hopes that they would try at least one.

For example, one teenage girl was obsessed with trying to get pregnant simply because she wanted a baby. I tried to help her see how having a baby would hinder many of her plans and goals for the future, but she didn’t really see that. I then gave her many other things she could be doing instead of trying to get pregnant and she finally decided to try one which is playing softball. She tried out for the team, made the team and two years later graduated from high school with a scholarship to play softball and never got pregnant.

While her mother thought I had worked some type of miracle (she was sure her daughter wouldn’t finish high school without getting pregnant) all I did was give her an opportunity to try something new and that ended up being self-affirming and she basically did the rest.

As a therapist, it is easy for me to be non-judgmental, to allow teenagers to continue making mistakes and learning from them while still giving them healthy alternatives until they finally realize that what they are doing isn’t working and are ready to try something different.

For parents, it’s hard for them to have that same amount of patience because the attachment they have with their teen makes it much more painful for them to witness their teenager continuously sabotage themselves by making poor choices. It’s very difficult for them to be as objective as I try to be.

Because this is very difficult for most parents to do, seeking help from a therapist is often the best solution, especially if the behavior is self-destructive such as cutting, suicidal thoughts, eating disorders, etc.

A book I recommend for teenagers who are constantly self-sabotaging themselves is How to Get Out of Your Own Way by Tyrese Gibson.

Popular Psychology

Mental Health Awareness Week: Borderline Personality Disorder

8 Oct 2013by Torey C. Richards, LMHC1 Comment

Perhaps out of all of the different types of personality disorders, borderline personality disorder is the most studied and most known as it seems like more and more people today are being diagnosed with borderline personality disorder (BPD) and it was definitely one of the most common personality disorders I run into when working with teenage girls.

People with borderline personality disorder are said to stand on the threshold between neurosis and psychosis. They are characterized by their incredibly unstable affect, behavior, mood, self-image and object relations (how they relate to others).

Borderline personality disorder is thought to represent about 1 to 2 percent of the population and is twice as common in women compared to men.

People who have borderline personality disorder seem to be in a constant state of crisis. They experience almost every emotion to the extreme and typically have mood swings. They can go from being very angry and confrontational one moment, to crying the next moment to feeling nothing at all the very next. They may even have very brief periods of psychosis known as micropsychotic episodes that are generally not as bizarre as those who have full-blown psychotic breaks and may even go largely unnoticed or written off as “strange”.

The behavior of people with BPD is highly unpredictable and they generally do not achieve everything they can to their full potential. Their lives are usually marred by repetitive, self-destructive actions.

These individuals are very often associated with cutting and other self-injurious behaviors as they may harm themselves as a way of crying out for help, to express anger or to feel pain or numb themselves from intense and overwhelming emotions and affect. As a matter of fact, most of the young women I ended up counseling who had BPD were referred to me for their self-injurious behaviors and/or their intense mood swings.

They may feel both dependent and hostile which creates an environment for stormy interpersonal relationships. They can be dependent on the people they are closest to, yet lash out with intense anger at the smallest perceived slight or frustration. They basically pull and push people away all the time, yet they can not tolerate being alone and will prefer chasing and trying to have relationships with people who are not good for them, even if they themselves are not satisfied in the relationship. They tend to prefer that roller coaster over their own company.

They will complain about being treated like crap in their relationships, discuss leaving their partner, yet if their partner doesn’t respond to their text or phone call they will panic and do whatever it takes to track them down.

When they are forced to be alone, even briefly, they will take a stranger as a friend or become promiscuous to fill the loneliness they feel. They are often trying to fill the void of chronic feelings of emptiness, boredom and lack of a sense of identity. They may even complain about how depressed they feel despite all the other emotions that they usually display.

People with borderline personality disorder tend to distort their relationships by characterizing people to be all good or all bad. They will see people as either nurturing or as evil, hateful figures that threaten their security needs and are always threatening to abandon them whenever they feel dependent. The good person, even if they really are not a good person, then gets idealized while the bad person, even if they really are good, gets devalued. More often than not, the same person can be seen as good one moment and bad the next, meaning that a woman can see her husband as perfect and caring today and tomorrow he is the most evil man in the world and she hates his guts, even if nothing really changed between them over the last twenty-four hours.

This aspect of BPD I found extremely frustrating at times because one moment a client would see me as the only person in the world who could understand and help her and the next session she would treat me like she hated me and like I hadn’t ever helped her. One client in particular for instance was chatting with me like I was her best friend one week, the next week when I was redirecting a negative statement she made about herself she said “F*ck you” out of the blue and walked out of the room, only to come back the next week and apologize, but this cycle repeated itself over and over again. It wasn’t uncommon for her to tell me in one session that she “couldn’t stand me” and the next session tell me that I was the only one who understood her.

Another reason people with BPD are trying even for therapists is that they are very good at subconsciously projecting a role unto someone and getting that person to unconsciously play that role. It can be very draining and even scary trying to deal with someone who has BPD as their impulsiveness and instability as well as their dependency needs can make them overwhelming for many people.

For the most part, this particular client and all other clients I’ve dealt with who had BPD were overall pleasant people with great personalities whenever they were in a good mood and I generally enjoyed our sessions, but there were times when they made therapy so difficult that although I enjoyed working with them, I was relieved when I was able to discharge them, not that I was happy to get rid of them so to say, but it was draining and by then I felt like I had given them everything they could have learned from me and now needed to practice the skills they built up with others.

DSM-IV-TR Diagnostic Criteria for Borderline Personality Disorder

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is what we use in the mental health field to diagnose mental disorders and personality disorders and it list the criteria for BPD as:

A pervasive pattern of instability of interpersonal relationships, self-image and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

1) Frantic efforts to avoid real or imagined abandonment.

Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.

2) A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.

3) Identity disturbance: markedly and persistently unstable self-image or sense of self.

4) Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating).

Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.

5) Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.

6) Affective [mood] instability.

7) Chronic feelings of emptiness.

8) Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).

9) Transient, stress-related paranoid ideation or severe dissociative symptoms.

Treatment

Psychotherapy has had the best results for treating individuals with borderline personality disorder, especially when combined with pharmacotherapy. Reality-oriented and social skills training are ideal in order to help people with BPD see how their actions affect others. Intense psychotherapy on an individual and group level is often recommended to help clients work on their interpersonal skills and to deal with their self-destructive and self-injurious behaviors.

Dialectical behavior therapy (DBT) is a specific type of psychotherapy that works great with people who have borderline personality disorder, especially those who do self-harm behaviors like cutting. It has perhaps gotten the best recognition for being high effective with people who have BPD.

I mostly used psychotherapy in the form of cognitive behavioral therapy, but later started utilizing much of DBT and it proved to work faster if not better than traditional cognitive behavioral therapy.

More Information

There are some great books on borderline personality disorder, but I recommend the classic, I Hate You- Don’t Leave Me: Understanding Borderline Personality Disorder by Kreisman MD, Jerold J. and Hal Straus as a great place to start.

www.borderlinepersonalitydisorder.com is another great resource and they even have a list of movies with characters who have BPD and they include:

Fatal Attraction (1987)

In “Fatal Attraction,” the infamous femme fatale character played by Glenn Close displays the emotional instability and fear of abandonment that are symptomatic of someone with Borderline Personality Disorder. Her character also exhibits the BPD symptoms of self-harm, intense anger, and manipulation as she stalks her former lover and his family.

Single White Female (1992)

Jennifer Jason Leigh’s character in “Single White Female” exhibits the Borderline Personality Disorder symptoms of fear of abandonment, impulsivity, and mirroring as she attempts to take over the persona and life of her roommate (Bridget Fonda).

Girl, Interrupted (1999)

“Girl, Interrupted” is based on the memoir of Susanna Kaysen, who struggled with mental illness and Borderline Personality Disorder as a teenager and young adult. The film, which stars Winona Ryder and Angelina Jolie, centers around Kaysen’s 18-month stay at a mental hospital.

Hours (2002)

The three main characters in “The Hours,” which include author Virginia Woolf, all struggle with Borderline Personality Disorder, depression, and suicide. The movie, which links women from different generations to Woolf’s book “Mrs. Dalloway,” stars Nicole Kidman, Meryl Streep, and Julianne Moore.

Monster (2003)

Charlize Theron transformed into the role of female serial killer Aileen Wuornos in “Monster.” Wuornos was diagnosed with Borderline Personality Disorder, which may have contributed to the unstable and angry behaviors that led to her killing at least six men.

My Super Ex-Girlfriend (2006)

One of the few comedy movies that features a character with Borderline Personality Disorder is “My Super Ex-Girlfriend.” In this movie, Uma Thurman portrays a woman with superpowers and a secret identity who also displays the BPD symptoms of impulsivity, unstable interpersonal relationships, and poor self-image.

Popular Psychology

How The Mental Health System Is Failing Minorities

3 Jun 20133 Jun 2013by Torey C. Richards, LMHC3 Comments

I’ve wrote a bit about how the mental health system is failing those who need it most and a lot of those people are usually poor and/or minorities.

Working in an inner-city area I’ve always been valued as a licensed mental health counselor able to diagnose and treat a wide array of mental issues and refer clients who needed more attention, testing or medication to people and places able to provide those services.

Sometimes I didn’t quite appreciate or understand the praises I got from other school administrators, faculty even clients and their families. To me I was just doing my job, but to them, at times I was seen as a hero.

It wasn’t until recently that I actually thought about this. Within the past year two crucial agencies pulled out of the school because of lack of funding. These two services provided mental health counseling to the students who needed it three days out of the week while I was there everyday. They were not licensed and generally dealt with less severe, but no less important issues.

Because these two agencies are no longer on campus, this year my case load exploded to way more then I could handle by myself, but I had no choice but to try to handle it the best I could which at times wasn’t always that great. I was overwhelmed, underpaid and under appreciated by the agency I work for, but very much appreciated by the school, students and families I served.

To make things worse, I may not be at the school after the end of this month because funding is being cut from my agency as well.

While to me it is ultra important that these kids and families receive my services, like I wrote in my previous post, it boils down to money over actual quality of care.

It was then that I started realizing that there weren’t many options for those in inner-city communities who need mental health services, largely because poor and minority people with mental illnesses are more neglected and inner-city communities receive less funding which is one reason the two agencies I mentioned above pulled out of the school I work at, they lost some of their funding.

A lot of the funding that comes for mental health servies in inner-city communities is based on grants, and grants come and go very easily, often doing great work in a community for a couple of years and then leaving them without any support.

With that being said, it’s really hard for the kids I work with and their parents to receive quality mental health services in their community.

Many of them end up getting services through the jail or prison or are involved with child protective services which is where many of them end up because they have issues such as uncontrollable behavior that haven’t been addressed, but this creates a host of other problems due to the stigma that comes with it and because it eternalizes a racial stereotype that this is where Black people end up.

However, once these people are no longer incarcerated or receiving services through child protection services, without support, most will regress back to their previous mental states and behaviors. Only about 33% of African Americans suffering from a mental illness are retrieving proper treatment.

Because of this neglect, there isn’t much research on treating minorities with mental disorders such as depression, schizophrenia, bipolar disorder, substance abuse and others conditions.

Yes, it is true that for the most part, there is little to no difference in these disorders across races or socio-economic statuses, but there are cultural and social differences that play major roles in properly treating these disorders.

African Americans have been ignored for decades when it comes to mental health. Before the 1960s, it was believed that African Americans could not get bipolar disorder or depression for example. It wasn’t until 2001 when former Surgeon General Dr. David Satcher, who is African American, released Culture, Race and Ethnicity. A Supplement to Mental Health: A Report of the Surgeon General, which brought the disparities into national light.

Working with minorities from African Americans, Haitians, Latinos and Asians, I know that culture plays a large role in who and how individuals receive mental health services.

Some cultures are very private and trying to get the whole family together for a session can be almost impossible, while others, especially African Americans, seem to be more suspicious of the mental health system in general and are more likely to stop treatment early without any follow up and to not follow through on medication recommendations.

Because of this distrust, many will turn to a friend, then their pastor, and then their general doctor before finally turning to a mental health professional for help with a disorder.

Because of all these issues, I see why my role within the school I work with is seen as so important. I am able to bond with the students and give them and their families services that they may not otherwise receive.

On top of that, I think I am helping to remove some of the stigma associated with getting help for a mental health problem.

Many of my minority clients, when I first meet with them automatically tell me that they are not going to take any medication or go to the mental hospital, as if that’s all those who work in the mental health field do, medicate people or hospitalize them.

Through getting to know me, they realize that I just want to help them get through whatever is bothering them and I have no plot to medicate them or put them in a mental hospital unless it is absolutely necessary.

One of the students told me last week when I told her I wasn’t sure if I would be back next school year that, “If you are not here, there will be more kids going crazy, more people fighting and using drugs”. That thought saddened me. I even thought about volunteering some of my time to the students if at all possible.

I am not a hero, I am really just doing my job and doing what I feel called to do, but I see that without my services being conveniently offered on campus where students and their families can easily access them, there isn’t much else around. Unlike in more oppulent areas, there aren’t any private facilities with modern technology. There’s nothing.

So yes, the mental health system is failing most people who truly need it, especially minorities and poor people who are largely ignored and underserved including teenagers just trying to survive in a violent, crime ridden neighborhood at an inner-city school that serves as their haven away from their broken homes and communities.

Monitoring Your Teen: Your Perspective VS Their Reality

31 May 201331 May 2013by Torey C. Richards, LMHCLeave a Comment

I recently watched an episode of Dr. Phil where a mother thought her 15 year old daughter was a popular teen and earning good grades. This mom thought she had the perfect teen, until one day her daughter disappeared and was found days later by the police.

Only then did her mother find out that this teen had not only recently witnessed a murder, but that the life she actually lived was is stark contrast to the life her parents believed she was living.

In reality, their daughter was not this popular teenager with good grades, but she was a drug using, bullied teen who was meeting and sleeping with older men she would meet online on a regular basis. Some were more than twice her age and married. One even committed suicide and she was the one who found his body.

This reality, was nothing that her mother could ever imagine her daughter going through.

This got me to thinking about a lot of the teens I work with and how their reality often totally differs from the their parents perspectives.

Many teens I work with have parents who believe that they are doing good in school and are really active in after school activities like band and drama, while often these kids are failing school, skipping classes and using after school activities as covers to do other things such as having sex and using drugs.

As a matter of fact, I was so alarmed at the amount of teenage girls who told me that they were having sex after school (while they were supposed to be in drama or band) in an unsupervised location on campus, that I went to multiple school administrators and school resource officers to crack down on the number of teens on campus unsupervised after school.

Here you have parents thinking their child is staying after school to rehearse for a play, yet they are having sex in a storage closet, or leaving campus altogether to have sex or use drugs, but returning to campus later to be picked up by their parents who have the slightest idea of what is really going on in their teens lives.

I’ve sat down with numerous parents who were stunned to find out that their kid was failing multiple classes, missing dozens of unexcused days from school or wasn’t actually in the school play she had been supposedly staying after school for everyday for the past two months.

Teens will be teens, and most of these parents I spoke with took it for granted that they had “good kids” so they rarely checked on them or monitored their activities. They just assumed that they were always doing the right things.

On the Dr. Phil show, he drew the contrast between this young girls realty and her parents’ perspective:

Her Parents’ Perspective Daughters’ Reality

Spent time playing computer games Spent time meeting men online

Spent the night at friends’ houses and didn’t leave Snuck out of friends’ houses to meet men

Popular at school Bullied at school

Relationship was wonderful Parents were distant

I don’t mean for this to scare any parents, but I want you to understand the importance of monitoring your child, even when they are teens… especially when they are teens. It’s important that you trust your teens, but it also important that you verify what ithey tell you is going on.

Monitoring Your Teen

Monitoring your teen means asking questions. It means knowing where they are, who they are with, what they are doing and what time they will be back home. It also means having them check in regularly. Your teen may not like this, but over time they will grow accustomed to it if it is consistent and they know what to expect.

This is especially important when your teen starts getting involved with more activities outside of the home including school activities. Many parents think that as long as their child is at school they are safe and being monitored, but that often is not the case. After school activities can create time and opportunity for teens to get themselves into trouble.

If your teen stays after school for an activity, drop in every now and then to make sure they are where they said they will be.

You don’t have to make it obvious. Maybe bring them a snack or genuinely be interested in whatever the activity they are involved in. The same goes for school. If you can’t drop in every now and then to make sure they are at school, most schools have websites just for parents where you can monitor your child’s attendance, grades and assignments.

Monitoring your teen is about communication and respect on both ends. Here are a few tips:

Let your teen know that you will be monitoring them so that they won’t be surprised. Like I said, they may not like it but they will grow used to it if they know what to expect and it is consistent.
If you sense trouble, make those surprise visits to the school, the park, the football field, or call their friends’ parents to make sure your teen is where they said they would be. Let your teen know this is something you may do sporadically.
Get involved in the activities your teen is doing at school. If your teen is in band, try to become a band parent, or a drama parent, or just show up to support your teen and the school. The more likely the chance that you will be around, the less likely your teen will do things you disapprove of.
Have a rule: “No parents, no party”. The amount of unsupervised parties the teens I work with go to that are filled with sex, drugs and alcohol is astonishing. Make sure that if your teen is going to a party there will be adequate adult supervision.
Get to know the other adults in your teens’ life such at teachers, mentors, coaches, employers, etc. This is important for a number of reasons, but this can also be a network where you can compare notes. If you think your teen is doing great in school, a teacher could tell you that they are missing class a lot or getting bullied for example.
Monitor how your teen is spending their money. You wouldn’t believe how many parents I work with who would give their kids money and have no idea what they are doing with it.
Monitor your teens online and electronic devices such as phones and ipads. Teens get in all sorts of trouble online and they generally don’t want you in their online lives, but when their safety is your priority then compromises have to be made.
Monitor their physical and mental health and look for signs of changes so that you can address them early or seek professional help if needed.

There is much more that could be added to this list, but this is a good start. Most parents will add their own tailored made to their child.

How much monitoring is enough depends on your teen. If they show you that they can be trusted, are accountable and reliable, then you may back off some and only monitor them every now and then, but if they have shown you that they can’t be trusted, you may have to monitor them more.

Look for changes in your teen such as new friends, different behaviors or activities. These are signs that you may want to monitor your teen a little more; also when things are changing such as moving to a new neighborhood, school or when things at home are changing such as divorce or a death in the family.

We all did things as teenagers that make us uncomfortable to think about today, but we are glad that we came out relatively un-scathed. Monitoring your teen so that your perspective matches closely with their reality will hopefully help your teen avoid some of those unnecessary situations, some of which can be life altering and deadly.

One Teens Attempted Suicide

25 May 201325 May 2013by Torey C. Richards, LMHC6 Comments

Today I got one of those out of the blue phone calls that I dread. I was out of the office preparing files for an upcoming audit when I got an email from one of the teachers at the school I work at asking me to call her as soon as possible.

There’s always a lot going on at the school, but I assumed she wanted to ask me for advice with dealing with one of her students or to refer a student to me for counseling. I called her and she informed me that one of my students was in the hospital in critical condition after attempting suicide the night before.

I almost cried. I know that’s not the professional way I was supposed to feel, but I am human and have passion for my clients. Sometimes too much, but that feeling felt appropriate. I have never (fingers crossed) had a client actually commit suicide, but I know it’s always a possiblity. I’ve done crisis counseling at enough schools after a teen has committed suicide to know that it happens all too often. As a matter of fact, 3 weeks ago a student at a high school not too far from the one I work at killed herself.

It’s not that this is the first client of mine to attempt suicide, but this is probably the first client of mine to make a serious suicide attempt. I don’t want to underplay any suicide attempt, but I have had many clients who have made superficial lacerations to their wrists or took three ibuprofens in a “suicide attempt”. Most never needed to go to a medical hospital for medical attention.

Sure, I had to have them sent to the psychiatric hospital because they were having suicidal thoughts and any attempt has to be taken seriously, but it never shocked me because I knew that while they were hurting emotionally and psychologically, they didn’t want to die. They wanted help, they wanted people to see and know that they were hurting, but they didn’t really want to die. The fear in that though is that they could accidentally kill themselves.

This situation was different for a number of reasons.

1) I was very close to this client. I had been working with this particular client for almost two years helping him get through depression, grief and anxiety. I actually tried to become more of his mentor than his counselor because that’s what I felt like he needed most as a young man approaching adult hood.
2) A few months ago this particular client came to me and told me that they were seriously thinking about ending their life. I had him admitted to the psychiatric hospital where he was prescribed medication for anxiety and depression. I was surprised and scared that he didn’t come to me this time before he tried to take his life.
3) He had a lot to look forward to. He was graduating after almost not qualifying to graduate. I had just giving him a graduation card saying that I was excited for him about his future.
4) And lastly, I had just saw this client the day before and he was his normal, apathetic self. I saw no warning signs that less than 24 hours later he would take 3 months worth of medication all at once.
5) While all suicidal talk, gestures and attempts have to be taken seriously, from personal experience, the teens that actually kill themselves do so with little real warning. Some may tell all their friends that they love them, or apologize for past wrongs, but from the crisis counseling I’ve done at different schools after a student has committed suicide, there is rarely any apparent warning signs yet in hindsight, grieving students, faculty and parents usually see subtle signs that they missed.

His mother found him in his room, unresponsive and called 911. He was rushed to the hospital where a host of procedures were done to save his life. When I went to the hospital to see him he was still unresponsive, a result of all the medication he had taken, but the doctor was pretty sure he would make a full recovery… physically.

The fear is, when he finally comes to, is he going to be happy that he’s still alive, or disappointed that he failed to end his life?

That’s why I want to be there for him. I stayed with him in the hospital today for as long as I could, but the hospital staff that was in charge of sitting with him around the clock because he is on suicide watch, told me that it would be at least another day or two before they expected him to start coming around.

I don’t feel like I failed as a counselor. That’s one of the first questions I asked myself. I think that the reason it bothers me so much is because he is my client and I feel a sense of responsibility for him, although I know I can’t be responsible for the decisions he makes.

Looking at him laying in the hospital today was depressing. At times he looked dead except for the frequent rapid eye movement visible through his closed lids. I just hope that when he comes to that he realizes that he is alive for a purpose and rejoices in attempting to discover what that purpose is. I’ll definitely be here to help him anyway I can.

Popular Psychology

Counseling Minors and Confidentiality

14 May 2013by Torey C. Richards, LMHC2 Comments

Confidentiality is a crucial part of counseling. Clients have to believe that they can tell me practically anything and it won’t be repeated to anyone, including their parents.

All of my clients know that everything they tell me stays between us except:

If they tell me they plan on killing themselves or someone else
If they tell me that are being abused
If I am court ordered to release information, and because I work in a school
If they have drugs or weapons on campus.

Also, because I work primarily with juveniles, I leave a little wiggle room by saying I will also report anything “life threatening” which may not include marijuana or alcohol use, but may include intravenous drug use or meeting adults online.

Even with these rules of confidentiality, teens will still inevitably tell me things that need to be reported to their parents, the school, law enforcement or child protective services.

More often than not, the child already knows this before they tell me so they aren’t usually upset when I have to make that phone call.

The problem generally comes from parents, who may not understand confidentiality. They think that their child is in counseling and as the counselor, I should tell them any and everything their child is doing and can get testy when I have to explain to them that confidentiality doesn’t work that way and that it’s actually illegal for me to tell them any information that doesn’t fall under the exceptions above, without their child’s permission.

I understand these rules and have worked within the confines of them for many years, even when I am hearing information that I wish I could tell parents. Information I actually knew would help the situation, if the parents knew.

For instance, last year a young lady was devastated when she went to a friend’s party and got raped by him and four guys she didn’t know. She was in tears when she confided in me and after calming her down, I practically begged for her to give me the name of the guys, some who went to the same school as her, or to report it to law enforcement.I gently repeated this request each session as we processed the trauma.

I offered to go with her to make the report, but she was adamant about not telling me any identifying information. She told me that she was scared that they would come after her if she told. No amount of me trying to convince her worked and at the end of it all, I had to allow her to make that decision she will have to live with for the rest of her life.

As much as I wanted to report that crime to law enforcement and her parents, I couldn’t. I had no identifying information, she wasn’t abused by a caregiver or someone in authority and she wasn’t a danger to herself or others so my hands were tied. All I could do was try to help her get through the emotional and psychology pain she was feeling. She went through a period of deep depression and eventually transferred schools.

I have had teens who have had abortions and miscarriages without their parents ever knowing they were pregnant. Kids who have battled substance and alcohol abuse right under their parents noses.

I always strongly encourage my teenage clients to involve their parents in their treatment though family counseling, but most teenagers are hesitant to let their parents know the things they do when they are not looking, or think that their parents will just be angry, judgmental or not listen if they do open up.

I usually only do a couple of family sessions a month and those usually happen after emergencies such as suicidal thoughts, severe panic attacks that require medical attention or another extreme circumstance that causes the parents to be concerned.

That’s usually when, with the child’s permission, I feel like I can finally truly help them without restraints. Trying to help a child solve a problem that need parental involvement, when they don’t want the parent to be involved is truly handicapping.

However, this is usually also the time when parents get upset that I knew about the abortion, or the drug use, or the date rape that they didn’t know about, months sometimes even years before.

I let them know about the confidentiality regulations set by the Health Insurance Portability and Accountability Act (HIPPA) that prevented me from giving them that information, even when it was valuable information about their own child.

Most parents calm down once they realize that without the confidentiality between their child and myself, it would have been unlikely that their child would have told any trusted adult and received at the minimal, mental and emotional support as well as guidance and encouragement.

Some minors want help or at least to talk about issues in their lives that are concerning them, but will only do so if they know that their parents will not be notified. Not all parents are supportive and some parents could use the information to further cause damage to their child, knowingly or not.

Take for instance a girl I know who is scared of her father who has a past history of physical abuse against her. He’s told her that if he ever finds out she is having sex he will kick her out on the streets. Yet, she is having sex and thinks she may be pregnant. Should I risk her losing her housing in order to tell her father that she may be pregnant?

I believe breaching confidentiality, while it will give parents more information about their child, it is less likely to truly make a difference if that child just learns to hide their problem or not admit or talk about their problem anymore, resulting in them getting less help.

I definitely understand when parents are frustrated with confidentiality when it comes to their children, which is why I always encourage open communication and family therapy, but most kids I deal with would never want their parents to know their issues and unless it’s something that puts them or someone in immediate danger, my hands are usually tied pretty tight.

Popular Psychology

Day of Silence

19 Apr 201318 Apr 2013by Torey C. Richards, LMHCLeave a Comment

Did you know that today is the Day of Silence? If you didn’t know, don’t feel bad because I was just educated about this last year by some of my students.

What is the Day of Silence? The Day of Silence is a nation wide, student led movement to bring attention to anti-gay, lesbian, bisexual and transgender (LGBT) bullying, harassment and name calling in schools.

Students across the nation from middle schools to colleges take a vow of silence to represent the silencing effect bullying and harassment has on LGBT students and those believed to be LGBT.

The event is sponsored by the Gay, Lesbian and Straight Education Network (GLSEN). Student use their vow of silence to speak up against anti-LGBT bullying and harassment.

I spoke with some of the LGBT students in my school who are planning on participating in the Day of Silence and they are all extremely passionate about it. All of them have been bullied, harassed, felt ostracized or misunderstood in someway and all want to stand up to against those who choose to treat them different from other people just because of their sexual orientation.

Many of them have gotten their straight friends to also participate in the Day of Silence by wearing duck tape (they chose red) around their mouths and not speaking all day. That’s a powerful statement and one I support wholeheartedly.

Often LGBT teens and young adults feel so alone. This show of solidarity and support is extremely positive.

While students are encouraged to remain silent throughout the day, GLSEN doesn’t encourage classroom disruptions and makes amends for students to talk in class if a teacher insist that they answer a question. However, they also encourage students to talk to their teachers ahead of time for more positive and understanding results.

The day is supposed to be a positive educational experience, not a day of interruption. It’s a silent protest against the harassment and bullying that causes way too many LGBT students to miss school, have poor self-esteem and substance abuse problems, and even attempt and complete suicide each year.

I wrote a previous post about how young is too young to discuss sexual orientation which talks about the importance of the Gay Straight Alliance (GSA) and other support groups on campuses for LGBT students and those who support them. The Day of Silence is a powerful way to help other students and school administrations recognize the needs of LGBT students.

The Day of Silence doesn’t stop at the end of the day. GLSEN hopes that those who participate in it will continue to draw attention to the plight of the LGBT student body and community in positive ways and encourages schools to implement solutions that address anti-LGBT bullying and harassment.

GLSEN recommends schools:

Adopt and implement a comprehensive anti-bullying policy that enumerates categories such as race, gender, ethnicity, religion, sexual orientation and gender expression/identity.
Provide staff trainings to enable school staff to identify and address anti-LGBT name-calling, bullying and harassment effectively and in a timely manner.
Support student efforts to address anti-LGBT bullying and harassment on campus, such as the formation of a Gay-Straight Alliance.
Institute age-appropriate, factually accurate and inclusive curricula to help students understand and respect difference within the school community and society as a whole.

I know first hand from working with many LGBT students the painful affects that bullying, harassment and name calling can have, especially when they feel like they can’t voice their concerns to other heterosexual students, adults, teachers and their parents.

I encourage all of us, even if we can’t participate in the Day of Silence, to find one way we can stand up against bullying and harassment in any form, against any person, even if it’s as simple as intervening when we see it happening instead of watching in silence.

Parents: Have The “Sex Talk” With Your Teens Or I Will

12 Apr 201312 Apr 2013by Torey C. Richards, LMHC5 Comments

I don’t really like talking to other peoples kids about sex although as a counselor in a high school it’s something that inevitably happens.

I wrote earlier about talking to preteens about sex, but I’m finding that many teens have never had the “sex talk” with their parents beyond their parents threatening to kick them out or disown them if they ever got pregnant (although I’ve never known a parent to actually follow through with either threat).

However, because many teens don’t feel like they can talk to their parents about sex, they are getting their information from some very unreliable sources which usually leaves them unprepared mentally and emotionally for the complexities of sexual activity and vulnerable to sexually transmitted diseases, pregnancy and even abuse.

Last Monday I was counseling a young teenage girl who had just turned 15. She admitted to me nearly a year ago that she not only was having sex, but had been with several partners, most of them not even her boyfriends but guys she was friends with or guys she just liked.

Well now she has a new boyfriend who is a virgin, and although they have been together for a several weeks (which is forever for teenagers), they are thinking about having sex.

Let’s call her Trisha and her boyfriend Zac.

Because Zac is a virgin and apparently has a better relationship with his parents, he told them about him and Trisha’s plans to have sex. Zac’s mom was a little upset, but realistic and instead of scorning her son, she talked to him about sex and protection, a very good call. What she did next however, I’m not so sure how I feel about, but I understand it.

After talking with her son about sex, she then talked to Trisha about sex, assuming that she too was a virgin. She even went as far as to say she would get Trisha birth control, which made Trisha very uncomfortable.

Parents, do you really want someone else talking to your teen about sex and birth control, especially a parent that you do not know?

Well if you don’t talk to your teen about sex, someone else will and they may not have the best information and probably won’t have the same opinions, views or values as you do.

I was concerned because I felt like this was something Trisha should be talking about with her parents, not Zac’s, yet Trisha feels like she can’t talk to her parents about sex because they hold both her and her older sisters to such high standards and even threatened to kick them out if they ever found out they were having sex. By the way, according to Trisha, they are all already having sex.

Because of this fear of not only disappointing her parents, but also of getting kicked out, Trisha doesn’t feel safe talking to her parents about sex at all and has just been getting her information about sex from her friends and sisters, who are all also high school teenagers.

I encouraged Trisha to sit down and talk to her parents, at least her mom about sex.

She wants to get on birth control, but doesn’t think she can talk to her parents about that and definitely doesn’t want to get birth control from Zac’s mom. I even offered to have a family session with her and her mom and/or dad to help facilitate “the talk”, but she’s too scared to even discuss sex with her parents and let them know that she is thinking about sex, let alone already having it.

I know from past experience, because of this fear of talking to her parents about sex, she leaves herself vulnerable.

She’s more likely not to use any protection consistently or properly and to hide everything from her parents, including if she ever feels violated, if she ever thinks she may have a sexually transmitted disease, if she ever gets raped or if she even gets pregnant.

One girl I knew hid her pregnancy from her parents all the way up until she went into labor and had a child at 15. Her parents had never had the “sex talk” with her and it was only then did her parents find out that their daughter was no longer a virgin.

I definitely don’t want that to happen to Trisha and so if she is afraid to have the sex talk with her parents, I feel like it is my responsibility to at least give her valid information about sex, protection and to point her in the right direction for other information and questions she may have.

We talked about condoms, the importance of putting them on correctly and using them each and every time from the beginning to the end. We also talked about birth control for her, but I strongly encouraged her to have the conversation with her parents. I also had the school nurse talk to her and gave her several pamphlets for her and her boyfriend about sex.

She had lots of questions and lots of the information she had was so invalid that she was sure to end up pregnant before graduating from high school, such as standing up right after having sex is a foolproof way to avoid getting pregnant because gravity will prevent the sperm from swimming up.

Another thing I did was encourage her to wait. I talked to her about how sex can change relationships, sometimes for the worst and how there are other things they can do besides having sex, such as holding hands, kissing, hugging, talking, going for walks, out on dates, etc.

All the while I also kept encouraging her, trying to give her the strength to have this conversation with at least one of her parents. I don’t think a 15 year old should be engaging in intercourse, but she’s already been doing it since she was 14 so we have to be realistic.

Many parents feel like having the “sex talk” will encourage their teens to have sex, but teens are going to be curious about sex and may engage in sex regardless. It’s just a matter of how informed or ill-informed they will be.

Lot’s of parents feel betrayed and hurt when they find out their teenager is having sex, almost as if they just found out their teen was using drugs.

Remember that consensual sex between teenagers is not a crime and your teen is more likely to get pregnant or worse if they feel like they can’t talk to you because you will get mad or upset. It’s important that parents put their emotions aside and consider their teens’ choices and emotions.

I encourage parents to talk to their teens about sex, about being safe and healthy. They can also allow their teen to talk to their doctor about being sexually active and the physical responsibilities that come along with that, if they don’t feel comfortable or knowledgable enough to do it.

It’s important that your teen feels like they can trust you and that you guys have an open relationship where they can talk to you about everything, just remember that even with that, your teen probably won’t tell you every single thing.

The teen years are about trying to discover their own independence and breaking away from their parents some, so accept that there may still be things your teen won’t tell you, but make sure that they know that you will be there for them if they need you.

While I definitely prefer not to be the one having the sex talk with your teen, I’d much rather do that now than to be talking to them about how to get a pregnancy test, being good parents while trying to stay in school or about visiting a free clinic to get tested for a STD, three conversations I actually have way more often.

Disordered Eating And Body Image Issues In Teenage Girls: Part 1

8 Apr 20138 Apr 2013by Torey C. Richards, LMHC2 Comments

Working in a high school with teenage girls, I come across teenage girls with body image issues regularly.

Take for instance, one of my 15 year old clients who is so convinced that she is fat that when I first met her she was only drinking water mixed with apple cider vinegar for breakfast and lunch.

For dinner she would have a very small meal. She was not overweight, but due to teasing about her “putting on some weight” by both her mom and peers, she see’s herself as fat and ugly.

Because of all this, her self-esteem is shot and it’s taken weekly individual therapy sessions and weekly support group sessions to get her to at least start eating a light breakfast and lunch, although she is still struggling with body image and self-esteem issues.

Society Creates Body Image Issues In Girls

Unlike boys, teenage girls are put under immense pressure to be beautiful, thin and feminine in most Western industrialized countries. However, biological changes and weight gain are natural parts of pubertal development.

Like the client I was talking about above, her weight gain seems to be more of a womanly weight gain. She seems to be filling out and taken on the body of a woman, compared to that of a prepubescent child. This natural weight gain that most girls experience during puberty, goes against our cultural’s view of what being beautiful is, which for women includes extreme thinness.

These are conflicting messages for preteen and teenage girls.

On one hand, they are naturally developing and putting on weight, while on the other hand, they are getting messages from society that says their weight gain is unattractive.

Female identity in one part is defined in relational terms, society says they are supposed to be interpersonal and care about other peoples needs, feelings and interests which makes them more vulnerable than males to other people’s behaviors towards and opinions of them.

Another major part of female identity is beauty. In our culture, physical attractiveness contributes a lot to interpersonal success, which is one of the main reasons females strive to be beautiful, to assure popularity and respect.

Also, physically attractive girls are typically seen as more feminine compared to less attractive girls or girls who challenge our cultures traditional views on femininity through their political views such as feminist, or through their sexual orientation, such as lesbians.

Girls tell our society that they are feminine by being concerned with her looks and trying to achieve our culture’s ideal of beauty.

Because our culture demands that girls care about other people’s opinions and that they are defined by their physical appearance, which society says includes being very thin, there’s no wonder girls are motivated to pursue thinness, at times by any means necessary including starving themselves to death.

Combine these issues with the natural weight gain of puberty and there’s no wonder many teenage girls develop body image issues.

Many teenage girls I’ve worked with who are physically perfect, not even slightly overweight, some were even underweight, suffer from intense body image dissatisfaction.

A girl I’ve been working with since last year was naturally thin, yet wanted to be thinner so bad that she starved herself to the point of needing to be hospitalized. Like many of the girls I work with who have body image issues, her pursuit for thinness and beauty was so consuming that almost every other aspect of her life, including her education, goals and future took a back seat.

Eating Disorders

Not all girls with body image issues go on to develop an eating disorder like the young girl I just mentioned above, but many of them will.

Eating disorders are a major concern when it comes to the health of teenage girls with an estimated 1% to 3% likely to meet diagnostic criteria for either anorexia nervosa or bulimia nervosa.

Anorexia nervosa is when someone refuses to maintain a minimal average body weight and has body image disturbances such as feeling fat even when they are very thin, and in females who are menstruating, they may experience amenorrhea if their body weight is low enough.

Bulimia nervosa typically includes periods of binge eating, followed by drastic methods to compensate for the binge eating including excessive exercising, fasting, vomiting, using laxatives, etc., accompanied with body image disturbance such as thinking one is much more overweight or unattractive than they really are.

Besides these two eating disorders, there are some girls who have other patterns of eating that fall under disordered eating, such as laxative abuse, vomiting after eating some meals, extreme calorie restriction, and binge eating.

Eating disorders typically begin in early adolescence with much of it’s symptoms typically evident by the late teen years.

While not all girls with body image issues develop full blown eating disorders, there is little research into why some girls do and others don’t develop an eating disorder.

During part 2 we will look at some of the risk and protective factors for young girls to develop an eating disorder.