With permission, I pass on words of wisdom from a client. This person wants all of you to know that she wasn’t attentive in how she stored her medication, which led to it being ineffective. She said she kept it in her car so she could conveniently take it each morning as she left the house. She said she wants everyone to know that it got too hot in the car, which wasn’t good for her meds. For those of you taking meds, she encourages you to pay attention to the temperatures suggested on the label. She says once she began storing it properly, it worked better.
Now onto comments from two different teenagers dealing with extreme loneliness at school. There are many, many of you reading this who suffer from loneliness. Not having one or two good friends in your life is devastating at any age. For a teen it’s even harder because it’s so noticeable. You walk around your school campus and have nobody to sit with at lunch. You don’t know where to go at break. Even if you have a place to sit at lunch, you’re not included in activities outside of school hours. You might be “okay,” but without friends you’re probably not thriving.
My heart aches for you. We are wired to belong to someone. There are a few of us who genuinely don’t need people, but that is not most of us. Most of us need someone to belong to and we need someone to belong to us. This innate need is deeply ingrained. If you don’t belong to anyone at school and nobody belongs to you, please tell your parents. I know that discussion might be awkward, but your outlook on your entire life can change if you are given some tools to rectify the loneliness.
Sometimes loneliness is really hard to fix. Sometimes you have no insight into why you aren’t building connections with others. We always work on that in therapy because I have come to see it as a basic human need. Not having someone underlies at least half of the cases I see when a teen is refusing to go to school. It is also present in a high percentage of those I see who come in for depression and anxiety.
One of the first things to consider is going where you’re wanted. Some of you who are lonely do have people who like you, they just aren’t the people you have your heart set on. Usually these people are kind but maybe not as “fun.” Trust me when I tell you that these people are worth putting time into. Being in the popular crowd is far less important than having a place where someone is glad to see you each day.
Some of you don’t really have anyone you can identify as a place you can go. This is trickier, but not impossible. It becomes important to start looking around for who else needs a friend instead of who can meet your needs. It’s a change in mindset, but it does start the process of resolving the loneliness.
Finally, there are some of you who have enough social anxiety that you cannot bring yourself to do or say the friendly things necessary to get close to others. Give us a call in that case; counseling and/or group therapy can be of temendous benefit in those cases.
I have a brief update to give on the last blog, which talked about the website/app Hims. It was reported to me that a person doesn’t even see a doctor on that site and can get antidepressant medication. The update that was given this week is that there is a texting conversation with the doctor before the prescription is written. No at all ideal, but slightly better than just a self-survey.
I’ve learned something new in the past few months. It’s now come up twice. A friend of mine is a psychiatrist (for those who don’t know the distinction, a psychiatrist has attended medical school and has received extra training in mental disorders and medication) explained to me that many people suffering with Bipolar Disorder cannot tolerate marijuana AT ALL. He said it causes a higher incidence of paranoid psychosis for this group than for the general population. He told me to pass along to all of you that if you have Bipolar Disorder, you should NEVER use marijuana.
Let me give a short clarification on what Bipolar Disorder is. Many people have a misunderstanding because the term “bipolar” is used as slang for mood swings. Bipolar Disorder is a difficult mental illness for someone to live with. It causes times of mania or hypomania, which means periods of little to no needed sleep with some combination of euphoria, anger/agitation, impulsive decision-making, sexually irresponsible behavior, rapid speech and/or thoughts, and grandiose ideas. These periods are followed by a marked and profound period of depression. The depression is intense and miserable. One client described it to me as “mashed potatoes. It’s as though everything has the color of mashed potatoes and the flavor of mashed potatoes. The world is devoid of life.” The depression can last for years on and off without any interruping mania for some. The pattern and timing of depression and mania varies from person to person.
I’m sure you can understand that someone dealing with the unpredictability of Bipolar Disorder might be drawn to marijuana. However, it is understood to be something that will destabilize the Bipolar Disorder over time and can even add in psychosis. The bottom line: It’s not worth the risk. By the way, I’m not a fan of it for others either. I know that alienates some of you, but the long-term effects of cannabis just don’t justify the short-term pleasures.
I want to bring you little tidbits I hear from my clients that are fascinating and/or important. Then I might give my commentary on it, or I might not. Just passing along thoughts from those who actually live the day to day of being an adolescent dealing with mental health issues instead of you just reading articles from those who have opinions about it.
A tampon machine has been installed at the local public high school in the MEN’S restroom. It was reported to me that the majority of students find this bizarre and actually “quite funny.” Most of the tampons were apparently extracted by adolescent boys who found the situation amusing and used them to prank one another throughout the day…The moral of this little anecdote is that adolescent boys will continue to handle the uncomfortable with humor and play no matter how seriously an adult wants them to take something. I personally hope nobody takes that away from them as humor is an excellent means of processing the uncomfortable (especially if it wasn’t done in a mean-spirited way).
A reflection on Hims and Hers- A telehealth company: A client has reported it is shockingly easy to obtain certain types of psychiatric medication for anxiety and depression. I have not vetted this company and cannot verify this report. I also do not know if this company prescribes to children. A cursory look at their website seems to indicate they prescribe for things such as hair loss, anxiety, and depression. This client told me it was easy to get a prescription for an antidepression WITHOUT EVEN SEEING A DOCTOR!!! This client is very astute on mental health issues and expressed alarm. Apparently one filles out a survey and then an email is sent with directions and a prescription.
-Sorry folks. After many thousands of hours working in the mental health field, I can’t get on board with this if this is true. Psychiatry is complicated. While some of my clients are correct in their self-diagnoses, many, many, many have been wrong. In some cases, taking an antidepressant would have caused a worsening of symptoms, not an alleviation. You simply have to talk to a doctor about meds before taking them. Period. I won’t bend on this opinion. Can you talk to your primary care doctor? Yes. That is an appropriate place to start. Your primary care doctor has theoretically received enough training to help you start the process. Sometimes they will prescribe, and sometimes they will refer you to a psychiatrist, neurologist, or some other specialist. In the 15 years I’ve been practicing, I’ve seen people need to see a rheumatologist, endocrinologist, pain medicine specialist, orthopedic surgeon, OBGYN, or oncologist for what initially appeared to be psychiatric symptoms. Your primary care doctor and/or psychiatrist know to look for other things causing depression and anxiety symptoms. Here’s the most important point: Depression and anxiety are not always the diagnosis. Very often they are symptoms of another underlying issue. Let’s use the metaphor of a skin rash. Sometimes a skin rash is the diagnosis, but a break-out on the skin can indicate many other things going on with the internal organs. Depression and anxiety are no different.
That’s it for today. I look forward to sharing other interesting tidbits with you next time. I am unbelievably privileged to get a front-row seat to everything going on through the eyes of the courageous, amazing adolescents I work with in therapy. It’s an honor, and I’m proud of all of you for hanging in there during what feels like tumultuous times.
Helping teens grow and families improve connections,
Hooray! We now have in-person group therapy! This has been a long time coming. Many teens benefit from hearing what their peers have to say (when an adult is present to moderate). This is such a nice option to offer for your families because some teens have things to work on in a more social setting, the cost of therapy is lower for group therapy, and sometimes it’s easier to learn from listening to someone else walk through a struggle than to be on the spot about your own struggles.
Last month CE4Less.com was kind enough to offer a free class on treatment for PTSD in veterans in honor of Veteran’s Day. I learned so much from this class that I’ve changed my strategy in dealing with trauma in general. While we rarely work with veterans at Teen Therapy OC, it has been easy to apply the techniques to adolescent and young adult clients.
The class introduced Cognitive Processing Therapy. This is a prescripted, step by step process of working through trauma that has led to nightmares, flashbacks, intrusive thoughts, hypervigilence, fear, anxiety, insomnia, and/or the depression associated with PTSD. So far my clients with PTSD have responded positively to this protocol.
I think in the case of my clients who are in the middle of the CPT treatment, they feel better because CPT doesn’t require them to talk directly about the events that occurred. It instead allows the client to explore how the events are affecting them today. It lets them find out what internalized messages related to trust, relationships, self-governance, and boundaries have come out of the trauma. Many clients don’t realize they are living by a set of “rules” they created for themselves as a result of their trauma. These rules are almost always self-protective in a way that doesn’t adapt well to their current life.
Here’s an example modified to keep complete confidentiality for my clients: When Jane was 16 she got drunk at a high school party. She was not so drunk that she blacked out the experience. She remembers making out with a guy who nobody else seemed to really know at the party. He convinced her to go out to his car. When they were there, Jane was assaulted by this guy and it really scared her. She got home safely, but Jane didn’t tell anyone what happened. A few months later she began to have nightmares. She became jumpy when friends at school tried to hug her. She started to feel withdrawn, fearful, and powerless. She also felt paranoid each time she saw a black SUV drive by that it could be this guy in his car. Six months after the assault, Jane felt like she’d lost herself to a prison of anxiety, flashbacks, and a sense that the world could not be trusted.
Jane came to counseling and was diagnosed with PTSD. She was relieved to know there was an explanation, but she didn’t know what to do to get her life back. She didn’t feel ready to share details of the event because that felt too overwhelming. She was thankful she could start CPT without going into detail about her trauma. She was able to complete the first steps (impact statement and stuck points) and already see there was a light at the end of the tunnel.
In no way do I profess to be an expert at the administration of CPT just because I took one class. There are therapists with more training in this treatment protocol. I do have extensive experience with teenagers though, and some begin therapy to talk about what they think is bothering them only to discover their symptoms are in response to a trauma. I’m incredibly grateful to have this tool available to help. It seems to be working well. I’m also grateful to the Dept. of Veteran’s Affairs for making these tools free to clinicians so they can guide their clients through this process.
Hello, I’m Lauren! If you notice your teen struggling, you might be feeling helpless, hopeless, frustrated or concerned as a parent. Try to remember, there is hope. I want to help your adolescent feel better. My hope is for them to enjoy their life again. I want them to feel confident they can handle whatever situations arise.
