by Lauren Goodman | May 10, 2024 | Teen Grief and Loss Counseling
Grief and Loss and Trauma
Five years ago, I was referred a client for an anxiety disorder. However, it became clear pretty quickly that she had PTSD. Also, the client had a separate therapist for grief because she had lost her father to cancer. Tragically, it was a long and ugly battle. At points he wasn’t aware of who his family members were. He dealt with many physical indignities, which were sometimes witnessed by his children. Sadly, it was cancer at its worst.
Eventually, this client’s PTSD symptoms showed. They came after witnessing the suffering her dad endured. So, not only did she have to work through tremendous grief, but she had nightmares and startle responses and avoidance and hypervigilance all related to the healthcare system. One day, a grandparent went into the hospital. When the client came to her therapy session, she endured a complete panic attack at the thought of visiting.
Unfortunately, trauma and grief often go hand in hand. If your teen is dealing with trauma related to the situation that caused grief, then your teenager may struggle to even start grieving. The act of grieving can trigger a trauma response.
What causes PTSD?
By technical definition, PTSD is when someone witnessed an event causing immense suffering or potential death to the self or someone close to the self. The traumatic response occurs within 3 months of the traumatic event(s). For the first month after the event occurs, we call it “Acute Stress Disorder.” However, if it hasn’t resolved by the 1 month mark, then it becomes PTSD.
If your teenager loses someone close to him or her, your teen has the possibility of developing PTSD related to the event. However, the majority of teenagers do not develop PTSD after a death. This means you cannot automatically assume your teen was traumatized by the death of someone close. Being traumatized means having an extremely distressed response after the fact.
What are some symptoms of posttraumatic stress?
Adolescents with posttraumatic stress exhibit a mixture of symptoms. Common ones include nightmares, flashbacks (reexperiencing the event after a trigger), hypervigilance, paranoia, panic attacks, trouble sleeping, trouble concentrating, and guilt or shame. One of the first things I notice as a therapist who treats PTSD is a strong avoidance of certain situations. For example, in the case of the client from the beginning of this post, she strongly avoided doctor’s offices and especially hospitals.
What do I do if my teen has grief and traumatic stress?
You get help. Typically, PTSD and grief become complicated. PTSD responds to treatment, but the treatment is complex. Thankfully, if a therapist helps your teen calm down their whole mind and body instead of remaining in a stress state, then your teen can start the grieving process. Getting through some of the grief also lessens the stranglehold of guilt and anxiety that PTSD has on its sufferers.
How is PTSD treated?
There are several methods for therapeutic treatment of PTSD. The two discussed here are primarily what we use at Teen Therapy OC. Firstly, we use EMDR (usually done by Carrie Johnson). This is a form of treatment that should establish different neural pathways for trauma cognitions. The idea is that the sufferer of PTSD no longer runs into the same emotional dead-end when trying to process trauma.
Secondly, we utilize CPT (cognitive processing therapy). Veterans with PTSD often use CPT, but it also works well with the non-military population. CPT seeks to reduce the shame and guilt associated with PTSD. This reduces the power of negative thoughts in the trauma process, which relieves the cycle. Typically, teens who complete the CPT protocol show marked improvement in their PTSD diagnostic scores. At TTOC Lauren or Mark does this therapy.
Call if You’re Unsure
In any case, if you are reading this post, then your family may have been through something very difficult. Our hearts go out to you and your teen. Please feel free to call and talk about your situation to see if therapy makes sense for you. The phone call is free.
Helping teens grow and families improve connection,
Lauren Goodman, MS, MFT
by Lauren Goodman | Mar 5, 2024 | Teen Grief and Loss Counseling
Delayed Grief in Adolescents Years Later
Grief hits at different times. Grief in adolescents often happens right away and then reemerges again later in life. It frequently coincides with major milestones. Delayed grief simply means grief that comes well after the tragic event.
An Adolescent Grief Story
It’s now been years since her mom died. She can still remember those final days. There was so much waiting. She felt a sickening sense of inevitability that almost made her impatient for its end. Then when it finally came, it was both horrible and an odd relief. Her mom had just been sick for so long.
She expected the waves of grief that came after. Everyone had told her they would. They promised to check in on her and that she could cry whenever she needed to. She found that both comforting and intrusive.
Now she’s eight years older. She’s close to finishing high school. She has a steady group of friends, a place at a college this fall, and has blossomed into a beautiful and poised young woman even without the guidance of her mom for the day to day. So why she wonders is she suddenly stricken with a depth of delayed grief that feels as fresh as if mom just died?
What Do the Experts Say?
Jazmine, our therapist who specializes in grief and loss in adolescents, notes that people often go through bouts of delayed grief when they hit major milestones in their life. The young woman described above is about to graduate high school. This rite of passage marks the transition from childhood to adulthood. It is an event most every child wants their parents to witness. On top of that, the transition out of childhood feels foreign, exciting, scary, and overwhelming. Teenagers like knowing they have a safe landing place where they can retreat to the comforts of childhood when adulting feels exhausting. This girl is naturally longing for her mother in this situation.
Relationships with Our Loved Ones Continue On
The part that confuses this girl is why she longs for a mother she only knew as a child. What she isn’t thinking about is that her relationship with her mother has continued. Firstly, she has never stopped loving her mom. Secondly, she still talks to her. Thirdly, she has a sense that her mom would be proud or her mom is watching from time to time. This relationship is still part of the core of her being.
Although her dad doesn’t talk about her mom as much as she’d like, she still is learning new things about her mom’s personality every time she’s with her grandparents. All through high school she has created a sense of her mom in her life collated from her own memories, anecdotes others have shared, and a composite of her favorite things about her friends’ moms. So, when explained this way, it’s only natural she is feeling a keen sense of delayed grief as she readies for an enormous change in her life.
Jazmine also tells us this girl is likely to experience grief again when she completes college, when she gets married, when she has her own children, and when she copes with tragedy and strife.
Delayed Grief Years Later
Grief is long. It retreats from a pain so acute that one cannot breathe into a dull ache. It becomes easier to set aside for a more convenient time as there is distance between the loss. However, it becomes something we live with, not something we get over. Hopefully, living with the grief gives us a dignity and wisdom instead of bitterness and anger. While it is a universal human experience, that is not the case for teenagers. This means there are less people who know what to say and how to support a teen going through loss. That is where grief therapy can help.
If your teenager is dealing with acute grief or delayed grief that is reemerging after a long latency, please feel free to call. While we might not necessarily recommend therapy, we are always happy to be a sounding board as you sort through what to do.
Helping teens grow and families improve connection,
Lauren Goodman, MS, MFT
by Lauren Goodman | Feb 27, 2024 | Therapy for Chronically Ill Teens
Therapy for Chronic Illness in Teens
Therapy for Chronic Illness is useful in treating one layer of chronic sickness or chronic pain. At the bottom is the baseline problem in the body causing the chronic illness. This is something like POTS or cancer. The second layer is the physiological symptoms. Here you find dizziness, joint pain, exhaustion, etc. The top layer, where therapy is helpful, is the psychological contribution to the body’s suffering. This is the stress your teen experiences because of and about the disorder. Your teenager probably has a level of isolation and modification to regular life that is depressing. Also, your teen may experience fear of causing a flare-up with increased activity. These psychological aspects of chronic illness and chronic pain/injury decrease emotional and relational quality of life, which we all know leads to slower physiological healing.
Counseling helps a lot with the top layer. So why should you consider therapy if your teen has chronic illness or pain? To reduce isolation, strategize about how to work through fear of relapse when the fear limits activity your teen is capable of, focus on purpose that can be achieved even with physical limitations, and work towards finding joy even when your teen isn’t happy. In other words, some form of counseling or support for chronically ill teens is essential.
An Example Case: Therapy for a Teen with POTS
When you have something like POTS (Postural Orthostatic Tachycardia Syndrome), you can spend a lot of time feeling dizzy. Some people find they faint. This especially happens when they get too hot or go from lying down to standing. It also occurs at random. Knowing you could faint without warning and that you are apt to feel very dizzy at any time causes fear of feeling that way.
Several years ago I saw my first POTS client. I don’t even know how she came to see me for therapy because I had no experience with chronic illness at the time. In fact, I didn’t even have my own diagnosis of lupus yet (although by then I wasn’t feeling well on a regular basis). This sweet, gentle, kind teenager was living with constant anxiety. It turned out she was really, really afraid of getting dizzy. When she had been at her most ill, the room spun so much that she dared not even open her eyes. She spent days and then months in bed.
So, how did therapy help her? She was sent to me because I had experience using cognitive-behavioral therapy with teenagers. When it became evident that she had already done a lot of the medical work necessary to live tolerably with POTS, then I realized she had the aforementioned layering to her symptoms.
Layering for the Teen with POTS
At the root of this particular teen’s issues was POTS. The second layer was her miserable symptoms. She felt a lot of brain fog, dizziness, nausea, and fainting without much warning. The top layer for her was a fear of fainting unexpectedly. It generalized to fear of dizziness because to her that was a sign fainting was likely. She developed a lot of anxiety. To control the possibility of fainting, she lay in bed for hours every day. She became physically weak and socially isolated. This increased her anxiety. But, what does anxiety cause if it rises to the level of panic? It causes brain fog and dizziness. So now, how was she to tell which was which?
After she attended the fabulous Mayo Clinic PRC in Rochester, MN, she came home knowing how to manage a lot of her physical symptoms (the middle layer). She still had dizziness and brain fog related to anxiety. Therapy made a significant impact on the top layer of her suffering as she was taught to use cognitive behavioral therapy methods to confront her fear of dizziness and associated anxieties. In her case, the Mayo Clinic doctors told her there wasn’t a direct cure for the bottom layer of her illness (POTS), but that it could be tolerably managed. Because of hard work, her life improved enough for her to return to school and start socializing again.
Counseling for Chronic Illness
How does therapy help with this? Counseling isn’t medical healthcare. So, it doesn’t help at all with the root cause of your child’s disease. Counseling also has little impact on the middle layer of the cake, which is the physical discomfort that you and your teen seek to manage with medical intervention. Counseling for chronically ill teens is quite helpful with the top layer of the cake. It can help your teen learn to discern when pain is caused by a physiological process in the body versus when it’s caused by stress and anxiety about the illness. By reducing stress, anxiety, loneliness, and depression, therapy for chronic illness helps bring the intensity of suffering down a notch or two.
Support for the Family
The counseling process also helps families living with the person suffering from chronic pain and illness. You have to walk on a tightrope of doing for your teen where they can’t without being an enabler. You must not do for them where they can do for themselves. Firstly, you will create a learned helplessness in your child. Secondly, if your teenager does all he can, then they can retain as much physical and emotional strength as possible. It’s just that it’s incredibly difficult for a parent to know which side of the line they are on. You don’t want to convey a lack of sympathy, but you also don’t want to prevent your teenager from living as fully as possible. Therapy can help you ferret out the mixture of flexibility and discipline your chronically ill adolescent needs from you.
Helping teens grow and families improve connection,
Lauren Goodman, MS, MFT
by Lauren Goodman | Feb 19, 2024 | Therapy for Chronically Ill Teens
Whether your teen is suffering from POTS, cancer, an autoimmune disease, or one of the many other thousands of things that can go wrong with the human body, living with chronic illness is hard. These include breathing exercises, regular exercise, better sleep, distraction, and proper emotional support. While none of these steps will cure the chronic condition, they are steps that can mitigate some of the misery.
Physical Ways to Help Teens With Chronic Illness
Breath Techniques
Breathe in deeply. Hold your breath. Breath out slowly. Breathe in deeply. Hold your breath. Breathe out slowly. Controlling breath is one of the relaxation techniques that is helpful for teens with chronic illness and chronic pain. Slowing the heart rate down through concentration on breath control helps lower anxiety. Lower anxiety means a more relaxed body. This usually translates to a reduction in physical suffering.
Imagine breathing calming, healing breath into the area of pain. Picture the breath filling the lungs, exchanging oxygen for carbon dioxide, and adhering to your red blood cells. Picture it moving through your body into to area(s) of discomfort. Imagine the area of discomfort relaxing. Imagine your red blood cells taking the carbon dioxide away from your pain, exchanging in the lungs, and exhaling from the body. With that, picture some of the pain leaving the body too.
Exercise
I read an article that people with chronic injuries tend to baby their injury. They probably don’t mean to. I believe they fear causing a setback or that it will hurt while exercising. However, this researcher went on to discover that people who were pushed to continue some form of exercise eventually found their pain receded. In many cases it disappeared. For this reason, I love the idea of asking your treating physician for a physical therapy referral whenever appropriate. PT helps me manage my lupus symptoms, and I have attended at least a few sessions per year ever since getting diagnosed. Consistent exercise in line with my doctor’s recommendations has also helped control my pain. I hope it can do the same to help your teen living with chronic pain or chronic illness (more here).
Sleep
You already know this. I know you do. However, it cannot be overstated. Protecting sleep is one of the most important things people with chronic illness can do. My rheumatologist told me right from the outset that this was the single most important change to make in my life. She said I must lie down for 8 hours per night so that I at least have the chance to get enough sleep. Now I guard my sleep time carefully. You must also prioritize this for your chronically ill teen as it is a key way to help them feel somewhat better.
Mental Techniques To Help Teens With Chronic Pain and Chronic Illness
Distraction
My aunt just had knee surgery. She has been in considerable pain for the past 4 weeks since the operation. A couple days ago she said to me, “It’s the weirdest thing. When I get on the phone with someone and start chatting, the pain recedes.” That didn’t seem strange to me. The brain is amazing in the ways it focuses. When we are enjoying relationships and conversation, other things fade. When we have something urgent to focus on, we tend to lose sight of everything else. While extreme pain will always cut through to the forefront of your conscience, dull chronic pain can recede somewhat. So, make a concerted effort to help your teen focus on something challenging that isn’t overwhelming. Then your teen dealing with chronic illness or chronic pain will have some relief.
Emotional Help for Teen With Chronic Disease
Empathy and Understanding
This is where a support group and/or therapy play a huge role! Sitting with someone who understands the frustrations, need for modification in activities, the sadness, and the fatigue that comes with constant suffering and vigilance against suffering is a big deal. Your teenager often feels like the only teen who is living a less carefree life than his or her peers. It gets lonely. Working with someone who understands the feelings that come with chronic pain/illness helps your teen make better choices. Your teenager is more likely to find purpose in the suffering too. According to the National Institute of Health, people who have support from a counselor or peers who really get chronic conditions have better psychological health, shorter healing times, and better preventative behaviors. I would add that it is easier to find meaning in the suffering when talking to others who also understand.
At Teen Therapy OC we are here to help. You are welcome to call or connect with us if your child is living with a chronic condition. Not only do I (Lauren) live with one, our whole team is happy to listen or pray with you as you navigate this extremely challenging journey.
Helping Teens Grow and Families Improve Connection,
Lauren Goodman, MS, MFT
by Lauren Goodman | Feb 16, 2024 | Teen Grief and Loss Counseling
Is it Teen Grief or Depression?
More than a few times I’ve seen clients come in for therapy unsure if what they are suffering is teen grief or depression. It is reasonable to be confused by this because they can feel very similar. When your teenager loses someone close, life turns upside down. When this happens, teens feel as if life loses its meaning. Likewise, depression takes away clarity about the meaning of life. Because of this confusion, depression and grief can be hard to differentiate.
Can it be Both Depression and Grief?
The short answer is, yes, sometimes. If your teenager was already depressed, grief can layer on top. However, if the depression wasn’t present before the loss, we don’t diagnose depression while an adolescent is bereaved. For the first two months after a major loss, therapists and psychiatrists do not typically diagnose Major Depressive Disorder. The timing of depression is one of the ways clinicians differentiate between depression and grief in teens (and all people actually).
What is a “Typical” Progression of Grief?
After one to three months, most teens feel their grief shift. While the loss is forever life-altering, teenagers tend to establish their new normal. They began to laugh again. They start to reengage with friendships. If they are coping with the death of a parent, they start to align closely with the other parent or guardian. Of course, there are still times when grief floods over them until they feel debilitating sorrow, but these instances became less and less frequent.
Please don’t read this and start thinking, “Oh no! There’s something wrong with the way my teen is grieving,” if their process doesn’t match this blog post. Every single person is different. So, while I can tell you what happens with a lot of teen grief scenarios, it doesn’t necessarily mean depression if your teenager is different.
Which is Which?
For some teenagers, the initial grief never lets up. They continue to walk through life feeling nearly numb after the death of the loved one. One teenager I saw wasn’t engaging in any part of life a full year after she lost her dad. She barely got out of bed, combed her hair, or completed any schoolwork. At this point, the grief had crossed into Major Depressive Disorder. The grief triggered the depression episode as she had been a well-adjusted teen before his death. However, she could not shake the brain fog, heart-wrenching crying spells, and confusion that came over her within hours of his death.
In this client’s case, her bereavement had become so complicated that she fit the criteria for Major Depressive Disorder. This is partially because of how long she was in this state. Without treatment for adolescent depression versus treatment for only grief, she may have continued to languish.
What is the Difference Between Teenage Grief and Depression?
Grief and depression feel similar. They both involve pervasive feelings of sadness. They both can suppress the body’s energy. Both grief and loss take away interest in activities that are normally enjoyable. They both create a sense of hopelessness and exhaustion. In contrast, grief tends to let up with time. As one priest put it, “Grief is love with no place to go.” Depression is a shutting down of the whole system. As the love slowly finds new people, ways to honor a memory, and is shared with others who also miss the deceased, active grief becomes integrated. Depression can’t do this. Depression is lonely. It tends to be an absence of joy.
What Can I Do?
Talk to your teen. Find out what they are thinking and feeling as best you can. Ask if they would like to talk with someone. Find out if they feel stuck. And, if you feel stuck in how to help them, please feel free to call. Even if you aren’t sure about beginning counseling right now, at TTOC it’s always a therapist who answers the phone or calls you back. We take a lot of 10-15 minute phone calls where we listen and talk about possible steps even for people who don’t end up booking an appointment. In fact, sometimes we recommend you watch and wait before deciding on therapy. In the case of teen grief versus teen depression, this very well could be the recommendation. We are just happy to support you wherever you are in your process.
Helping teens grow and families improve connection,
Lauren Goodman, MS, MFT
