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Treating Panic Disorder

Your heart is racing. You’re sweating. Your hands are tingling. You’re struggling for breath. You feel dizzy and queasy. Your body is so out of control you feel certain you’re having a heart attack.

The number of visits to the emergency room because of a panic attack that feel like a major medical event is staggering. According to psychiatryonline.org there are approximately 1.3 million visits to the ER each year because of severe anxiety.

The good news is that Panic Disorder is treatable. Panic attacks can be reduced in frequency and severity with cognitive behavioral therapy (and sometimes an accompanying medication). One of the steps your cognitive behavioral therapist will take you through is a set of interoceptive exercises. I speak a little bit about this process here:

Helping teens grow and families improve connection,
Lauren Goodman, MS, MFT

Should I Let My Teenager Struggle? When to Intervene

Raising happy, healthy adults can mean letting our teens "skin their knees." Image credit: stockimages at freedigitalphotos.net

Raising happy, healthy adults can mean letting our teens “skin their knees.”
Image credit: stockimages at freedigitalphotos.net

About a month ago my elementary aged daughter kept forgetting to bring home her homework.  At first I drove her back to school.  I told her comforting things like, “No worries.  Everyone makes mistakes.”  Then it became a pattern.  I started to struggle with the question every parent faces, which is ‘When do I let my kid experience failure and when do I rescue?’  Finally I told her that starting the following week she’d have to just live with the consequences.  Interestingly she hasn’t forgotten her homework folder since then.

 

I’m guessing if you’re reading this, your child is older and you are facing some situation where you have to decide how to best help.  Is this a time where you let your teenager cope with their sadness/anger/stress/frustration?  Is this a situation where you step in because it is simply too much for a teenager to handle on their own?  These are two of the toughest questions we face as parents.

 

I have worked with a number of teens whose parents have always intervened for them.  I bet you can guess the result.  These teenagers are indecisive and scared of the world.  They do not know how to deal with anything uncomfortable.  If there is a class that is too difficult, their parents have called the school counselor to help them switch out.  If there is a job they don’t like, their parents have let them quit.  Unfortunately these teenagers have been taught they are completely unable to cope with discomfort.  Until they learn otherwise, they will have a very challenging adulthood.

 

On the other hand, there are parents that force their kids to stick through absolutely everything.  There is a time when it is appropriate to quit.  This refers to unhealthy dating relationships, unhealthy friendships, making a wrong choice and stopping the course, etc.  It’s not that parents ask their kids to continue these particular activities, but their kids have internalized the idea that it is never okay to quit anything.  These kids have to learn when to just let something go, which is often a challenge for them.

 

So, as a mom or dad, how do you deal with this dilemma?  As carefully as you can, you try and guide your children.  It’s important to always keep the big picture in mind.  What do I want my teenager to learn from this situation?  The big goal is to raise healthy, functional adults.  As a parent, what do I do in this scenario that helps my teen reach the big goal?  This is more important than them feeling good about something right now.  Do I call my kid out of school today because they aren’t ready for that math test, or do I let them get a failing grade because the painful lesson will make them more responsible in the future?  Every choice has its consequences.

 

Helping teens grow and families improve connection,

Lauren Goodman, MS, MFT

Tips for teens after leaving rehab

Making new, sober friends after rehab is essential.  Image courtesy of photostock at FreeDigitalPhotos.net

Making new, sober friends after rehab is essential.
Image courtesy of photostock at FreeDigitalPhotos.net

Leaving rehab is usually a celebratory time.  People discharge rehab feeling very strong and certain they will not relapse on drugs.  They have gone over and over what they need to do in order to stay sober.  Any good rehab will warn its clients how easy it is to lapse back into the old lifestyle.  Plans are set, barriers against using drugs or alcohol are put in place, and the person goes home.

Now what?

Here are some tips for staying sober:

1. Get plugged in.  Find a recovery group that has strong, consistent members.  Teenagers often feel awkward about walking into new situations.  However, this is truly life or death and it is worth overcoming the embarrassment.  Alcoholics Anonymous and Celebrate Recovery are two types of groups that can be very helpful.  There is a Celebrate Recovery just for teenagers called The Landing.

2. Find a new hobby.  Old habits and activities remind teens of when they used to use drugs or alcohol.  New hobbies don’t have the old associations.  If you used to get stoned and then listen to loud music, it’s time to hike instead.  If these are hobbies where a social group can be joined, even better.

3.  Recognize that it is easy to stay sober around sober people.  Your teenager no longer has a physical need for their drug because they overcame that in rehab.  There will be a psychological attraction to the drug for a long time after the physical need has disappeared.  Teenagers who come home and immediately get involved with wholesome kids have a much lower rate of relapse.  On the contrary, teens who come home and see old friends have a high rate of relapse.

4.  Be honest.  Parents, you need to allow your teenagers to tell you if they are having cravings.  They need to be able to tell you without you getting really upset.  If they can come to you, then you can help them through it.  Discuss your plan for this ahead of time.  Agree that if they are having a craving you will take them down to the beach and just walk with them, or something like that.

5.  Do not assume you are immune to relapse.  Teenagers comes out of rehab overconfident.  This means they call old friends and sit to the side while friends use.  Before long they just take a drag on a cigarette.  Then it’s, “I just used pot once.  That’s not really a serious drug though.”  Quickly they are all the way back into it whatever they went to rehab for in the first place.

Following these 5 tips will really help your teenager keep their sobriety after rehab.  It is a challenging thing to do.  With the right attitude and focus though, it’s entirely achievable.  Probably the most important two tips on this list are the ones discussing social groups.  Teenagers are heavily, heavily influenced by peers.  Being around clean and sober people makes recovery much easier.

Helping teens grow and families improve connection,

Lauren Goodman, MS, MFT

Firm and Compassionate Parenting

Parenting is a roller coaster for all of us. Last night my usually level-headed, even-keeled daughter lost her mind because I asked her not to use her brother’s art supplies. This was incredibly uncharacteristic, but hey, we all have off moments. She was asked to go “take a break” for 30 minutes in her room. I didn’t want to give her a negative consequence because this outburst was so unlike her that I figured she could reset if she could calm down for a bit.

Instead of hearing this as a chance to regroup, she became more angry and started yelling at me. At that point I was forced to inform her she’d have to go to bed even though it was an hour early. She cried, begged, and pleaded for this not to be the case.

As a therapist I was keenly aware of how crucial this moment was in parenting her. If I chose to give in to her sincere apologies and entreaties to roll back her consequence, then I’d teach her she can negotiate with me. If I chose to repeatedly remind her, “This is all your fault,” then I’d be callous and harsh. My husband and I instead chose to hold the line of her consequence while showing her immense compassion. We understand that compassion doesn’t equal soft boundaries. We held her through her tears and talked to her, but still put her to bed. She was still a bit weepy when we kissed her good-night. We reminded her she is deeply loved and tomorrow is a fresh start. However, we did not give in to her desire for a reduced consequence. She felt our love but also understood our line.

I realize this isn’t easy to do. It requires a cool head. You can’t profess some unreasonable consequence in your anger because you’ll almost certainly be required to roll it back later. Or, if you stick to it, you’ll be strongly tempted to put all the responsibility on your teenager in order to justify your own overreaction. Even though my husband and I did it well last night, we are far from perfect in this arena. It’s still a work in progress, and probably always will be.

Here I share a few more thoughts on being both firm and compassionate; I hope it helps:

Helping teens grow and families improve connection,
Lauren Goodman, MS, MFT

Getting Out of a Bad Relationship

You know you should break up with him. You know he’s not a good human. You know you’re lonely/unhappy/depressed with him. Why can’t you end it? You ask yourself this on a regular basis. Your friends and family hate the relationship. Sigh. It’s so hard.

If you know you should get out, but you can’t bring yourself to do it, here is some great advice on how to start:

Disclaimer #1: If your bad relationship is violent and/or dangerous in some other way, this advice doesn’t apply to you because you don’t have time to take baby steps. Please take what feels like a drastic step and do whatever is necessary to preserve your safety such as calling the police or contacting a battered women’s shelter.

Disclaimer #2: While I speak in a way that directs this towards females, this advice is for males too.

Helping teens grow and families improve connection,
Lauren Goodman, MS, MFT

Bad Relationship, Bad Emotional State

Ryan…oh Ryan. I so badly wanted you to make me first. I so badly wanted you to dedicate yourself to me the way I was dedicating myself to you. Instead you dangled the carrot just enough to keep me hanging on. I was never in first place. There was always the promise I would be after “just this one more thing,” but I never was. My emotions in reaction built from confusion to anxiety to sadness to desperation to resentment to strength.

Any good therapist could have diagnosed me as depressed or anxious; they would have been wrong. I learned from you being in a relationship that didn’t feed me and didn’t honor God led to the emotional experience of depression and anxiety. I thank you now for this troublesome time in my life because I better understand my clients. The number of lovely young women and young men I meet with who seem depression and anxious, but are feeling that way because of a bad relationship is staggering. They always ask the chicken or the egg question, but it is answered when they cut the anchor. Once they let go of their Ryan, they almost always feel a significant improvement in their mental health.

Helping teens grow and families improve connection,
Lauren Goodman, MS, MFT

Teen Girls’ Concern With Their Weight

Fitness and thinness can become an obsession for teen girls. Photo Credit: Marin via freedigitalphotos.net

Fitness and thinness can become an obsession for teen girls.
Photo Credit: Marin via freedigitalphotos.net

Are you worried your daughter is overly concerned with her weight?  You’re not alone.  Studies have shows teenage girls are dissatisfied with their bodies at a rate ranging from 50% to as high as 90%.  It’s distressing to think that many adolescents feel preoccupied with wishing they looked different.

There is a big difference between teenagers who do not like their bodies, and those who go a step further.  Some may not like what they see, but they still wear swimsuits, eat normally, exercise appropriately, and do not complain about themselves too often.  Other girls are regularly trying to diet, and feel very self-conscious in certain attire.

I had a college roommate who was as beautiful and fit as could be.  We went to school in Tucson, Arizona and it was dreadfully hot every Fall when we’d start classes.  Despite this, I never once saw her wear anything besides pants.  When I asked her about this she said it’s because her legs looked fat, and that they would never look as good as they had when she was a ballerina in high school.  As a result she created a rule for herself that she was not allowed to show her legs under any circumstances.  She ultimately created more and more rules for herself until she had imprisoned herself in the trap of anorexia.  It was heartbreaking.

If you’re worried about whether your daughter is too concerned with her weight, she probably is.  You wouldn’t be clued into this being a problem if it weren’t.  Just in case though, here are some things to watch for:

1. Your daughter has cut out certain types of food such as “carbs.”

2.  Your daughter won’t wear a swimsuit in front of anyone.

3.  Your daughter talks about food constantly.

4.  Your daughter makes comments comparing her body to other girls or women on a regular basis.

5.  Your daughter seems to be on a perpetual diet and/or exercise regimen.

6.  You daughter has calorie counting and/or fitness tracking apps on her phone.

If you start to see some of these behaviors, it’s time to begin the conversation about whether your teenager is too concerned with her weight.  It can quickly bud into an obsession that overtakes her life.  Believe me, I know since I struggled with this very obsession from age 15 to age 22.  That is seven years of my life I can’t get back.  The main focus during those seven years was weight loss and fitness at a time when I should have been having fun with friends and learning a lot in school.

I work with a great number of clients who are unhappy with their appearance.  Some of them have gotten all the way into an eating disorder, and others are on the borderline.  It’s always helpful to them when A) they realize many, many others feel the same as they do and B) there are so many other facets that make up who a person is.  Treating poor body image is not as simple as this, but it’s where you can start as a parent.

Helping teens grow and families improve connection,

Lauren Goodman, MS, MFT

Tips for Keeping Teens Safe This Halloween

Keep your teens safe on Halloween with these ideas. Image courtesy of samarttiw at FreeDigitalPhotos.net

Keep your teens safe on Halloween with these ideas. Image courtesy of samarttiw at FreeDigitalPhotos.net

Halloween is on a Thursday.  This is an “uh-oh” for a lot of parents of teenagers.  Many of you have teens who are going to help you pass out candy, or just have a couple of friends over to watch horror movies.  That’s awesome!  Those sound like really healthy, safe ways to celebrate Halloween.

 

However, some of you have to worry about what your teenager will be doing and who they will be with.  Will they be drinking?  Will they be making-out with random people?  Will they be pulling pranks that might get them into trouble?  Will they be trying some weird drug at a Halloween party?

 

Here are 5 tips to help keep your teenagers safe this Halloween:

1. Don’t let them wear a costume if you don’t approve.  This is especially important for teenage girls.  They are at an age where they are almost expected to wear a costume that shows way too much skin.  Don’t let your teen out the door dressed as a promiscuous nurse, or provocative version of some comic book character.  You get the idea.  Halloween is a night where inappropriate dress is often accepted; you don’t have to join the crowd and just look the other way.  You can help your teenager dress up in a way where they look cute, but don’t attract the leering eye of every person they walk past.

 

2.  Check your teenager’s backpack.  Don’t let them leave your house with a backpack unless you know EXACTLY what’s in there.  Open bottles and smell them.  Even the best-behaved teenagers consider drinking on Halloween.  Since Halloween is on a Thursday night (so almost the weekend) the probability that they actually will drink doubles.  Your teenager might have a bottle of what looks like Gatorade, but it may be mixed with vodka.  I’m not saying you can’t trust your kid, but you just never know.  I have seen a great number of teens brought into my office because their very surprised parents caught them drinking or smoking, etc.

 

3.  Know where your teenager is going, who is driving them, and what the contingency plan is.  If there’s one constant with adolescents it’s that their plans change.  Make sure you and your teenager have gone over exactly what you want them to do if plans change, and how they will get there.  Make sure they communicate with you regularly throughout the night.  If you don’t hear from them at an appointed check-in time, let them know in advance what their consequence will be (The most logical one being that you go pick them up right away).

 

4.  Have the party at your house.  If you allow your teenager to have a bunch of their friends over then you can control their environment.  You can make sure there’s no alcohol, no making out in random bedrooms, no smoking, and no party-crashers.  You can be certain everyone has a safe ride home at the end of the night.  You get the comfort of knowing your teen is in their own bed at the end of the evening.  The downside to this is that you probably won’t get to bed when you want to, and there will likely be a mess to clean on Friday morning.  However, those might be prices you’re willing to pay to know your child is safe.

 

5.  Let them trick-or-treat.  A lot of parents have a cap on the age a teenager can trick-or-treat.  I really do understand this.  Overall though walking from house to house where there are a lot of small children and parents around is a pretty safe activity.  Maybe it’s a little tacky to let your seventeen year old collect a pillowcase-full of candy, but would you rather have them doing that or at an unsupervised Halloween party?  Invite them and their trick-or-treating buddies back to your house afterward for scary movies and a pizza.

 

The basic ideas of keeping your teenager safe on Halloween is that they are in a supervised environment, and you know exactly where they are.  You are in close contact and there is a plan in place.  Definitely let them go and have fun with their friends.  Just remind them this is a chance to earn more trust and freedom from you if they handle this holiday with maturity.

 

Helping teens grow and families improve connection,
Lauren Goodman, MS, MFT

How To Stop Feeling Self-Conscious

Every teen feels concerned with what others think, especially about looks. This can’t be helped. It’s part of human nature.

This week I felt like a teenager because of a big, crazy set of stitches on my lip that look like a really bad cold sore. Everywhere I went it felt like people were starting and were grossed out. Watch this video and see for yourself what ultimately happened.

Helping teens grow and families improve connection,
Lauren Goodman, MS, MFT

Why Adolescents Need Rules (if they’re the right kind)

Love your teens with grace, affection and rules. Image courtesy of David Castillo Dominici / FreeDigitalPhotos.net

Love your teens with grace, affection and rules.
Image courtesy of David Castillo Dominici / FreeDigitalPhotos.net

Parents, there are some of you who give your teenagers rules and consequences, but are very fair about it.  Bravo!  Keep it up.

 

There are some of you who have completely rigid rules for your teenagers.  You are grounding them all the time, and your adolescent can’t even remember the last time you had fun together.

 

There are still others of you who really want to be “cool” moms and dads.  You’re the parents who let your teenagers have parties at your house and you just stay upstairs.  You know it isn’t right, but you just don’t feel comfortable setting limits with your teenager.

 

This post is geared toward overly strict and overly permissive parenting styles. If you’re overly strict, there’s a decent chance your teenager feels criticized at every turn.  They really don’t know how to please you.  On the other hand, if you’re letting them do whatever they want, consider who will teach them about life.  Since it isn’t you, they’re going to learn it from their peers.  This means other teenagers are raising your teenager.

 

Setting limits for children is an essential part of helping them feel loved.  When they are two years old you might let them run around on the driveway, but you stop them from going into the street.  As they get older, they get more and more room.  By the time they are teens, they ideally are allowed a lot of say in their activities.  However, when they might metaphorically run into the street, you still stop them.

 

Here’s an example.  It’s great for teens to date.  Just as small children “pretend” to do adult activities, such as play house, teens “play” at adult romantic relationships.  They are learning!  It’s really good for them to do this while they still live in your house and you can guide them.  However, if you see them heading into something that is beyond their ability to manage, you stop them.  Here’s an example of what I mean: even though it’s a good idea for teens to date, it’s not a good idea for teens to have sex.  Any teen will tell you the physical risks that come with sex such as pregnancy and disease.  What they can’t articulate is the emotional risks that come with sex.  You, as an adult who has had sex, do understand the emotional risks associated with being sexually active with someone.  You understand the connection that occurs, and the emotional pain that comes if that bond is broken.

 

An overly strict parent will not allow their teen to even date at all because they don’t want their adolescent child anywhere near sex.  An overly permissive parent not only looks the other way if their child becomes sexually active, they might even allow the teenager’s partner to spend the night at their house.  A parent who teaches their child how to date without allowing their child to be sexually active is one who is allowing their teenager to explore who they are becoming, while lovingly placing protective limits on their teenager’s behavior.

 

Teen dating and sexuality is just one example.  The real point is to help you understand where to set limits on everything your teenager does.  Allow them a bigger area to roam as they earn your trust, and as they can handle it.  Don’t be so strict that while you protect them from any failures, they are not learning how to live life.  Don’t be so permissive that while they might like you better, they are exposed to things beyond their adolescent years.  Find the middle ground that keeps you in charge as the parent but lets your child develop; this is loving your teenager well.

 

Helping teens grow and families improve connection,

Lauren Goodman, MS, MFT

The Teenage Christian

For the teenage Christian there are many challenges. Image Credit: Iamnee and freedigitalphotos.net

For the teenage Christian there are many challenges.
Image Credit: Iamnee and freedigitalphotos.net

Because I am very serious about my Christian faith I tend to get referrals from churches and families seeking a therapist who is also a Christian.  I would estimate though that at least half of the teenagers I work with are either of a different faith, or do not practice a religion at all.  This is fine in the context of a counseling relationship because compassion, care, understanding and guidance are aspects of counseling that transcend any religious or cultural differences between me and my clients.

 

Today though I am writing to my clients, both present and future, who are Christian teenagers.  I want you to know you are not alone in walking a path that feels incredibly difficult at times.  You are called to have the highest level of integrity, and that often means you do not end up in first place.  While you have plenty of friends who find ways to cheat on tests or homework assignments, you are asked not to behave this way.  Sometimes you probably give in to this temptation as I did several times in high school.  Afterwards you might get the grade you were hoping for, but there is no satisfaction in it.  You are left with a sense of guilt that can only be remedied by admitting your fault.  This is even harder to do- face up when you know you’ve done wrong.

 

You also are following the moral and emotional guidance of Christ.  These days some of your beliefs are culturally unpopular.  You might find yourself dealing with some mild form of verbal persecution among your peers.  While it is extremely unlikely you have faced physical abuse for your beliefs, if you are strong in them, you have very likely been called a name or two.  This happened to me in high school as well.  I was called mild things like naive, to completely inappropriate and incorrect names such as bigot, and one time I was even called a neo-Nazi.  In no way did I ever have even the slightest inclinations towards white supremacy.  This came from the mouth of someone who was angered when I said Christians believe there is one way to Heaven.  I did go home and cry though because it felt terrible to be so completely maligned when I was trying to live my life in a very loving way towards others.

 

Another challenge you will most certainly face is moral dilemmas when you hang out with your non-Christian friends.  A great number of them probably party, drink, lie to their parents sometimes, and are sexually active.  It is really easy for you to attend youth group and go to church on Sundays, but still partake in these other things.  In high school I had one foot in my faith and church, and one foot in the party scene.  I justified it by saying I wasn’t the worst one there.  I very rarely drank, and instead usually chose to be the designated driver.  The problem was that I was lying to my parents about where I was going, and was tempted by other things as well.  I was moral shades of gray.  I know A LOT of Christian teenagers who do the same thing.  It is tough for you to keep your non-Christian friends if you never do the things they like to do.  But, this is exactly why it’s so important to understand that you walk a challenging road.

 

I think the most important thing you can do right now is keep a daily connection with God.  Read your bible regularly, pray and stay involved in a small group.  If you do these three things the desires of your heart will more likely align with Christ.  That makes it a lot easier to follow Him than if you are trying to use your own will-power to be a “good kid,” but you don’t actually know a lot about who Jesus is.  Then it becomes a religion of right and wrong instead of a relationship of love.

 

Helping teens grow and families improve connection,

Lauren Goodman, MS, MFT

Happiness

Happiness eludes many of us. Listen to this brief story of how Dr. Martin Seligman determined to become a happy person. His research has shaped what we know about happiness and how we have the power to increase our feelings of positivity and happiness.

Helping teens grow and families improve connection,
Lauren Goodman, MS, MFT

Help for school anxiety

Dreading school can make life miserable for a teenager. Image courtesy of luigi diamanti at FreeDigitalPhotos.net

Dreading school can make life miserable for a teenager.
Image courtesy of luigi diamanti at FreeDigitalPhotos.net

For some teenagers, school is exciting.  They cannot wait to see friends, and really don’t even mind being in class.  If you’re reading this though, that is probably not your kid.

For a lot of adolescents, Monday is the worst day of the week.  Going to school is terrifying.  This can be for different reasons.  For some kids the pressure of homework, tests, and getting up early is overwhelming.  For most teenagers though, the anxiety associated with school is social.  It is hard for some teens to imagine that anyone will be excited to see them.  All they can picture is either being teased, or being ignored as the other kids excitedly greet one another.

As a parent who loves your kid, and most likely thinks the world of your kid, what do you do?  When you see their heart breaking because they just don’t feel comfortable or confident, it breaks your heart too.  We all revert to one of two attempts to help our children.

The first thing you might be doing is trying to solve it.  You might be telling your child how to make more friends (or how to offend less people depending on your perspective).  You might say things like, “Just walk in smiling.  That always makes a person more attractive to others.”  You might offer to let your kid have a party, or you might buy your teen the latest clothing trends.  Realistically though, are you making a huge impact in this way?  Your children’s feelings on the inside won’t have changed much, and this reflects outwardly to the other students.

The second approach might be to diminish your teenager’s concerns.  You might tell them things like, “I bet more people like you than you think.”  You might also tell them they are imagining it, etc.  Here you are near the right track, although not quite on it.  You need your teenager to be the one who says, “You know, I bet more people like me that I realize,” instead of you telling them.  How in the world do you accomplish this?

The techniques I’m going to offer you aren’t foolproof, but they’re worth a try.  Firstly, try telling a story about yourself at that age.  Make sure it’s a story where you felt similarly.  If the end of the story is that you were better liked than you realized, then include that.  However, don’t make it up.  If the end of the story is that you really weren’t very well liked in high school, leave it there.  At the very minimum your child will feel understood; that is primarily what they are seeking when they talk with you about school related anxiety.  This will help them to feel a little better because they will know they are not alone.

The next thing you can try is having your teenager examine the facts.  Tell them, “We are going to look at both sides of this and then come to a conclusion.”  Have them first tell you hard evidence that proves they are correct in their assuming people don’t like them at school.  Do not allow things like, “I just know it,” or “Jennie likes Carmen better than me now.”  Next make your teenager tell you why they are liked.  Believe me, unless your child smells, is rude or never brushes their teeth, someone is friendly toward them.

If the anxiety stretches beyond basic nervousness, also consider getting a little extra help.  Counseling tends to work very well on school-related anxiety.  You can always start with what’s free.  Put a call in to your teen’s school counselor.  If you’re not comfortable with that, or the school counselor doesn’t help, then it’s probably time to call a licensed therapist.

It is my hope your teen has an amazing school year.  I hope they learn in the classroom, and grow as an individual.  Every year is a new chance for your child to blossom.

Helping teens grow and families improve connection,

Lauren Goodman