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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

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