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My adolescent clients have been coming in with terrible angst. They are triggered and tested to death. Kids say that school has no meaning because all professors do is “teach to the test.” This was before the pandemic. Now, with online school winding down for the summer, kids and teachers who are high achievers are burnt out (can't focus, can't think, can't move); kids who are low achievers often get inappropriate help, like being muddled into a co-classroom that combines autism with ADD, dyslexia, and mentally ill kids all in one small, unventilated space. My client said she couldn't read because the other kids were screaming.  College students relate that they are anxious about the “cancel culture” and they’re running out of safe activities to do for the summer. My own daughter recently went to visit her college to hang out, just pretending that everything was normal. The worst President in history is sitting on his throne while Gen Z are tallying their college debt and wondering if there will be a job after graduation. They don’t want to work in this gig-economy and their parents have thrown up their hands worrying about what’s next. A perverse kind of relative morality, with lies and deceit perpetrated by this administration, is gaining traction, while doing the right thing and basic decency are a lost art.  I told one of my clients to go volunteer somewhere and he looked at me like I was insane. Kids come in saying their parents are awful. Like a parent who says, I’m going to have another child to give me what you can’t, I’m getting divorced because of you, I’m going to send you away, I’m tired. Or, we will no longer pay your bills if you don’t do something! I had one mom say, looking straight at her daughter in the office, “You’re a 5, but you could be a 10.” I don't think I have ever heard anything so crushing in one fell swoop. Teens and young adults come to therapy alienated, estranged, confused, isolated, lonely, angry, clinically depressed, anxious, avoidant, and socially scared to death. They think their parents’ anxiety is contagious.  They turn to substances, self-harm and self-doubt; they turn to more and more risky behaviors, hoping someone will stop them from becoming utterly numb.  But alas, no one is available. Vaping has become the culprit of some serious if not fatal issues, but keep your eyes on the prize. The underlying causes of self-destructive behavior have not changed.   Here’s what I’ve gleaned: Anxiety and depression, OCD, mood problems and personality disorders have some inheritable characteristics but you can’t “catch” them from your “crazy” parents. Learn to face your fears early and often. If you avoid them you stagnate. Your parents have their own problems. They cannot transmit them to you. Try to grow and learn in ways they can’t. What can divorcing parents do? First and foremost agree that the welfare of the child is paramount. Then it is important for both parents (together if possible) to give the child a framework that is age appropriate to make sense of the divorce. It may be something as simple as, “Mom and Dad cannot live together but we both love you and will continue to take care of you.” The framework statement of course will be much different for a 6-year-old than a 16-year-old child. Explain to the child it is the parent’s choice and it is not their fault. You will have more success if you have this conversation more than once. So before you strangle your kid for his attitude, kill him with kindness and sense the positive outcome. Acknowledge what he or she is going through. A little support goes a long way. Parenting is hard.  Parenting a teen through a divorce and a pandemic deserves a medal. Resources: https://www.mindful.org/mindfulness-meditation-anxiety/   https://www.amazon.com/Moms-House-Dads-Kids-Feeling/dp/0743277120/ref=pd_lpo_14_t_0/144-4455833-9978314?_encoding=UTF8&pd_rd_i=0743277120&pd_rd_r=28aa9221-c24d-4342-9a0c-4580512e8b3e&pd_rd_w=vpFrE&pd_rd_wg=RyO6U&pf_rd_p=7b36d496-f366-4631-94d3-61b87b52511b&pf_rd_r=VYE3Q30CZ8TXAK73V48H&psc=1&refRID=VYE3Q30CZ8TXAK73V48H   https://www.amazon.com/Why-They-Act-That-Way/dp/1476755574/ref=sr_1_1?dchild=1&keywords=why+do+they+act+that+way&qid=1592860728&sr=8-1

Photo credit: Rosalind Bank It occurred to me the other day that I was laughing with a client because I completely and utterly understood where she was coming from. And then it hit me. No wonder I've been so busy helping my young adult clients overcome anxiety—wait for it—I “have it”, or should I say, “it has me” too! Of course, I have known this for many decades, but that day I had a kind of breakthrough. I can laugh at the insanity of it all. I've been there and done that on almost every occasion. My client Elsa said she was afraid of driving over bridges. Hmm, I don’t have that one. But I do have the one where my husband is driving too fast and I think I’m going to fall into the Hudson River. Then there’s the one where I’m going on a job interview and I think to myself, “OMG, I have gained so much weight since I had kids!” Or my mind goes blank and I forget everything I ever accomplished. Then there was the time my puppy ran across the highway and I had a panic attack. The worst is ruminating. Although I teach clients all day about fight or flight or freeze, I forget that I myself need to take a break from overthinking. When my kids started driving, I gained a new and paralyzing dread that someone would run into them. Add to that health and money worries, and sirens passing by while I’m quietly doing paperwork at home—catastrophizing is my specialty. Like what you are reading? For more stimulating stories, thought-provoking articles and new video announcements, sign up for our monthly newsletter. Self-care is our therapy buzz-word and it works wonders. My friend, a fellow therapist, said I need a spa day. “Do it!” My patient debated the whole day if she should take a “mental health day” from her demanding teaching schedule. “Do it!” Another patient wondered if she should take up journaling again. “Do it!” And the very process of pushing through your fears is instructive; it combats avoidance. My client was afraid to call her doctor for some results. “No problem, do it in my office.” My client was terrified to sleep over at his Dad’s new apartment. “Build up to it.” Once, many years ago, when my mother was dying of cancer, a kind and wonderful boss at Disney.com handed me a laptop and said, “I’ll see you when you’re ready.” Ask for help. Take a small step. All the clichés stacked up to the sky, or, as Annie Lamott says, “Bird by Bird.” The simple catchphrase, “Do it” flows so easily from my mouth—it just doesn’t quite make it to my ears and into my brain. Clients often ask me, “How I can begin to trust my inner voice when all I know is worry.” And I tell them “For one thing, you have a choice. It’s your life. Own it. Take care of it.” It seems to me that people in other countries get more time off to recharge. Only here do we grind ourselves until there’s no more fuel. And, let’s see if we are mislabeling anxiety as something else? If it’s not anxiety then what is it? 1. Anxiety from the past may be triggering a fear of abandonment. My client Mary wants to marry her boyfriend but thinks he might be cheating. She stalks him on Facebook, Instagram and Twitter on an hourly basis, based on her "hunch." She finds nothing but cannot stop her obsession. This is no longer a gut feeling, it's a bad habit, a self-destructive, relationship-bombing behavior that is sure to drive someone away. In this case, although there is no evidence whatsoever that he's a cheater, Mary continues to rely on her false "gut feeling" which only serves to create more anxiety and self-sabotage. Go back to where it’s coming from and try to counter the fear with a more realistic appraisal. 2. Anxiety masks as fear of the unknown. My client Joya wants to go out with a boy from her fraternity, but he is a “player.” When he finally asks her out, she says no based on what her friends have said. The information she has obtained is from the past, and unproven, especially since Joya really likes him. She continues to rely on second-hand information instead of living her own life. She is more afraid of the unknown than finding out the truth about him by using her own judgment. Unknown fears need to be faced, not avoided. Sometimes when I’m driving to a new place, I make it a habit to stop somewhere en route to pick up a treat or run an errand. This makes the unknown into a little adventure. 3. Anxiety is not the same as intuition. Jessica thinks her boyfriend is simultaneously dating someone else. Her so-called intuition is based on patterns and evidence that she has directly observed—he's always late, keeps his phone locked away and acts sneakily. Intuition tells her from observed experience that he is hiding something. Anxiety, fueled by insecurity misguides her into convincing herself that he is doing something wrong and that he will inevitably leave her, instead of leading her to confront him directly. As psychologist David Barlow warns us, “don’t believe everything you think.” “Ask him what's going on instead of making up stories in your head,” I suggest. Test the intuition with objective observation. Your anxiety may have something to tell you. If this sounds tricky, it is. Intuition can be considered a neutral and unemotional experience, whereas fear is highly emotionally charged. Reliable intuition feels right, it has a compassionate, affirming tone to it. It confirms that you are on target, without having an overly positive or negative feel to it. Fear is often anxious, dark or heavy. Take a step back and breathe deeply for a moment. What's the worst that can happen? What part is objective and what part has no business in the present? If it belongs in the past look at what happened. It's over. You are safe now. The only way to separate from rumination is to pause. My last client of the evening recounted her fight with her ex-girlfriend over text. “Please Hannah,” I said, “unplug for just five minutes. Then assess how you feel. You are only feeding the attention-seeking behavior of your ex. Can you step back? What will happen if you just sit quietly?” Can a therapist, this therapist, heal herself? The phone rings, the news blares, and real tragedy rings into our consciousness, implanting itself in vivid living color from a smart TV into our visual field whether we want it or not. I can help my clients not because I’m master of my anxiety and of my fate, but because I’m continuously right there with them. My friend calls and says “Let’s take a walk.” “Yes, I say. Let’s do it, everything else can wait.”   https://www.psychotherapy.net/blog/title/combatting-anxiety-bird-by-bird Originally published: GoodTherapy.org © 2020 Psychotherapy.net

Several of my clients were talking about change.  Hard to leave college.  Hard to make friends.  Hard to find a job, live at home and not know what you want to be when you grow-up.  They were all young adult women ages 20-30 and they felt they were supposed to know already. While evidence now shows that our brains aren’t fully formed until the age of 25, (and a two-year lag for boys), we expect a lot of our young adults.  The pressure to succeed is more intense than ever: an economy for the rich and famous.  Excluding everyone else.  So if you’re an average kid from an average town chances are you didn’t get many breaks.  At least not yet.  To seize your 20’s says Meg Jay ( http://www.ted.com/talks/meg_jay_why_30_is_not_the_new_20?language=en ) can be extremely empowering.  Not the throw-away years but the make-it-or-break-it years.  I mean emotionally. When I finished college I lived for six months in my Grandmother’s apartment in Queens.  It was a dark time.  First my car was broken into.  Then my wallet swiped on the subway.  Then a deepening depression.  My parents had divorced when I was 15 and I had postponed the grief process until that moment, too busy trying to be a teenager, then a young adult to make time for the loss.  I was consumed with boyfriends of a most serious nature.  I was popular and good at school and sports.  Now after college there was nothing.  Without friends or school I had no idea where to go or what to do.  Though I had my parents’ support, I felt lost and alone.  I had also just broken up with my boyfriend.  Or rather, the other way around.  Because I graduated a semester early, I lost a critical piece of closure that haunts me to this day.  That was the first of my several young adult mistakes.  It would be years until I got my bearings again.  Only to plunge into yet another stormy relationship that ended poorly, usually involving me thinking the world had ended.  At that time, nobody, not even my super emotionally intelligent mom used the words anxiety or depression, even though looking back it was so obvious.  I think a bit of prozac might have gone a long way after college.  Still.   So when these girls started repeating the same thing in therapy I said, “Why not form a group so we don’t have to repeat ourselves?”  I was skeptical because of scheduling, not because of my group skills.  I had done groups many times.  Groups for refugees navigating the healthcare system in NYC; Groups for MS patients; Groups for parents in court-mandated custody litigation; Online Community Groups and Groups for Leukemia patients and their families all over the US.  But this was different because it sprung out of an organic need: the need to connect, belong, socialize and be understood by so many young women, all in it together, though they had never met. These were all college types, middle-class from mixed ethnic backgrounds.  All had found college to be too excessive either academically or alcoholically.  All had chosen a slightly different path from nursing school to community college to hard work at a restaurant or bar.  None (but one) had found true love yet, and all were struggling financially.  The most repeated topic was: he never called me back.  The next biggest topics were: how to talk to parents, money, divorce, relationships, sexuality, identity and betrayal.  And finally, texting or “talking” to someone who was perfectly capable of sending pictures of his penis but equally incapable of making a time or date to meet.  Hook-ups would be no problem.  Girls, Guys, hooking-up.   Call me old fashioned but these young women thought it sucked.  There was not one among them who wanted anything other than a committed relationship or a “steady” “boyfriend.”  But if you’re 25 and emotionally 23, plus struggling to become independent in a bad economy (read: the rich got richer), and he’s 26 and developmentally 24, and, he lacks the frontal lobe executive function called “planning,” what do you think you get?  Nothing.  That’s right.  A text, a sext and a hook-up.  No more, no less.  Where were the normal guys?! As time went on, I continued to marvel at how every man they chose (or who chose them) couldn’t pick up the phone.  I’m told by my feisty 16 year old that this cannot be true of all men.  I am no feminist, but pick up the phone, man!  More often it was dwindling “talking” by text and then radio silence.  This went for before and after hook-ups, dates, meetings or outings.  A brief text, then dead.  “He deaded me” is even a thing.  It seemed these young men had no obligation to commit to anything, ever.  I can imagine them at work telling their bosses, “maybe I’ll hit you up at the meeting later.  Or maybe not.”  And I’m sure they didn’t get through college by “maybe attending” a class/maybe not.  These girls were miserable.   Hook ups left you feeling empty.  Like Lena Dunham on “Girls,” the Millenium mood was dark grey, cynical, entitled but ultimately lacking any vestige of charm. The topics were savory at first but soon catapulted into deeper territory.  We had loves and losses, sex and abortion, “day drinking” and bondage.  But none was more ultimately empty than just being dumped with no explanation.  While the guy trotted off to his next exploit, these young women were left holding the bag, wondering in the absence of any language what the hell they did wrong.  Beating themselves to a pulp for an answer made for crippling self-esteem issues, distraction from school/work and a conclusion that never-ending failure would be the norm.  Their friends getting married on facebook, what other conclusion was there?  My job was to support the process (key in social work oriented therapy), inject cbt-type strategies such as thought restructuring or decreasing negative self-talk, and acceptance such as “be here now” and dbt relaxation into what is, without judgment.  Also of course I could provide my own life lessons on loss, maturity, patience and resilience.  (God knows I had ample material). The best gift I was able to give as a therapist to young adult women was freedom from anxiety.  Concepts I employed consisted of: anxiety won’t kill you. whatever doesn’t kill you makes you stronger. you have a choice whether or not to be anxious. the things you worry about rarely happen. (other things happen) you cannot control everything. stuff always comes up. you can handle it by tolerating it. revving up doesn’t make you accomplish more; it makes you careless. worry is a waste of time (do you want your surgeon to be worried?) worry eats up mental space better used for more productive hobbies. panic attacks are not heart attacks. no one ever died from a panic attack. we have outgrown fight or flight but our brains haven’t. anxiety is like a bad habit. anxiety will pass. What I found as their therapist was that these women longed for meaning while the men they encountered wanted anything but.   I also heard that men’s binge drinking on campus, date rape/sexual assault and frat-sickening hazing behavior was at an all-time high.  Paying all that money and piling up debt and then to come out with a degree in alcoholism was just sad to me.  Nothing too new, but sad nonetheless.  Colleges seemed to be wracked with scandal and suicide.  (See Dartmouth and Stony Brook in recent articles).  So I joined the board of directors of my old College Counseling program to see if I could make a difference.     When young women drink to excess they get taken advantage of however mature they appear.  When young men drink too much they often become aggressive and destructive.  Men on campus drink on average of 9 beers per week.  (Female students tend to consume 4 drinks per week versus male students, who drink more than double the amount at 9 drinks a week.  Persons become at-risk drinkers , or those most likely to become alcoholic, when the number of drinks per week climb. In at-risk women, the number of drinks per week is 7 per week; for men the number is 14).  I felt bad that with so little self-esteem they could permit themselves to tolerate really abusive situations.  However, when as a therapist you let go of trying to “fix,” of course good things come your way.  Back to the books and Yalom and process to realize it was enough that the other group members told them “stop!”  We care about you.  You are worth it. Using Group Work Principles - Process  I wanted to rush to go deeper; I wasn’t satisfied but they were.  They kept it casual until one more emotional evening triggered the next.  I made sure everyone got a turn to vent.  When I tried to structure, they resisted.  Like all successful groups, they began to govern themselves.  We made a rule of confidentiality of course but did not restrict social media and outside socializing.  In some circles, this could be considered risky or even wrong.  However, why would I want to restrict them if these were the only friends they might have on earth right now. Group Composition -  Morgan was a pretty and shapely young lady who had experienced it all in high school and was now looking for something deeper from life.  She had a string of low-life boyfriends, none of whom could follow through on anything.  She couldn’t understand the repetition of this pattern until she was forced to confront what she wanted; not what he wanted.  Reminded that her father left when she was young, she realized she was only searching for him, not something better…  Ultimately she found greater confidence and could stand alone. Larissa was bright and lively, having just broken off with a very serious college relationship.  Lost and confused she wondered what was next.  With all the pressure she endured in her young life from succeeding in top schools to watching her parent’s divorce and change values, she ended up re-evaluating her own ideas of commitment and deciding it was she who wasn’t quite ready…  She ended up finding a mature boyfriend who treated her right. Jayne was the oldest member, newlywed but estranged from her family due to their radically conservative ideas about life, religion, and family values.  Jayne discovered through group that while she was an “outsider” she could find comfort in her new group family.  Her goal was to stop beating herself up for leaving the old family and accept her new direction, as painful as that might be…  She found peace in being a free-thinker, unlike her family of origin. Casey was a gorgeous, hard-driving young woman from a large immigrant family that put her needs last.  She spent most of her 20’s with a man that treated her as second-class, reinforcing her self-doubt and resentment of herself and her relationships.  Through the group she could use her outspoken anger to channel some changes and personal growth and vow that living alone was better than living in fear…  Finally she shed some of her defensive facade to relax into whatever might come. Deanna was from a strict middle-class family who didn’t understand their daughter’s need to expand her life.  They kept her close and allowed little.  She spent her college years working in her room and going out with a small circle of friends.  She wanted something more but had no idea how to get there.  Through the group, the one who was too shy to talk, Deanna found her voice…  She decided to meet some new people and expanded her circle immensely. Robin was a hard working, attractive young adult who found going from college to work a bit of a shock.  Suddenly everything was regimented and her freedom was gone.  Being an adult was hard work.  Saving money and living at home was demanding and exhausting, and her body was adjusting to the new routine.  Her old boyfriends became nothing but immature jerks after she passed them by in every way…  Eventually she got medical help to become stronger in her daily life. A newer member, Joy, at first seemed like she couldn’t express herself at all, but soon began to blossom.  Painfully shy and stuck after a very pressured college experience, she had no idea what to do next.  She felt incredible expectations from her family yet they insisted there were none.  Not knowing where to turn, the group gave her a safety net for the profound sense of confusion as to who she was and what she would become, a common trap for 20-somethings…  With the group’s support, she achieved the courage to apply to graduate school. Marina came and left but had a deep impact on the group with her soulful way and seeking something different than college life.  She wanted to work and be independent as quickly as possible but her rock-star boyfriend and her random panic attacks kept getting in the way.  Soon she found she must put herself first if she was to succeed.  After brief therapy and anti-anxiety medication, she was on her way…  She only stayed a short while but made a commitment to taking better care of herself. Bethany was a pretty, old-fashioned young adult who still kept stuffed animals and slept next to her sister.  She hated frat boys and beer pong and wanted to find her way through college without randomly hooking-up.  Each guy she met was more unreliable than the last.  Often they would pursue her and then drop her without explanation.  Trying to make sense of it put her into a spiral.  She was exasperated…  After things calmed down she found it more peaceful to simply be alone. Jocelyn didn’t stay long in the group.  She recently discovered she was bi-sexual and began dating a series of girls whom her parents frowned upon.  She also had an extremely debilitating medical problem along with depression about which her parents hardly understood.  She was in all this alone at the age of 24…  Group forced her out of isolation, the first step. Therapist’s Point of View- As the “core group” began to solidify I worried a lot if I was being effective and compulsively tried to “deepen” the conversation.  As I began to relax they were able to tell me that they liked the group just the way it was.  Just talking, venting and sharing, taking turns.  It soon became clear that my need to control and get it right, and my own insecurities still plaguing me after all these years of experience, were beside the point.  The group had sustained itself.  Nevertheless, the interventions I made were to reinforce the shared group experience, the universal nature of the 20-something experience, and the repetition that anxiety was normative given these conditions.  I also increasingly pushed the more reticent members to link up their past with their present, thus gaining insight for the first time.  Finally, I was “motherly” in that I could see, from where I sat, that life would ultimately deal them their share of traumas, yet I knew they could withstand it with the appropriate support.   I was in a therapy support group at that age with a strange, worldly character who influenced me greatly at the time.  We used to do weekend “marathons” ending with a feast from his Turkish wife.  I recall the benefits but also the tragedy years later when I found out that some of us got worse instead of better.  Life deals you certain cards.  I can only guide and witness and let go.  I know I’m a good therapist now not because I’m a nice lady but because the skills of communication are subtle.  And becoming more silent in my own mind is essential.   On the last several Tuesdays the women were dwindling down and I thought maybe the group is over.  But the following week, we were back to 7 and going around.  I do want them to interact more but they seem to feel safe just spewing.  They are lively, insightful, dynamic, shy, overwhelmed, scared and lonely, by turns.  I remember those days.  Wouldn’t even want them back. Hook-Up Hell and Other Tales: A Year in the Life of a 20-Something Support Group Originally Published in Journal "GROUP" by, Donna C. Moss, MA, LCSW-R  @2015 copyright

I kept away from trauma treatment for a long time; I thought it would make me depressed. Yet now that we're in a pandemic, I decided to dive in.  More and more of my clients were presenting with symptoms of PTSD. Thanks to the pioneer Bessel Van Der Kolk we have a model for trauma treatment that finally makes sense. Rather than just reciting the trauma, with the real danger of re-triggering the client, we take it slow as molasses until the client is ready to reveal their trauma story.  They can only do this when they feel SAFE.  Once I discovered yoga, I understood why this made sense. I came to yoga close to 20 years ago because of sciatica pain all the way down my leg.  No other remedy helped.  And believe me I tried.  But it was yoga that CURED it.  Again and again yoga gave me benefits I could never have imagined.  It's not about the workout.  It's about quieting your mind IN SYNC with your body.  It's that simple.  You have to do it over and over to see that yoga contains an inherent truth: The Body Keeps the Score.  This seminal book, which shot up the best seller list during COVID, instructs us to RELAX the breath/body and the mood will follow.  It could have been called the mood cure for our time.  For therapists who are afraid of body work, don't be.  You can stop the session to help the client prevent "flooding" or send them home with simple videos for rest, restoration, self-care, yoga, and meditation. Right now you can do a neck roll or legs up the wall or a child's pose and feel the benefits. What else do you know that gives you such instant gratification, and is free too! Did I have trauma?  I never thought so.  I had lots of losses, bouts of depression and up and down anxiety, but trauma?  Well it turns out I did.  The pain I was holding in my body was unlocking and I was scared.  I cried.  But release I did.  The major trauma of my childhood, my parent's divorce, had followed me into every relationship. The fear of abandonment governed my decisions, and my sciatica came back.  Slowly slowly I worked it out. According to the book Stolen Tomorrows I realized that my patients with histories of sexual abuse were going to take a lot more time.  After all, how could I not educate myself about this pressing issue while working with young adult females during the #metoo era?  Stories kept coming.  And the book says, for every major developmental milestone that a girl missed (or a boy) as a teen and young adult during the time the abuse took place, that's how long it will take to undo it, and go back and reintegrate the missing years.  Wow.  And it worked.  My first trauma client (a social worker!) sat with her discomfort for a year.  She brought her mother in at last, and laid the blame at her feet.  It went well.  The mother took it in.  She tried and they cried a lot.  The girl made boundaries for her abuser and continued to do therapy and body work, moved away and formed her first successful adult relationship.  She told me she would never forget the moment when I simply said, can you sit with that?  That was the beginning of un-freezing. Here are some of the incredible insights from the trauma training with Van Der Kolk.  See if it fits and see yourself as healing on a journey.  It's your life. 1. Physical helplessness 2. Left hemisphere goes off line 3. What is the thought from before -- cognitive flashback 4. Whole body trauma story comes at the end 5. Brain set to see danger 6. Wake yourself up to the feelings in your body 7. Split off parts of yourself (longing to be touched - exiled bc it was your fault) 8. Dorsolateral prefrontal cortex is off line - this connects the past to the present 9. You can regulate yourself 10. You cannot analyze yourself out of it 11. Notice without reacting - prefrontal cortex 12. Can't go into the trauma until person can look inside herself  13. Make the memory of the trauma go to the past (not exposure) but feeling safe again 14. Repetition compulsion to repeat the trauma 15. Educate the primitive brain to come into the present (calm down/tapping/breathing/yoga) 16. Open up the heart to self-compassion Right now we endure fires, hurricanes and viruses, war veterans, genocides, starvation and systemic racism from a leader who failed to lead, a failure of basic empathy.  We must try to help our clients overcome existential fear with gentle understanding and wisdom from inside - the demand is greater than ever...

**photo credit: Rosalind Bank I get it, you get it.  For me it only started when my kids began driving.  While I'm sitting in my peaceful suburban bubble working away, the dulcet sounds of drilling and leaf blowers have been a mainstay.  That piercing sound that goes right through your soul is something I continue to be startled by but not wrecked by.  Now take two lovely teenage girls and put them in a car for the first time.  That anxiety of a crash, a siren, a sharp crack of the breaks down the road, metal on metal, now that gets my attention.  I can no longer work.  My body is in a state of massive shut down, sweat drips from my temples uncontrollably as I visualize some morbid tragedy and some kid, my kid, making a bad decision.  My stomach is weak and I'm trembling.  My breathe is shallow and scared.   All of this is fight, flight or freeze.  I know plenty about it.  Primitive echoes of how to protect oneself from a saber toothed tiger.  Totally unnecessary to the current situation.  My heart is pounding outside of my body.  I feel I might collapse.  I use the wait ten minutes rule.  And voila, I recognize that I have lost touch with reality for about a second, but I am not going crazy, schizophrenic, heart attack or utter collapse.  I have my breathe to bring me back home.  I wait. It's fun working with panic, anxiety and even anger because the relief is in the moment.  Teen and young adults who have little experience regulating themselves can teach themselves to do it!  A little meditation, the Calm App, a moment of pause, legs up the wall, a walk around the block, a hot shower, a cup of tea, some lavender oil, a quick call to a friend.  You can do this and so can I. Creating space to pause is the method.  Probably invented by Yogis 5,000 years ago through prayer and meditation, your mind becomes quieter.  It stops telling you you're no good.  It just lets you rest, restore, relax, be yourself, calm down and reset.  But I need my anxiety to get things done, people say.  No, not so much. Last night I was speaking with a young couple over zoom of course.  I first reinforced how loving they seemed and helped the man to accept that talking was OK and that he was doing a great job of supporting his partner.  Then she described that when she gets frustrated/unheard she goes from zero to 60 in ten seconds.  Then she starts getting flooded and cannot control herself, starts hitting and punching whatever is in her way.  This is the child's response to "NO." When I asked her if that sync-ed up with her childhood experience it was there in living color. Her parents were not patient with her as a child and it left her feeling other/different/disrespected.  Like instead of making any effort to understand their child, they simply dismissed her.  Now when her boyfriend casually dismisses her she becomes enraged. Just like with anxiety, you can slow your roll.  I asked her what that would look like and asked her boyfriend to help her with it.  Now they have a plan to practice.  We also mentioned the Imago Dialogue which is helpful in getting to understanding.   When Israeli commando pilots were in Europe on missions a psychologist did a famous experiment.  Instead of counting their flights from 1 to 40, they tried counting down from 40 to 1.  What a difference perception makes.  What we see as stuck now becomes something more squarely in our control.   So keep your cool.  Calm is the way to get things done.  Trust me, I've been working at this longer than you have.

***Photo Credit: Rebecca Weston Corona Times Every day my phone rings, a parent calling for their 13 yo daughter with depression; or a young adult asking about therapy for isolation/anxiety.  What is going on?  My head has been in my phone for so many months that my eyes hurt.  Each day I'm doom-scrolling or looking for a headline that says, we can exhale from the Trump Trauma.  It's quarantine, it's covid, it's remote learning, it's kids in bubbles, it's parents losing jobs/sanity, it's a leader without a map, it's groundhog day, it's getting colder/darker.   At last we see a ray of hope as a society but will we heal in time for my kid to finish college in some decent, meaningful way?  And what about all her friends?  Who are we in this fractured time? Why are so many kids showing up with depression/suicide?  My patient who just identified as gay said the night before the election, "I just want my rights, ya know?"  We hear about the screens - the screens don't help.  But I'm not anti-technology.  I'm all for what tech can do for us, like cure covid and organize my desktop. Unlike that muddle of a movie the Social Dilemma, we can accomplish great things with advances in AI.  Technology can even swing a state -- if only we could send truthful messages.  When a Narcissist is POTUS we do fear for our security.  Unpredictability and provocation are part of his game.  Most people don't live in a nonsensical world of lies.  We also know about the isolation that is 2020.  Obviously isolation is no good for anyone.  I see kids who manage to keep their structure and kids who don't.  I found a quote in a therapy magazine I thought was perfect: "Dividing up your day is an important thing to do.  When the temporal structure breaks down, we break down." My point is that there is something far more malignant than the President himself.  Our kids are losing their motivation.  They told me they feel PARANOID to go out and they are agonized about losing time in their quest to move toward independence, the GOAL of young adulthood. They are despairing that not only is their future bleak but their identity will be wiped away, "poof" as one client said, in a wave of hatred.  Is this how we want them to live?  Latched to their homes without ever launching?  I used to talk about failure to launch.  Now it's failure to go anywhere.  You see some of my clients have adapted.  Adaptation to working from your bedroom is a good thing.  But some have not.  These kids are now exhibiting symptoms of social breakdown .  When you're 19 and you can only go out once a month to sit on a blanket with a friend things are real bad.  Of course they are busting out.  What else are they going to do?  So the next time you think about reprimanding your kid for not wearing a mask (of course), empathize with their stagnation.  Can you imagine if we were locked down in HS?  Empathy for the lost time.  Empathy for the lost popularity, empathy for that sports award that isn't coming. Empathy for the science project that won't ever be displayed.  Empathy for the kid who finally made a friend but lost her over the last six months.   Human connection is everything for teens and young adults.  And now, nothing.

I studied family therapy for many years. Then I studied working with teens. Then I studied trauma. So when I got a new case that had all three I thought, whoa, why not? After more than 20 years in private practice you’d think I’d be at least confident. But I would argue each person is unique and therefore each case is new, no matter how skilled you are. Then again, maybe people are more the same than different, and a good therapist is a good therapist regardless. No matter. I said yes when I should have said no.   The case unfolded slowly. The 16 year old girl was reticent so I “rolled with the resistance.” Not to mention zoom. Yeah. So when she finally told me about her Mother and the family dynamics I was still pretty shocked. You’d think I’d heard it all. The girl was smart, pretty and isolated. Her moods were up and down. She was good at school. But her first issue was a break-up with a girlfriend. Not a girlfriend. A girl friend. Sorry. These days that means a lot. Kids want you to be “relatable,” (I love how they introduce me to new hip words). They don’t necessarily want to “amplify” their differences, but they do want to name them.   I get it. I’m woke. HAHA. At 58 I’m old enough to be their grandmother. But luckily I got the young-looking gene, so even though I let my hair go grey during the pandemic, I can still attempt to skew young. You have to call it "weed" also. Never pot -- then they know exactly how old you are. They wait for you to smile when you say it. They are always testing if they can trust you. Teens today, during COVID, don’t trust any adults, even more than they didn’t before. I smile and say “Oh they let you keep a mini fridge in your room and think alcohol won’t be stored in it? Interesting.” I wait. She laughs nervously. Like I’m going to bust her. But why would I? If she’s being honest, the one thing I CANNOT do is rat her out. That would bust the therapy, not her. Everything is confidential, they understand, until it’s not. They understand very well. In this case it comes to light that the Mother is an addict. Not just any addict. An out in the open, no adequate treatment addict. The Father won't leave his three teens alone with her, so he quit his high level job. This is not some “low class” family mind you. They are in the upper echelons of suburbia in professional jobs. Just sayin’. The other sibling is in college. So my client is left alone with her absolutely adorable loving Mom by day, who becomes wholly “out of it” by eve. That’s right, she “sundowns” or something like that. So if my client needs something, she has to deal in the daytime. She knows all the telltale signs of when it’s too late. She knows how to tip toe, walk on eggshells, fend for herself, stay in her room, come out, watch a movie or go away. If all hell breaks loose, you can bet it’s “after hours.”  “Why not go to Dad when you need something?” I say.  She says, "Oh no, then he’ll blame it on Mom."  "Why not go to sis?" Then sis will come down on Mom and Dad and her. So you see each protects each. Then no one is protected. The family therapy scenario is -- with all these secret alliances, how can there be trust or safety? The teen scenario is, she can’t separate from her friends because she has no one else. The trauma piece is still unfolding. Shut in her room like, well, a “shut-in,” how can she make new friends with any hope of keeping them if “everyone leaves.” Whether it be emotionally or physically or both.   After just a few sessions of this I say, “This is making me very sad.” She looks at me smiling. She knows. I say, “We have to look at what this is doing to you.” You know what I think is the worst part? That when she got caught with alcohol, she didn’t get punished, as if to say, the parents sanctioned it. Ask my kids how often they got punished. Like never. I’m not the punishing type. But they begged for it, as all kids do. Because they NEED BOUNDARIES. The age old literature will remind you, when they push, they need something to push against . If one parent is weak, they can smell it from a mile away. If this kid got a simple grounding boy would that be a relief. Instead she gets a “Shhhh don’t tell Mom." Or "shhhh don’t tell Dad." Or worse, stuff all your feelings because don’t you know, Mom has Borderline Personality Disorder and she CAN'T TAKE IT! This is Bad Stuff. How she longs to tell her feelings but can’t. Where do they all go then? Take a guess. She is now medicated same as her sister. Because you have to be in this house. No matter how much it costs. I ask if I can have a meeting with Dad. What would you say, she asks. I would say he needs to lean in to what she needs not protect Mom, who is an adult.  She says, “Don’t bother. It will make it worse." So I don’t. I respect her wishes (I am transparent that way). I shudder to think about the kid’s future isolation into herself. Her race to nowhere with college on the horizon. Her retreat to her room, as they all do there in that really big house, especially after dinner.  Especially alone.

**PHOTO CREDIT: AUDRA AVIZIENIS What is the latest on teens and mental health? How about the NY Times Expose on Instagram being bad for girls' mental health. Shocker alert!!!  Anyone who lives with one of these girl creatures could tell you that more time on the phone equals more time distressed.  I have literally spent entire sessions on, "Why did he look at my post/snap/insta but NOT comment/like ?"  Why oh why indeed.  Much as I try to say it doesn't matter (!), who cares (?), or so what (?), they persist.   It seems we need a little perspective.  Time has morphed into new times.  Everything pre-covid seems dated.  My kids take it in stride as they strive forward in their goals and dreams, however muted.  Others not so fast.  For example one worries, where are my college friends because I missed 18 months.  The other says, many more applicants to grad school are suppressing my odds.  New worries such as climate change, oil spills, social media bad influencers, democracy in peril and anti-vaxxers are immediate concerns.  Mental health access should be part of any infrastructure as our human capital becomes more afraid, more timid, more weary.   What we do in therapy matters.  Even if it's a few minutes of checking in.  Last week one of my hs senior clients had a fender bender.  She was showing off with her friends.  Doing so well, she slipped into despair, "spiraling," as she said.  While another client, a senior in college, faced being dumped by her long-term boyfriend.  These are not easy transitions in any case, but now things seem heightened and fraught with the possibility of being STUCK FOREVER.  Finally, for one client I facilitated hospitalization when she said, "Is there a place I can go to just get away..."  In a week's time 3 girls' lives were on the line because of big and little anxieties.  Big and little behaviors.  Knowing the difference is what we therapists get paid for.  It may not seem like a lot, but it sure does count. So we try and try to come up with strategies for the pain and suffering that is life.  Having watched the horrific "Boy in the Striped Pajamas" again recently, we can barely imagine real life trauma, so busy are we with micro-aggressions.  I do not discount these legitimate triggers but neither do I want to make them my identity.  Philosophers long before us have grappled with the same dilemmas.  Wonder what people endured through the Spanish Flu of 1918?  It is estimated that about 500 million people or one-third of the world’s population became infected with this virus.  How did they cope?  It's hard to fathom whether a pandemic or a break up is at stake, and I'm not trying to equate or conflate anything. Perhaps it was true grit/resilience or ingenuity and American individualism that got them through; perhaps it's something else. Survival takes many forms.  But we must stay with it.  A young adult asked me, "should I try again to date/work/travel etc."  OF COURSE YOU SHOULD!!  How else do we move on?  Staying in bed is no longer an option.  That's one thing we know.  Also: Don't drop the honors class.  Don't skip the interview.  SHOW UP. Then perhaps even soar.

Three weeks ago a former patient contacted me because she had suddenly recalled an episode from her past, so long ago it was nearly forgotten.  She wanted to sort it out.  We had already established trust and safety in our former treatment. OK I said, let's go slowly. Making sure she was calm and regulated, we chatted for a moment about our annoying dogs.  The she told her trauma story.   While walking home from school she was attacked, touched and humiliated by a group of school mates in her home country of Lithuania.  As a young girl, and the youngest of her large family, she was often ignored, although she was extremely bright.  She was also the tallest girl in her class, making her stand out.  After this event, where she was thankfully unharmed, she internalized the shame that many of us have after a traumatic experience.  She stored it in her body and it petrified until frozen, cut off, exiled.  All of this language I use here is from one man's work, of course, Bessel Van Der Kolk, The Body Keeps the Score. Why would an esoteric psychiatry book be at the top of the bestseller list? The pandemic brought it home: no amount of talk therapy can unfreeze you.  In fact, we have learned it can re-traumatize you, the antithesis of what we want to achieve.  What should I do I thought? As we were running out of time, and it was by phone, I asked her to reflect on the experience of telling it.  She said she felt much relieved.  I encouraged her to meet with me again when we had more time.  Several weeks later she said she was ready to talk again.  We set up a phone session during which we would both walk our dogs. In the following session she spoke of another, similar experience, and how again she felt ashamed.  I asked her to take some nice slow breathes.  Why do I think it's my fault she asked.  I explained that because she was powerless then, she blamed herself for her inaction.  I also explained how trauma works and how she may have shut down as her only defense against real danger.  I explained that she protected herself and that was something to be grateful for.  As we spoke I validated her story each step of the way.  I waited patiently for her to continue.  I told her she was safe now.  That no one could injure her in that way now.  That she had learned to slowly trust those closest to her.  She realized that her mother may not have been able to empathize because she was simply too tied up with mothering to be available emotionally.  The client gained wisdom, perspective and stability by reaching out and reaching in.   How do you feel now?  She said thank you so much for allowing me to feel safe again.  I said I don't have superpowers but I do understand the process.  She asked if she needed more therapy.  I said you decide.  Whenever and however you're ready to continue, let me know.   What an honor to hand the power back.  No longer a victim, she happily told of her job pursuits and her marriage.  We were both entirely satisfied.  That is the work.

As we enter this third year of pandemic madness (which I thought was going to be over in two weeks), I managed to work constantly while staying in my little bubble of neighbors, friends and family, keeping my kids safe, getting one a vaccine in Plattsburg, NY, convincing my husband it would not cause him a blood clot.  It was an effort worthy enough for any family, still I stayed close to home, went to the usual spots and even planned a tiny vacation. At the vacation we learned that one of us had had a positive exposure.  From there we literally devolved into tiny mini head spins: when exposed, where exposed, how exposed and on and on.  OK get a test - you say.  Not so easy except I happened to have ordered a couple of tests online.  So she tested negative.  All was well after a day's worth of bickering.  I realized now that things went so much deeper in terms of our collective losses.  The empty zoom funerals, my clients' loss of work and connections.  The kids trapped in their rooms.  But this was different.  No one was going to die; we hopefully took care of that.  But we suddenly experienced the swirling anxiety of travel, uncertainty and turning on each other out of sheer draining frustration.  It didn't help that it was raining. I think this episode, which really only consisted of a lot of yelling about tests, taught me much more about the universal experiences of disenfranchised grief.  It taught me that each and every action has an equal and opposite reaction.  I learned that in spite of every precaution, my client who never went out and got covid in a cab was devastated, right before her wedding.  The people who got cats and dogs were happily walking around my quiet suburban idyll while others were languishing in hospital beds, quarantine, solo apartments, etc.  Movies without masked people seemed quaint.  I have to dig deeper I thought.  Now with my clients I'm not going to just roll my eyes about politics and safety and boosters and other pandemics of the past and working together.  I'm going to ask them, "How did this really effect you?"  "How is the ongoing strain on your life?"  "What can you change to start to feel more in control?"  "What do you miss about going out?" The experience is a package deal now: survival of the fittest, also the most flexible, and the most willing to accept the here and now. Instead of "Peace be with you" or "Namaste" or "See ya" I will say truly "Be Well in body/mind and spirit."

Let’s get rid of it.  The hook-up culture. I don’t know when it started. But let’s stop it. I’m guessing it began as a feminist thing. We want casual sex too! We don’t care! Our Bodies, Our Selves.   But we do care. In the last 15 years of my practice never once have I heard a young girl tell me that she liked being dumped the morning after.  As I was watching these confident olympian girls and women, first coming forward about that sickening doctor and then scoring gold medals in Korea, I though why must we put up with this at all?  Yes there has been a #metoo movement and a #metoo backlash including the former President Trump himself, but the real change has to come from our behavior. Say no to the hook-up (if you want to)! As my favorite therapist Lisa Damour stated in the NY Times a few months ago, don’t allow nudes. Make it wrong for a boy to even ask. Make the burden on him. Make them accountable. Make it REALLY BAD for men to ghost women.   My daughter is at a prestigious private college. She showed me an article that said 1 in 4 girls get sexually assaulted by the time they graduate. Really? Is that where my money is going? How can colleges sell themselves with that kind of mindset? According to Damour, An analysis of nearly 500 accounts from 12- to 18-year-old girls about their negative experiences with sexting found that over two-thirds had been asked for explicit images. According to the Washington Post, "Of students who reported hooking up, 41 percent used words such as “regretful,” “empty,” “miserable,” “disgusted,” “ashamed,” “duped” and even “abused” to describe the experience." I am seeing more and more young girls in therapy who have been sexually assaulted. I started thinking deeply about it.  And don’t you know I started to remember whole swaths of experiences that I myself had blocked out.  When we block out experiences we bring on states that young people nowadays call “numbing” or “emptiness.” This cutting off of experience or disassociation leads to serious problems down the road such as depression, alcoholism, avoidance and social anxiety.  I sat with my discomfort for a while. Then I read an excellent book called “ Stolen Tomorrows ” by Steven Levenkron.  What I discovered is that while my clients were complaining about hookups, hangovers, sexting and texting, what they were really reporting is that they had been abused in one form or another.  I found I was trivializing it by instead of saying, “Can you tell me more about that,” I was rushing past it, as if I wanted to push the trauma away.  I mean who really wants to talk about a one-night stand that ended badly?  The therapeutic task is to stay with the pain until it is healed sufficiently to move on; not breeze by it as if it never happened, just like the bumble who didn’t call back. This is why the mind/body connection is so profound; releasing trauma is a subtle, emotional and physical task (See: Bessel Van Der Kolk). How can we work through this culture shift: It’s never a good idea to have sex when you’re wasted. It’s lonely to have sex with someone you barely know. Sex with a stranger can lead to feelings of shame and regret. It’s OK to be alone. It encourages boys to behave badly. It gives you an emotional hangover. Starting out as friends is OK. Frat boys need manners: binge drinking is a disease. Consent is not a choice. Being rude, unreliable, fake and distant is thoughtless. Let’s make the next generation better, not more afraid.  Change can come incrementally and powerfully with our collective will and wisdom. It has to. Moss, D. (2019). Hook-Ups, Hangovers and Hopelessness: How not to Waste your College Years. Psych Central. Retrieved on May 11, 2020, from https://blogs.psychcentral.com/sext-text/2019/03/hook-ups-hangovers-and-hopelessness-how-not-to-waste-your-college-years/

By now we've discussed pandemic fatigue, languishing, anxiety, lack of services, suicide rates, social media, FOMO, triggers, fake news, school shootings, a former narcissistic, toxic, grandiose and insensitive leader (Trump), self-harm and trauma and more with our kids.   By now things should go back to normal.   Yet what is this new worry creeping into our consciousness?  I like to monitor new words I hear in therapy: intersectionality, amplify, conflate, weaponize, - fighting words. I'm also hearing this: "what's the point?" Or, the perennial, "how can I go to the best college?" These two extremes are not that far apart. One kid realizes she can check out and nobody will notice or care; another says the only way out is to torture herself with work and worry.  Neither is helpful or productive. Depression looks different in young adults in some ways.  So does mania.  Going to extremes and black and white thinking is a hallmark of the adolescent brain.  How do young adults find balance in a world increasingly in chaos?  How can I teach DBT or self-regulation when before my head hit the pillow I asked myself for the first time in my life, "what if there's nuclear war?"   We start with the breathe says my yoga teacher.  I guess the fulcrum of yoga and psychotherapy, or eastern thought and psychotherapy are a potentially liberating place from which to launch, when all else fails.  According to Mark Epstein,  “When we stop distancing ourselves from the pain in the world, our own or others’, we create the possibility of a new experience, one that often surprises because of how much joy, connection, or relief it yields. Destruction may continue, but humanity shines through.”― Mark Epstein,  The Trauma of Everyday Life If I had a dollar for every time I asked a teen to stop avoiding and start living...  fear cannot help you treat anxiety.  Only exposure can.  If we face the thing we fear, and we don't get struck by a lightning bolt, we can continue on our journey.  The only way around is through.  Or as Pema Chodron said,  “The only reason we don't open our hearts and minds to other people is that they trigger confusion in us that we don't feel brave enough or sane enough to deal with. To the degree that we look clearly and compassionately at ourselves, we feel confident and fearless about looking into someone else's eyes. ”― Pema Chodron Lisa DaMour, one of my favorite authors on teens and therapy, has discussed the enormous pressure on this generation in her book "Under Pressure."  One of the things she emphasizes is that we have to teach kids to TOLERATE discomfort, “Unfortunately, anxiety, like stress, has gotten a bad rap. Somewhere along the line we got the idea that emotional discomfort is always a bad thing.”― Lisa Damour,  Under Pressure: Confronting the Epidemic of Stress and Anxiety in Girls Try telling that to a 16 year old who just had a break-up and refuses to go to school.  Or the almost 17 year old that her parents' divorce is not going to cause her grief and upset as long as they conduct themselves with respect for the family.  When asked how her parents were behaving, one pre-teen told me, "They lead 'common lives.'"  I thought that was funny -- but yes, isn't that the goal?!  Some of these parents are acting like teenagers themselves as they frantically run from partner to partner and forget to make dinner.  All the kid wants is the car keys and the answer key.  To which the answer is usually a hard NO.  Or what if that teen's behavior suddenly becomes erratic to the point of misjudgment on everyone's part -- now that's when you might call the therapist.   But for all this to work, the precondition is openness .   When I rattle off 25 things the person can do to self-regulate and they do none of them during the week, what do you think changes?  Nothing.  Because they didn't change anything!  Resistance, anger, judgment and shame are all barriers to care.  Take a step back and slow down the therapy.  Make time to breathe and be still.  Then maybe you'll have a fighting chance at change.  But with no effort or over-effort, the body tenses; the work gets stuck; the future is frozen.  As the great Irvin Yalom said, “Despair is the price one pays for self-awareness. Look deeply into life, and you'll always find despair.”― Irvin D. Yalom,  When Nietzsche Wept   Despair is not the end -- it's the beginning of being seen, heard, understood.  Let's allow it some space.  Get ready.  Go.