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**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.

When my books flooded I was of course devastated.  Most of these I have duplicated on my kindle already.  But who can read anymore?  Lack of concentration, old age, pandemic languishing, check, check and check.  Growing up surrounded by books, I never took them for granted.  From the earliest age, I could remember the glee of receiving a box from the Bantam bestseller list every month.  My father worked in the industry when it was glamorous, like Mad Men.  My parents had those same floral prints on their clothes and couches during the 70's.  I think for a minute they were a power couple.  Now publishing is an outpost of top authors and die hards but most of us don't read.  I tried to listen to a book recently -- too many distractions.  Savoring the hard won inner journey of devouring a good novel is one of life's greatest joys. And yet as the industry tanked, so did our family. The books stopped coming when my father took off for a venture into film which never quite accelerated, after some brief successes.  As the world turned digital, I embraced it. My father did not.  He's read more than anyone I know and doesn't even wear glasses in his old age.  I guess denying your age has its benefits.  But denying that your whole industry has disappeared is not so helpful.  My best girlfriend realized her business of menswear clothing design was vanishing so she shifted gears to social work, of all things. But not my dad.  The books were his lifeblood.  How can you toss a book?  Truly.  Only a person of brazen lack of self-regard could treat books this way. Books made you smart.  I once offered my daughter $200 to read The Hobbit. The arrogance and narcissism and mood swings around my father continued to swirl from coast to coast, legendary book man that he was -- now flirting with girls half his age out of Bryn Mawr -- wannabe copy editors and such, he thought he was still in the game long after it was over.  Like Willy Loman he just kept pitching those manuscripts to whomever would listen.  Being graced with youthful good looks only fueled his need.  Hear ye, hear ye, come get a book or two.  My sister also had a need to be heard and subsequently became a drama teacher.  Everyone in my family and my husband's were all English majors of one varietal or another.  School teachers, speech therapists, theater people, writers, educators, editors and poets.  These were our people. What does any of this have to do with therapy you ask?  Well teens and young adults who are working, studying, creating goals and visions, taking summer school, and getting internships are doing well in this grind we call our economy.  Yet those who lost their motivation during the pandemic have no tools for getting out of bed.  Not a surprise, it all comes back to my favorite intervention: structure.  A daily routine and a nightly routine, and creating a separation between the two is a start.  You can even trick yourself into having structure. But the looming longness of our days seems to have the opposite effect: boredom and then catatonia.  As my yoga teacher says, "set an intention."  Even for the smallest things. You can stretch and grow and make mistakes and still live to tell the tale. Surviving a layoff, a breakup, a bad boss and an office party -- even a pandemic, are all opportunities for learning.  In Burn's book "Feeling Good," the bible of CBT, he simply states that making mistakes is the ONLY way to learn.  And in my favorite Ted Talk, Meg Jay says, your 20's is the time to try things.  How else can you know what you like or don't like?  Again and again young women come to my office or screen saying "I'm afraid/crippled/fearful/paralyzed/triggered that I don't know what I'm supposed to know." How can you know without experience?  How can you get where you're going without trial and error?  I like the expression, you can't blame yourself for not knowing what you didn't know before you knew it...  Get outside and keep your body moving. The only way around is through.  Then curl up with a good book and sit a while.

Post Pandemic Teens: My landscaper said, after this the kids are "spiritually bankrupt."  He's right you know. There are a lot of kids and adults who are scared to leave the house.  I'm not one of those. But it's weird.  Let's face it.  An entire generation has lost a year of their lives.  What have we gained or gleaned as a result?  My teen group explained it in terms of Macbeth which they are reading in 10th grade. A.  Lady Macbeth Speaks Out - she is mad and rightly so.  No partnership with a powerful figure can save her from her own guilt and malevolence.  She is damned if she does and damned if she doesn't.  Lady Macbeth is an out of control teen who stuffs everything from the people who love her most and locks it inside.  The result is a mental breakdown worth remembering.  To love and lose is one thing; to survive without guilt and other uncomfortable feelings is another.  Lady Macbeth kids need a place to vent and learn some critical life lessons.  The problem is the kids today won't take the chance to make a mistake.  The stakes are too high.  Live a little, I say.  It's good to make a few mistakes now and then.  How else can you know what you want or who you are?  Get out of your room! B. Macbeth as Self-Harmer - he is guilty guilty guilty but hey who cares?  If the adults all around him can get away with murder, why can't he?  Because it doesn't suit him to rage at himself.  Lashing out and turning on oneself leads to hurtful action and reaction (aka Trump). Macbeth must settle down and understand his limitations as a leader without losing himself in petty peer pressure.  He must agree to take his anger to the appropriate place - where he can be heard and understood.  Teens are saying they're too insecure to go out.  But now is the time to gain experience so in later years they can be more confident, not less.  Carpe Diem! C. The Three Witches - misogyny and hatred for women runs throughout the story and Lady Macbeth doesn't disappoint with her cunning manipulations of her husband, but the three witches know the future in ways we cannot.  Pay attention to the voices of ambition vs. corruption, tyranny and greed.  In your twenties it is your task to learn your identity not shatter it. Take the time to reach out to those who can help and support and hear your voice.  Let it take shape so you can do good deeds not lock yourself into your own revolving door of self-loathing.  Do this in a deliberate way by trying yes instead of I can't. D. Banquo's Ghost - rather than unchecked ambition like Lady Macbeth, try for humility in the face of grief, danger and trauma.  We have been through a lot this year - don't rush what you want.  It is not selfish to take time for yourself, choose wisely, settle down and consider your path.  As Banquo so studiously declares, That, trusted home,      Might yet enkindle you unto the crown,      Besides the thane of Cawdor. But ‘tis strange.      And oftentimes, to win us to our harm,      The instruments of darkness tell us truths,      Win us with honest trifles, to betray’s      In deepest consequence. What we have gained is gratitude, appreciation and contemplation; not the cycle of violence and despair.  Travel, see friends, call for an informal interview/internship, work, volunteer, be a voice for the unheard, be yourself, try belly dancing, free yourself from the bonds of isolation.  The time is now.

Really it's so bad. Teens are in trouble. The teens in my group are laughing and screaming, alone in their rooms or wandering in cars or sitting on zoom-homework or staring or crying at the screen, growing anxious and avoidant and not sleeping. I am just holding it and holding it, ready to burst myself. There's a hypnosis to it. My voice is rhythmic like a yoga teacher. I am projecting calm if not coma. I give them hope, patience, laughter. I let them cry. I am not afraid of tears. I am medicated and vaccinated and caffeinated. Yes it's true, when my thyroid went offline I got to take a drug that also helps w anxiety. Jackpot! The kids are not alright but we soldier on. No wonder they want to change gender/friend group/hair/family/school - what else is there to ponder these days? I keep them strong, I ask what they need because only they ultimately know. One said, "I need a friend." Then in the group I asked, would anyone be willing to be her friend? They volunteered one by one. We all cried. Life is just a game and we let slip away says Seals and Croft. Be patient with yourself. The process works. The girl said, ok I'll talk to my mom even though I am so very angry. Little tiny hints of Spring take form. Daylight Savings brings a new Vernal Day. You smell it on the wind. I am scared to go forward and scared not to. A lot of people have told me about time. Time is playing a trick on us all more like Russian roulette. Be ready.

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: 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.

**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.

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...

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

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

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 credt: Rosalind Bank Many therapists have "branded" their practices: Winding Road, Finding Yourself, Path to Fulfillment, Thoughtful Change, etc. etc. Nice, calm and creative names. They have a blog and a podcast. They pitch themselves on Youtube.  What does it all mean? To be honest, I'm not sure. I just finished reading "Maybe You Should Talk to Someone" and it was good. Better than I expected in this hallowed Irvin Yalom corner of the world where therapy becomes the drama for a book, filled with colorful anectdotes and insights. Marketing works. That lady is probably really busy now! I am already really busy. I don't even want to be really busy! Balance is more what I'm after with myself and my patients. I have taken the week off to practice what I preach: get away, take time to breathe, visit the doctor, take a walk with a friend. These things are priceless right now. After counseling young adults about going back to college in a pandemic, I need to see some teens who are thriving. They are! They will! The world may yet be the same, but perhaps we can now hope for progressive change for all? With all the terrible of 2020, will there be a chance to reset, evolve, move forward? I sure hope so. Kamala Harris, no matter her potential flaws, is a ground breaking choice. Let's try to be better! My therapy practice consists of patience, reassurance and routine. I don't impose any critiques on my patients that I don't try on myself. I am not above it all; I am right there with you. Being the therapist means you also engage in self-care. It means that if the process itself is slow that's OK. It means if you have been traumatized in this life, there's time for you and I to heal. I have discovered for myself that "the body keeps the score." After a lifetime of therapy, adding Yoga to my own practice has illuminated the meaning of mind/body. You do your CBT, then you do your DBT. In other words, gain empathy, gain strength and insight and distress tolerance, then do body work to integrate everything, consolidate, put the energy where it belongs. Put your money where your mouth is. Learn to calm down. Perfectionism is our curse. In my Inhale Peace practice I am teaching young people to take more risks, to get out of their rooms, to do something creative, purposeful and consistent, NO MATTER WHAT IT IS. Have a reason to wake up each day and make MISTAKES. Making mistakes, as Aaron Beck has repeatedly pointed out, is the ONLY way we learn and gather experience. Avoidance only reinforces avoidance. How easy it is! But how constricting. Boredom, not depression is the scourge of young people. Don't mistake boredom for depression. Boredom can be remedied. In fact, why not do something new today? Go around the block if you haven't been out. Start small. Cook dinner for your family! Take a ride. One of my clients tried a new coffee place every day during quarantine. It's his only daily adventure! Get off your phones. Try online learning. Although I haven't been too happy doing Yoga online, get outside and take a stretch. Move around. Yes the body holds the stress, the mind perpetuates it. Take a break! Really. It can't hurt.