Archive of ‘Depression’ category

This Pathology is Not All Yours… And Why Therapy Must Consider The Cultural Milieu

Psychotherapeutic training generally includes something called Universality as a healing technique. It stems from Irvin Yalom’s germinal Therapeutic Factors for facilitating group therapy. It basically means that when humans get to hear and witness another human facing something similar to their own experience, this communality engenders a sense of validation and fosters healing. Universality, with its relational delivery, inherently addresses the isolation any human can feel amidst a problem that had felt singular.

Normalizing Responses to Societal Issues

As a trauma-informed and relational therapist who specializes in climate change grief and disaster trauma; this is of interest to me for several reasons. A dominant one is that grief and anxiety created by several ongoing collective traumas are hard to separate from their myriad effects on a single person’s psyche, which at times is simply responding to these threats, pressures, and perils. Living within a colonial, imperialistic, and capitalistic society under threat of both climate change and continual pandemic pressures is not a cakewalk. Even that sentence stresses me out! The waters we swim in matter. Our collective ills contaminate human psyches and can show up as pain, depression, anxiety, panic, and the like. Our collective diseases become individuals’ problems.

And yet, as universality would have it, a clinician understanding these ills—as best they can from the purview of the client—is paramount to good treatment. Coping strategies alone are not sufficient, normalizing the client’s response to the collective deficiencies is part of alleviation of these pressures. Normalizing in this way may look like: “yeah, this is not, or should not be, normal.” This is a bit of disclosure from the therapist– a human to a human, both part of the same culture admitting where things stand.

I don’t think I am going out on a limb to note that our culture is currently struggling. As I write this, in Texas, transgender citizens’ rights are on the line. Gender-affirming care is slated to become criminalized, at times targeting trans children’s parents with threats of abuse. Recently, trans adults were added to the list with SB1029, which targets insurance companies and providers. Abortion is banned, though it is a medical intervention that can be lifesaving. To make matters worse, bounty laws that enforce this are creating an environment that is truculent and dangerously paternalistic. Books are being banned, and educators censored. A new Don’t-Say-Gay-esque bill was proposed just last week, modeled after Florida’s, which threatens an outright book ban around anything mentioning LGBTQ+, as well as censoring classroom discussions around the same. And the effects and human impacts of a climate changed are palpable and ever-increasing–in our area, we are recenrtly off the heels of another freeze. All of this on top of year three of the pandemic and its longstanding disruptions on learning, isolation, mental health, and physical health.

When Diagnostics Are Not Enough

And listen, I am not against diagnosing one’s mental health issues. Diagnostics as a part of comprehensive therapeutic treatment can be incredibly beneficial. They can certainly aid in devising and guiding successful treatment within the therapeutic consulting room. For the client who has been struggling with symptoms; a diagnosis can provide relief, an explanation, and a framework to describe their internal state or external behavior to themselves, family, classmates, work colleagues, and friends. Diagnostics on the whole can open up lines of communication within a treatment team, creating access to intervention avenues at the school level, or equally, funnel information to a psychiatrist who can better medicate. A correct diagnosis can create ease within a family system to remove the label of Identified Patient (IP) from a child’s role and help the system see their child or sibling from a more educated and supportive perspective. 

So- we can diagnose the person inside of the room however, we must also pay mind to the collective upheavals, distresses, and systemic issues that contextualize this individual. The medical equivalent might be something like this: we have a town next to a factory that is seeping toxic waste into the town’s water supply–a large and suspicious portion of the town comes down with a respiratory disease. Diagnostics alone would create a closed loop within the local medical system, with continuous siloed individual diagnoses reporting the disease created by this substance. AND/OR; the water supply could be addressed, and toxin mitigated. This is made more complex when we consider mental health as things tend to be created by many factors– and it can be tricky to suss out the causes, and the collective fixes. But complexifying our solutions, and as collectively as possible, is exactly the medicine called for in this era.

Psychologist James Hillman said (and of note, before the internet took hold):

“Of course I am in mourning for the land and water and my fellow beings. If this were not felt, I would be so defended and so in denial, so anesthetized, I would be insane. Yet this condition of mourning and grieving going on in my soul, this level of continuous sadness is a reflection of what is going on in the world and becomes internalized and called “depression”, a state altogether in me ─ my serotonin levels, my personal history, my problem…”

(Hillman, 1996)

Trauma-Informed Care as a Path Toward Healing

I know I am outting my politics, but alas—my last two blogs have been about porn and fairy tales so that cat is already out of the bag. Let’s take the example of gun violence. I see teens and work often with parents with young children. Both demographics are widely impacted by the nations’ lack of legislation on guns and are moreover the compensatorily-devised adaptation techniques that infiltrate our learning institutions instead of real action. If a teen client comes in saying; “I have had [X many] years of Active Shooter Drills at school and I am experiencing nightmares.” Yes, we can work to shift the nightmares, ameliorate the residual fear and treat the existence of such symptoms. But resounding data is against these drills and particular practices within. Why would I simply normalize them? 

A study quoted by Everytown bleakly reports:

“Active shooter drills in schools are associated with increases in depression (39%), stress and anxiety (42%), and physiological health problems (23%) overall, including children from as young as five years old up to high schoolers, their parents, and teachers. Concerns over death increased by 22 percent, with words like blood, pain, clinics, and pills becoming a consistent feature of social media posts in school communities in the 90 days after a school drill.”

Similarly, if a parent comes in citing concern their little one is going to be soon introduced to this practice at their new school, it would be wholly inauthentic of me to ignore not just the upset this future event is inciting but to not also see this concern within the structure of the collective climate. 

I speak here from a position of activism, allyship, and a desire to move forward as clinicians with eyes open, and as collectively aware as possible. No matter the source, symptoms and their manifestations are treatable. Therapy can provide meaning-making, the healing relationships can be sturdy-ing, and its structure and techniques can actively reify the resilience, connectivity, and vibrancy of the Self. If you love data, therapy has been shown in many forms to change the brain’s structure, namely in the frontal and temporal cortex, which enables more integration, processing capacity, and regulation of neural symptoms. When under the care of a trauma-focused and trained practitioner; trauma can be reprocessed to repair mental injuries from not only the initial trauma(s) but also any newer experiences that have been neuropsychologically linked up with the traumatic experience. EMDR, for example, uses bilateral stimulation as an adaptive information processing technique to reprocess and restore improperly stored, fragmented memories that can otherwise create interruptive and discontented states. The de-fragmentation and integration it engenders can be deeply impactful.

Therapy is helpful, and it is more helpful when it considers itself as a tool within a structure, that keeps in mind the structure’s influence on the clients it is aiming to help. I would be doing a disservice to clients to ignore the wider lens, and I hope that in and of itself is a helping technique. 

Resources

Clients

I am not telling you to do or not do anything, but here is a list of books that have been banned in Texas.

Other clinicians

Dr. Jennifer Mullan’s Decolonizing Therapy model provides trainings for Politicizing your Practice



Suicide Prevention: Conversations to Have with Your Teen

Conversations with our teenagers are vital in keeping them healthy and safe. CDC has reported an increase of adolescents who have had a suicidal attempt since 2020, the beginning of the pandemic (CDC, 2021). As a previous school counselor who did a lot of crisis counseling and worked with students who had suicidal thoughts, I want to encourage adults, parents, and educators to have these important conversations with your teens.

Ask the teen how they feel.

This sounds like a no-brainer, but this is the most important thing we can do for our adolescents. Instead of asking about how their day went or about if they finished their homework, ask them how they feel today. You can ask questions like this: “How do you feel about what happened today?” or “How are you feeling today?” or “What are some emotions you feel regarding ____?” Middle and high school students would always tell me that they wish more adults would ask them how they feel instead of only asking them about tasks they need to get done.

Don’t be afraid to ask the teen if they are suicidal.

Many people believe that if they bring up the word “suicide” it is going to suddenly make the teen curious about it. Nope! It’s a myth. Research has proven that bringing up the word will NOT increase the level of suicidal thoughts in a teenager (NAMI, 2020). If a teen is thinking about it, their thoughts about it won’t increase just because someone asks about it. Parents, educators, and adults, please do not be afraid to ask your teen if they are suicidal. Many adolescents just need to be asked this question – so many adults in their life are afraid to ask, so the teen may not have a space to open up about their suicidal thoughts.

If your teen happens to say yes, ask if they have a plan. If they say they have a plan, consider seeking treatment and support, and do not leave them alone. If there are any items that they can use to hurt themselves, remove those items from their reach. During this process, encourage open communication and don’t be judgmental. Immediately reach out to a therapist and/or treatment center and ask for support. For an additional layer of protection, reach out to their school counselor and inform them of this too, so that they can keep an eye out at school. Since adolescents spend most of their time at school, it is important to have an adult at school who is aware of their suicidal thoughts and/or plan. The more eyes we have on our teen, the more we can protect them from doing anything rash.

Ask the teen about any protective factors.

The more hobbies and people the teen cares about, the more likely they are willing to stay alive. Ask about the adolescents’ hobbies, social circles, and values. See if there are any factors that may light up their interests or passions. If they talk about a hobby they enjoy, ask about it often and ask about their thoughts and emotions regarding it. As a therapist, I always start off my conversations with my clients about their protective factors. It helps me to better understand what they enjoy and what keeps them interested in living life. 

Protective factors to ask about:

  1. Hobbies: What do they like to do in their free time? What clubs/sports/extracurriculars are they involved in?
  2. Social circles: Who do they spend time with? Who do they trust? Who would they turn to if they were going through a hard time?
  3. Physical health: Are they eating well? Are they drinking enough water? Are they spending an adequate amount of time exercising?
  4. Purpose/Values: What do they believe in? What do they value? What are some topics that get them stirred up? Do they believe they have a purpose in life?
  5. Self-esteem: What do they think about themselves? Do they believe they have the strength to overcome challenges?

If you have a teen who is having suicidal thoughts, please reach out to a therapist immediately. You can find a therapist with immediate openings at Austin Family Counseling by emailing [email protected].

Additionally, there are resources available that can offer immediate support: 

  • Call 988 (suicide hotline number)
  • Call 512-472-HELP (Integral Care Mobile Crisis Team) 
  • Chat with a crisis counselor: https://988lifeline.org/chat/ 

Citations:

https://www.nami.org/Blogs/NAMI-Blog/September-2020/5-Common-Myths-About-Suicide-Debunked

https://www.cdc.gov/mmwr/volumes/70/wr/mm7024e1.htm?s_cid=mm7024e1_w


Picture Books as Therapy

Understanding complex emotions and life events is difficult for anyone, but especially for children. When they don’t have the proper tools to express their inner turmoil and process their surroundings, this can often lead to frustrating interactions with parents and caregivers. One tool to give your child is seeing big emotions and hard situations played out in a book.

Books are a great way to help children understand their feelings, learn about differences, and begin to understand the world around them. This can start as early as toddlerhood with picture books! An extra bonus to picture books is the visual representation of emotions, interactions, and experiences. These can be jumping off points for all kinds of conversations with your little ones. Not only that, but it removes your little one from having to be the one with the heavy feelings or thoughts. Instead, by focusing on the stories of the character, you can discuss these feelings and thoughts without your child feeling put on the spot.

With that in mind, here are eight suggestions for picture books that can help engage your little one in some of life’s biggest questions:

Big Bear Was Not the Same

By Joanna Rowland

(Beaming Books, 2021)

Joanna Rowland is a fantastic author whose books tackle real-life issues. Big Bear was Not the Same discusses posttraumatic stress disorder and the effects that trauma can have on individuals who experience it and those close to them. In addition to Big Bear was Not the Same, her other books focus on tough topics such as grief, friendship when times are tough, and hope.

Ruby Finds a Worry

By Tom Percival

(2018, Bloomsbury)

Tom Percival is another picture book author that takes big feelings and makes them relatable to children. In Ruby Finds a Worry, Ruby experiences anxiety and thinks she is the only child with this issue. Eventually she realizes everyone gets Worries and the best way to deal with them is not to ignore them, but talk about them. Not only will the story interest your little readers, but the art depictions of the Worry are fun and engaging. Tom has many other books focusing on social emotional learning in his Big Bright Feelings series, including Perfectly Norman, Ravi’s Roar, and Meesha Makes Friends.

My Shadow is Pink

By Scott Stuart

(Larrikin House, 2021)

This was one of my favorite picture books of 2021 (and apparently one of my daughter’s also, since she made it read it 3 times on the drive home from the bookstore alone)! A young boy who loves pink and dresses and “things that aren’t for boys” struggles to be himself when he doesn’t fit in with his family and friends. Stuart’s beautiful illustrations and lyrical prose open the door for inclusivity, diversity, self love, and acceptance. This book gives children the permission to “be themselves, even when it’s uncomfortable.”

The Princess and the Fog

By Anthony Lloyd Jones

(Hachette, 2015)

The princess has everything she ever needs to make her happy until one day a fog settles over her and she can’t seem to feel happy anymore. The Princess and the Fog provides a fun, relatable look at childhood depression. An included guide in the back matter helps parents dig deeper on the topic. With realistic explanations of depression symptoms, Jones does a beautiful job of helping open up a conversation and foster understanding.

Don’t Hug Doug

By Carrie Finison

(Penguin Random House, 2021)

Bodily autonomy and consent are tricky topics to discuss with kids, but important nonetheless. Don’t Hug Doug approaches bodily autonomy in a way kids can relate to– with the concept of hugs. Doug doesn’t like hugs, but his friends and family often insist on hugging him! This book encourages children to ask before touching someone and to voice their own desires about how they are touched. Instead of a hug, why not a high five?

It Will Be Okay

By Lisa Katzenberger

(Sourcebooks Explore, 2021)

Katzenberger creates a kid friendly approach to anxiety through her story about Giraffe and Zebra. When going about his usual routine Giraffe experiences something that makes him so worried and anxious he just wants to hide. Zebra’s empathy and friendship help him overcome his anxiety and get back to enjoying his day. Katzenberger includes excellent educational back matter that can help parents and teachers engage deeper with the topic of anxiety. 

The Struggle Bus

By Julie Koon

(Kind World Publishing, 2022)

Each of us have experienced days where we felt like we were on the “struggle bus”. Nothing is going our way, we can’t seem to make things work out, and we have no idea how we’re going to get things done. In her book, Koon takes this to the next level by presenting children with images of an actual school bus as “the struggle bus”. Her lovely rhyme walks children through times of frustration, hardship, and ultimately perseverance. 

The Breaking News

By Sarah Lynne Reul

(Roaring Brook Press, 2018)

This year especially has seen lots of heartbreaking and stressful things in the news. From war, to pandemic, to school shootings, children may have been exposed to or have seen their caregivers’ reactions to media coverage of difficult situations. Sarah Lynne Reul tackles this in “The Breaking News” and helps show children and adults alike that while they may not be able to do BIG things to combat these issues, even small things can make a big difference. 

Each of these books are excellent ways to not only dig deeper into big topics with your children, but to encourage their love of reading and their imagination. 

For more resources on handling tough topics with kids, or to look into therapeutic interventions for yourself, your child, or family email [email protected].


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