Tag Archives: teenager

@TechCounselor: Navigating social media with teens

By Adria Dunbar February 5, 2020

I recently did a presentation for a group of high school parents on social media use. Instead of focusing on their children, I began by asking parents about their own use of social media sites like Instagram and Facebook. As a counselor, I believe my reflections on this experience might be helpful to other practitioners when working with adolescent clients or their parents. To begin our discussion, I asked the following questions:

  • How many of you use social media?
  • How many of you have thought about changing your habits around your social media use?
  • What keeps you from making these changes?
  • How often do you feel pressured to post, like, or comment on someone else’s posts?
  • How many of you have had similar conversations with your children?

This was one of the most eye-opening discussions of social media use I have ever had with parents. I had assumed parents periodically reflect on their own use of social media and were having conversations with their children about navigating the digital world. Every parent in attendance said they participate in social media sites. They all had considered leaving or changing the ways in which they use social media, but maintained their connections for a wide range of reasons, such as staying in touch with family and friends; using the marketplace; monitoring children’s use; getting news; or learning about events in the community. In addition, almost all of the parents had even felt pressured to participate in an online social media platform in order to maintain relationships, support someone in their social circle or avoid awkward interactions. However, none of them had considered having conversations with their children about their social media use. Why is that?

Many adults and parents assume that tweens and teens know more about social media than we do. And this may be true. But, at the same time, adults can help children process their experiences in these environments. Younger people may know how to post stories, use filters, and increase followers more than their parents, teachers, coaches, or counselors; however, this does not make them experts in social media. Young people need help navigating the uncharted territory these online environments create. Most counselors and parents are aware of safety concerns involving online activity, but there are other big-picture aspects they should also consider asking about, such as:

  • Tell me more about the social media platforms and apps you use. How do they work? What do you like about them?
  • What are your interactions like? Are they positive, or do you sometimes get caught up in negativity or conflict?
  • What kinds of pressure do you feel equipped to handle on your own? What types of pressure leave you feeling unsure how to handle?
  • How do you filter who you allow into your social media and who you deny entrance?
  • What is your ideal number of followers or likes? What would reaching that number mean to you?
  • What will you do if someone you know from school or work sends a follow or friend request, but you question their intentions? How would you feel about blocking or unfriending someone?
  • How would you react if you saw something inappropriate or unkind on one of the more publicly accessible platforms such as Instagram, Tumblr, Twitter or Facebook? Would your reaction change if you knew that your response could resurface in the future or in a different app?

Keeping up with the ways in which technology is changing our relationships and world can be a lot of work, but we cannot allow ourselves to take our hands off the wheel. Although not all counselors choose to participate in social media sites, such as Facebook, Instagram, WhatsApp, or Snapchat, it is crucial to stay up to date on the ways these social media platforms impact clients’ lives and relationships. For those who work with child and adolescent clients, it is equally important to find reputable resources to share with clients’ caregivers. Websites like commonsense.org can be helpful as a starting point. Local libraries and schools often hold workshops or sessions focused on navigating digital spaces as well.

Just as we cannot expect parents to navigate the digital world without guidance, nor can we expect that adolescents will understand all the social nuances of the online social world without our help. By partnering with adolescents, and allowing ourselves to find vulnerability in our lack of expertise, we may be able to help them think through some big questions about who they are, what they represent and how they want to show up in the world—not just online but IRL (in real life).

 

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Related reading, from the Counseling Today archives: “#disconnected: Why counselors can no longer ignore social media

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Adria S. Dunbar is an assistant professor in the Department of Educational Leadership, Policy and Human Development at North Carolina State University in Raleigh. She has more than 15 years of experience with both efficient and inefficient technology in school settings, private practice and counselor education. Contact her at adria.dunbar@ncsu.edu.

@TechCounselor’s Instagram is @techcounselor.

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Pushing through the vape cloud

By Lindsey Phillips November 26, 2019

Four years ago, Hannah Rose, a licensed clinical professional counselor in private practice in Baltimore, started vaping as a way to quit traditional cigarettes, but she ultimately found that it was even more difficult to stop vaping. “I was vaping at work, round-the-clock, in between clients,” Rose recalls.

One day after leaving a yoga class, she instantly reached for her vape. In that moment, she felt conflicted because her nicotine addiction did not line up with her values of being mentally and physically healthy. This values conflict made her want to quit, but the thought of doing so gave her anxiety.

Part of Rose’s anxiety stemmed from the fact that nicotine, which is in most vape juices, can be highly addictive. One pod (about 200 puffs) of the electronic-cigarette brand Juul contains 20 cigarettes’ worth of nicotine. Gail Lalk, a licensed professional counselor (LPC) and licensed clinical alcohol and drug counselor in private practice at Young Adult Therapy in Morristown, New Jersey, says she has seen teenagers who have gotten addicted after vaping one or two pods.

E-cigarettes often introduce nicotine to teenagers who were not previously smoking traditional cigarettes. This has been the case for the majority of Lalk’s younger clients. Lalk asserts that she hasn’t had a single client younger than 18 who started vaping because they were trying to quit cigarettes.

Recent statistics confirm the popularity of vaping among teenagers. According to the Food and Drug Administration, from 2017 to 2018, e-cigarette use grew by 78% among high school students (from 11.7% of students to 20.8% of students) and increased 48% among middle school students (from 3.3% to 4.9% of students). In December 2018, Surgeon General Jerome Adams issued an advisory about the dangers of e-cigarette use among teenagers and declared it an epidemic in the United States.

But why have e-cigarettes gained popularity so quickly? The big draw is the flavor, says Rose, who has experience working with clients battling addiction. Traditional cigarettes aren’t known for their good taste. The first time someone smokes a traditional cigarette, they usually start coughing and are left with a tobacco or menthol aftertaste.

Compare that experience with vaping: It doesn’t feel harsh when the user inhales, yet the user still gets a buzz of nicotine. And this experience comes in almost any taste imaginable — mango, mint, apple pie, cake, bourbon, coffee and so on. The options are so plentiful that some online vape shops organize the flavors by categories such as cream and custard, candy, sour and beverage. 

However, after a recent outbreak of lung injuries associated with vaping, e-cigarettes have been coming under increased scrutiny. The Trump administration has proposed a policy to ban flavored vaping liquids, and several states such as Michigan, New York and Massachusetts have already enacted similar bans. In October, Juul announced it was immediately suspending sales of its e-cigarette flavors.

Watch your language

Jennifer See, an LPC and a licensed chemical dependency counselor in private practice in San Antonio, advises counselors to be honest with their clients about the attraction of vaping. “These substances make these kids feel good, even if it’s just temporary. So, saying that they don’t is just not a good approach,” notes See, a member of the American Counseling Association.

Instead, counselors should acknowledge that vaping can be pleasurable and ask clients what they like about it, she says. At the same time, clients can be reassured that they have the ability to quit, even though it will be difficult, and that the counselor will be there with them every step of the way, she adds.

When referring to the issue of vaping during intake or in session, counselors need to be specific about the language they use, See says. Smoking is not “an umbrella [term for vaping] because people don’t really associate [vaping] with tobacco or nicotine,” she explains. “It’s almost its own category.”

On her intake form, See used to ask clients if they were using nonprescribed substances such as alcohol, tobacco or nicotine, or whether they smoked. However, she was finding that clients who vaped often responded no to these questions because they didn’t consider it to be the same as smoking. Now, See clearly asks if clients vape or Juul (the most popular brand of e-cigarettes).

This advice extends to the language counselors use on their websites and in how they advertise their clinical services. Rather than listing only general terms such as substance use or smoking, counselors should specifically list vaping if they are trained and feel comfortable working with the issue, See suggests.

Rose doesn’t believe that vaping should be the focus of counseling sessions, at least not initially. “Vaping is not the problem,” she explains. “It’s just a symptom of the problem. So, counselors [first] need to tap into that core-issue work.”

As Rose points out, even 12-step programs view substances as symptoms of a larger issue. “The 12 steps are not about not drinking [or smoking],” she says. “The only step that even mentions alcohol or nicotine is the first step. The other 11 steps are all about introspective work, practicing integrity, and looking at what patterns of behavior are no longer useful.” The success of this approach lies in looking for the underlying issue, not treating the substance as the problem, she says.

Parents often call See in a panic because they have caught their child vaping and want the child to stop. Parents — typically out of concern and fear — may try to punish or shame their children into quitting. See avoids any hint of shaming her young clients for their choices or even making assumptions about their readiness to quit whatever substances they are using “because I think that is a great way to alienate [the client],” she says.

Rather than launching into a discussion about vaping, See instead starts her sessions by getting to know the client. She will ask about school, home life and friends. She may ask, “What do you do in your free time? What activities are you involved in? Did you recently move? Do you have any pets?”

Often, these conversations reveal the role that vaping plays in clients’ lives, See says. For instance, a client may have started vaping because they just moved and wanted to fit in with a new group of friends, or because they are stressed out about applying to college.

See specializes in substance use and abuse and has expertise working with clients and their family members on issues around vaping. She has found that younger kids want to talk about vaping not only in social settings but also in counseling because they don’t consider it illicit and because they feel it is novel or cool to bring up the latest vape tricks and challenges. One popular challenge is for users to “hit a Juul” as many times as they can for 30 seconds. Another involves the “ghost inhale,” in which users inhale the vapor into their mouths, blow it out in the shape of a ball, and then quickly sip it back into their mouths.

Finding the underlying issue

Using motivational interviewing, See eventually asks clients if they want to quit vaping, if they are worried about their health if they continue vaping, and what their goals are for therapy. Part of the purpose of this questioning is to figure out the underlying reason that clients are vaping in the first place, See says. Is it because they are anxious or depressed? Is it simply because they want to appear cool?

To help clients pinpoint their underlying issue, See asks them to keep a journal to track their thoughts and behaviors connected to vaping. Often, as clients track when and where they vape — for example, when they’re alone in their room, when they’re with friends in their car, or when they’re bored — they also discover the real reasons they do it.

Clients keep track of their vaping habits for a few weeks or in between sessions, and then with See’s help, they look for patterns and clues that point to the underlying reason. This exercise also helps clients gain greater awareness of how much time and energy they devote to vaping, See notes. Often, people spend much more time vaping than they would smoking a cigarette, she adds. “Vaping is almost like chain smoking,” she explains. “That’s just another element that people don’t take into account.” See says some of her clients were vaping for two to three hours per day and didn’t realize it until they started tracking it in their journals.

As Rose notes, “Counseling can be helpful to look under the surface of the behavioral piece and bring a level of mindfulness to what is the thought or feeling that precedes [a client] picking up that vape.” She contends that this is not the time for counselors to use a solution-focused approach to try to quickly get clients to stop vaping.

“Smoking or vaping is a symptom, and the core problem is something internal,” Rose asserts. That’s why she believes counseling has so much to offer to people who want to quit vaping — because counseling goes beyond merely reducing the symptoms and helps to address the underlying issue. “A good competent counselor can really bring a deeper level of awareness to that core issue, [and] if that wound begins to heal, it prevents the problem from continuing,” Rose says.

A few years ago, Lalk, an ACA member who specializes in working with adolescents and young adults, had a teenager come to her because she had attempted suicide, was depressed, had past trauma, and was using lots of substances, including vaping. For the next two and a half years, Lalk worked with the client on her anxiety, depression, and maladaptive behaviors such as lying. After successfully addressing these underlying issues, the client announced on her own that she wanted to quit vaping and be substance free when she started college. In addition to continuing with counseling, the client used a nicotine patch and was able to slowly wean herself off of nicotine. Lalk says this was possible because the client started from a state of good mental health.

A mindfulness ‘patch’

See has had clients who, without thinking, pulled out their vaping devices in session. That showed how much of a habit it had become for them, she says.

Rose admits that she used to be on autopilot with vaping, and the first few days after she quit, she found herself instinctively reaching for her device. Because vaping can help release a person’s anxiety, making them feel better, it can quickly become a habit, Rose says. The challenge is unlearning this habit, which is a deliberate process, she emphasizes.

Similar to See’s tracking activity, Rose has clients journal to help them become more mindful about how and why they vape. She asks clients to write down (or at least notice) what was going on before they vaped, including their thoughts and feelings and their environmental and internal cues. She tells clients not to judge or change the situation. She simply wants them to notice it and make note of it.

“That awareness makes it more difficult to continue engaging in the same self-destructive pattern, and that pain and discomfort lead us to eventually stop the pattern,” Rose says.

Meditation is another effective way for clients to practice nonjudgmental awareness. “Yoga essentially saved me from smoking because it forced me to be still in my own body, and my cravings started to decrease the more I did yoga and the more I got comfortable with myself,” Rose says. “Any kind of mindfulness practice in any capacity can really help calm that craving because it forces you to … pause and be aware instead of act on impulse.”

“When you’re trying to quit vaping, it’s likely to unmask other anxieties,” Lalk says. The trick is to find healthy ways to process this underlying anxiety. Lalk finds patterning techniques helpful for her clients in this regard.

Lalk uses the common technique of deep breathing to illustrate patterning. Counselors often tell clients to breathe in a numerical pattern: Breathe in for four seconds, hold for six seconds, and breathe out for eight seconds, for example. This technique works because of the counting pattern, Lalk says. “Once you start trying to do [this patterning], your brain shifts and it calms you down,” she explains.

Lalk encourages clients to find a patterning technique that works for them. It could be doing beats with their hands, taking deep breathes and counting, writing poetry, or going for a walk and looking for patterns (counting every orange object that they see, for example). The key is to be mindful while doing the activity, Lalk explains. “Running is a beautiful way to pattern because you can count your steps. Just running for the sake of running if you aren’t being mindful about it isn’t nearly as helpful,” she adds.

With the help of a relaxation patterning activity, clients can calm themselves as they discuss their underlying anxiety or other issue with a counselor. Lalk points out that people often hide from whatever makes them anxious. Counselors can work with clients to instead address and acknowledge their anxiety and move toward it, not away from it, she says. Lalk says one of her clients can do four different beats with each of his hands and feet. Once he starts doing his beats, he relaxes and starts talking about his underlying issues.

See also helps clients find mindful replacements for vaping. One of her clients tracked her vaping behavior and discovered that she mostly vaped in her car — a place she spent a significant amount of time driving to school, work and other activities. Together, See and the client reviewed various alternatives that she could engage in while in her car: Would playing music help? Did she need something to do with her hands, such as squeezing a stress ball or play dough or twirling a pen in her fingers? Was her vaping habit the result of an oral fixation?

They finally decided the client would keep a water bottle in her car, and every time she wanted to vape, she would take a sip of water instead. In many cases, it’s about figuring out what clients can do so that vaping is not at the forefront of their minds, See says.

Changing the narrative

Lalk points out that people who vape are not strangers to negative, shame-based and judgmental comments from others. But this sends the wrong message, she says. The person may have tried vaping at a party and, in a short time, become addicted. This doesn’t make them a bad person; it just means they are struggling, she says.

Counseling can help clients manage negative internal and external comments. Rose has her clients practice nonjudgmental awareness. For example, a client might set a goal of not vaping all week, but at the next session, he confesses that he did vape, which in his eyes, makes him a “horrible person.” Rose helps the client separate shame (“I am a bad person because I vaped this week”) from guilt (“I feel bad for relapsing and using nicotine”). Whereas feelings of guilt can be healthy, shame and negative thinking aren’t productive, Rose says. Clients can’t shame themselves into quitting, even though they often try to do just that, she adds.

Rose frequently uses narrative therapy to help clients identify and change these harmful thoughts. She asks clients to write down all of the thoughts they have about themselves at the end of each day. Maybe they vaped that day and feel like a failure, or maybe they went the entire day without vaping and feel good about themselves.

Rose encourages clients to be mindful of the story they are creating with their words and thoughts. She asks clients, “What is the narrative you have created about yourself and your vaping?” Sometimes clients have internalized a narrative of “I’m a smoker,” and the more they say this, the more it becomes true, Rose says. So, if a client states, “I’m a smoker who quit two months ago,” Rose works with the person to change the story to an empowering one, such as, “I don’t vape. I’m not a smoker.”

“Those narratives are going to illuminate some more core issues like self-esteem or a lack of self-worth,” she adds.

Focus on the wins

See suggests that counselors can also help clients focus on their small victories. “Every time you don’t [vape] is a win,” See says. “And if a day didn’t go as great as you wanted it to, then just press that reset button and start over. You can start over at any point in the day. You don’t have to wait until tomorrow.”

See collaborates with clients to identify rewards and motivations that would work best for them. That could be buying new shoes with the money saved from not vaping that week or not allowing themselves to watch a Netflix show until they make it one day without vaping. The goal is to have clients build up their toolboxes, so she has them come up with a list of about 25 things that aren’t substances that make them feel good, such as running or going out to eat at a favorite restaurant.

Having a sufficient stockpile of motivators in their toolboxes ensures that clients will have an alternative to turn to when the craving to vape hits, See notes. Having only a few options — even if they are strong motivators — can backfire because not every tool will work in every situation. For instance, if a client is stuck in class and can’t go running when the urge to vape arises, he or she will need another tool to use in that moment. Clients should also make their goal visible to help motivate them, See adds. For example, they can put the goal on their mirror so that they see it every day.

Rose recommends the app Smoke Free because it focuses on positive reinforcement, not consequences. “It’s very strength based,” she notes. The app doesn’t show a picture of an unhealthy lung or treat the user as naive. Instead, it focuses on the benefits of not smoking and the progress people are making toward their goals.

Upon opening the Smoke Free app, users see a dashboard displaying how long (down to the hour) they have been smoke free. It calculates the degree to which the person’s health is being restored with icons that display improvements (by percentage) for pulse rate, oxygen levels, and risk of heart attack and lung cancer. It also shows users how much money they have saved by not vaping. The app includes a journal component where users can note their cravings and identify their triggers. To further encourage users, it includes progress made such as life regained in days and time not spent smoking.

“A knowledge of consequences does not dissipate the problem,” Rose says. “We absolutely know that smoking is highly correlated with lung cancer, and yet millions of people still smoke.” Younger generations often feel invincible, so focusing only on the consequences of vaping isn’t a sufficient motivator, she adds.

Forming alliances

Counselors must take steps to reach children and parents even earlier because vaping is increasingly making its way into elementary and middle schools, says See, who wrote the article “The dangers of vaping” for the website CollegiateParent. With parents, it is also helpful to educate them on what to look for because vaping devices, which can resemble a flash drive or pen, are often hidden in plain sight and are easily overlooked, See adds. 

Lalk recommends that counselors also take the time to learn from their clients. Through her alliance with some of her seventh- and eighth-grade clients, she found out which local stores were selling e-cigarettes to underage patrons. These clients also confided that one store owner said he knew the kids were underage but that the possibility of getting caught and having to pay a $250 fine was worth it because each vape sold for $60.

This knowledge helped Lalk take action in her community, including writing an article on how the shops, rather than the children, should be prosecuted, and participating in a movement to create ordinances setting new rules for establishments that sell vapes to minors. The businesses in her town now have to secure permits to sell vaping products, part of which requires acknowledging that they will not sell to minors. If store owners are found in violation of their permits, they risk losing their businesses. 

Rose used to facilitate two hours of group counseling at a rehabilitation center five days a week, and she regularly witnessed the shame reduction and healing that can happen in groups. “I believe the opposite of addiction is not just abstinence,” she says. “The opposite of addiction is connection.”

Accountability is another big piece in quitting, Rose says. She often tells clients who are struggling to call a friend with whom they can be honest or to find another way to keep themselves accountable to their goal of quitting or reducing the amount of time they vape.

Rose personally found that documenting her journey of quitting in a blog post kept her accountable. Others reached out and told her that her post made them feel less alone and motivated them to quit too. In turn, she thought twice before using her vape again because she wanted to respond to incoming emails by confirming that she was still vape free.   

See agrees that accountability and healthy rewards are smart strategies for helping clients who want to quit vaping. Peer pressure can become a big issue, especially for teenagers who don’t want to feel like the odd person out when seemingly everyone else in their crowd is vaping, she says. She advises clients to let people know they are quitting and to surround themselves with people who will empower and support them in their decision.

Accountability becomes even more important with adults, See points out, because they have more freedom and don’t automatically have someone watching over or checking in with them. That’s why having a support system is so important, she says. When clients feel like vaping, they can reach out to someone they trust and ask them for five reasons not to, See says.

See says clients might also consider posting on social media that they are quitting and openly ask for support, or they could participate in a 30-day challenge. One of Lalk’s clients participated in a challenge the person referred to as “No-Nic November.” These positive challenges can provide a good counterbalance to the vaping challenges that are so popular on social media currently.

When See dropped one of her children off at college, she noticed the dorm had placed a whiteboard with the words “Healthy Ways to Deal With Stress” written at the top. The students were adding their own suggestions, such as going to a pet store and petting a cat or going for a run. See loved this self-empowering technique and plans to incorporate it into her own practice by adding a Post-it wall where clients can add their own healthy ways of coping or their own words of encouragement.

Taking the first step

Quitting can be overwhelming, and sometimes clients don’t know where to start. See advises these clients to begin by taking small steps. Harm reduction can be a particularly effective early strategy because it empowers clients, See says. “Once they see they can harm reduce, then maybe [they] can harm reduce all the way to zero use,” she explains. “But putting them at the bottom of Mount Kilimanjaro and saying ‘get up to the top right now’ is daunting.” Instead, she asks clients what their “climb” to being vape free looks like for them. Do they want to climb fast, or do they want to climb slow?

Recently, See worked with a teenager who had been vaping for three years. She had been scared by the recent health reports related to vaping and wanted to quit. See asked this client about her motivators, and the client said she wanted to quit to protect her health, for her parents who were pressuring her to quit, and because of the monetary costs associated with vaping.

See asked the client, “What does 30 days without vaping look like?” The client’s eyes bulged. The thought of it was too much for her. So, instead, See and the teen client talked and decided she would remove e-cigarettes from just one place in her life.

By tracking her habits, the client learned she vaped mostly in her car. So, See suggested she remove the vape only from her car and also not allow her friends to vape there. See also instructed the client to notice and write down how it felt not having the vape in her car. Did she miss it? Did she reach for it without thinking? Together, they also made a list of possible replacements she could keep in her car, including a pen, candy flavored like her favorite vape juice, and a stress ball.

“That was one part of the mountain that she could climb,” See says. Feeling empowered by her success, the teenager eventually decided that she was ready to tackle the prospect of no longer vaping in her room at home.

Others, such as Rose, decide to take a faster approach and quit cold turkey. She notes that counseling can bring a level of mindful awareness to quitting and help clients figure out the underlying reasons they turn to vaping to fill an internal void. “The nicotine [and] physical addiction is a part of it, but that’s not the core issue,” she asserts.

Since she stopped vaping, Rose’s mindfulness practice has increased. She has trained herself to pause before acting on impulse. “The mental aspect is infinitely more difficult to unlearn than the physical addiction — ‘I’m sad, I’m going to vape. I’m happy, I’m going to vape. I’m bored’ — that’s the most common — ‘I’m going to vape.’ It’s something to do, something to reach for, essentially something to [help] avoid just sitting with [one’s] self in one’s own skin,” she says.

As Rose opens her Smoke Free app, her dashboard proudly displays that she hasn’t vaped for six months, 16 days and 13 hours.

 

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Lindsey Phillips is a contributing writer to Counseling Today and a UX content strategist. Contact her at hello@lindseynphillips.com or through her website at lindseynphillips.com.

Letters to the editor: ct@counseling.org

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Five social, emotional and mental health supports that teens need to succeed

By Dakota King-White, Sade Vega and Nicholas Petty September 9, 2019

Many teenagers have been exposed to traumatic events, and most experience regular life stressors. Exposure to violence and other traumatic experiences can have a lifelong effect on learning and may negatively impact academic achievement. Among examples of traumatic events that some teenagers experience are community violence, school shootings, the loss of a loved one due to death, parental incarceration, divorcing parents, a parent or caregiver with mental illness, and substance abuse in the home. Within the school setting, the negative influence of trauma on teens may lead to poor concentration, declining academic performance, school absenteeism, and the decision to drop out. These challenges create barriers for the success of teens in the academic setting.

Schools across the United States have recognized the importance of providing school-based mental health support because these services benefit students academically, socially and emotionally. However, questions regarding the issues facing teens and the types of mental health supports needed to deal with these issues require further examination. Implementing a needs assessment can assist schools in uncovering the answer to these questions. The findings can then help determine what programming should be implemented to improve students’ overall development, such as teaching them social skills to help them become productive members of their communities and school settings.

We wanted to learn more about the social, emotional and mental health needs of teenagers, so we conducted a needs assessment in which we surveyed 198 high school students in a Midwestern city. The teens in our study identified the types of emotionally stressful experiences they have faced since attending high school. They also described what schools could do to make them feel supported and better able to deal with the related challenges.

The following sections present the five top issues identified by the students we surveyed, along with recommendations on ways that schools can support teenagers socially, emotionally and mentally.

 

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1) Social media makes peer pressure a 24/7 problem. Teens today are confronting certain pressures that teens in the past didn’t face. A prime example: Social media has become an indispensable part of teenagers’ lives. According to a 2018 report written for the Pew Research Center by Monica Anderson and Jingjing Jiang, YouTube, Instagram and Snapchat are the most popular online platforms among those ages 13-17, and most teens have access to these apps on their smartphones. Anderson and Jiang note in the report that 95% of teens have access to a smartphone, with 45% of teens acknowledging that they are online “almost constantly.”

This constant mobile connection creates the conditions for teenagers to consistently be exposed to peer pressure even outside of the school environment. Mina Park and colleagues in 2017, in a journal article in Cyberpsychology, Behavior, and Social Networking, noted that hyperconnectivity to social media can also lead to depression, negative body image and eating disorders.

What schools can do to help: Teens must be given an outlet to discuss their frustrations when it comes to dealing with peer pressure. Students should be directed to their school counselors or other trusted adults in the school with whom they can share their feelings and pressures and get supportive, confidential advice in return. It is also helpful to allow for genuine conversations in the classroom about the importance of students being confident in who they are and embracing their differences. Safe spaces in schools allow teens opportunities to feel supported in a neutral environment, to accept who they are, and to embrace differences among their peers.

 

2) Bullying is a significant issue. Peer pressure is not the only problem arising from constant social media access. The other, and even more troubling, issue is bullying. Teens may experience, witness or engage in bullying situations, including cyberbullying, which is more prevalent among teens.

The Bullying Statistics website (bullyingstatistics.org) notes that cyberbullying may consist of teens sending cruel messages, spreading gossip or posting threatening messages on social media platforms, pretending to be someone else on a social media account, or sexting. According to recent statistics from the website, more than 25% of teenagers have been exposed to cyberbullying situations that have had a negative impact on them. Bullying can have a significant effect on teens socially, emotionally and academically. Some of the negative impacts include depression, anxiety, attendance problems, and decrease in academic achievement. However, many teens who experience cyberbullying do not tell their parents or guardians about these painful experiences.

What schools can do to help: October is National Bullying Prevention Month, and many schools across the United States take time to develop effective strategies to raise awareness about bullying and to prevent bullying incidents on their campuses. It is important for schools to create an environment in which victims of bullying/cyberbullying, or teens who witness the bullying of a peer, can talk to trusted adults about bullying situations. Help your students by providing safe places in schools where teens can disclose when they or their peers are being bullied, or even create a hotline for students to report bullying situations.

Additionally, offer professional development to teachers and other staff members on identifying the warning signs of bullying, and provide them with effective strategies to help students who are being bullied. Likewise, many parents are unaware of how to support their teens when they are being bullied, so invite parents to on-campus workshops where they can learn ways to address these issues with their teens. During the parent and family sessions, discuss the various types of bullying that take place, the warning signs of bullying, and school and community resources for victims of bullying and cyberbullying. Workshops for parents and families can add another layer of support for young people who are affected by bullying.

 

3) Students are concerned about their personal safety. In our study, the third top concern that students reported was anxiety about their personal safety. According to the National Institute of Justice, school safety is currently a common concern among educators and administrators across the United States. Teens may not feel safe in their schools because of gun violence on school campuses across the country or even violence in their own communities or neighborhoods. The National Institute of Justice has stated that more schools have increased their security measures to protect students. Many of these schools have instituted locked doors, security cameras, hallway supervision, controlled building access, metal detectors and locker checks.

More than half of the ninth- and 10th-graders and more than 70% of the 11th- and 12th-graders we surveyed reported that they had experienced a traumatic event while attending high school. These various traumatic events can cause students to feel concern about their overall safety in their schools and communities. This type of stressor can in turn affect how teens engage in their educational environments.

What schools can do to help: Trauma-informed methods must be put in place to support students and their overall safety. Trauma-informed approaches focus on ways to ensure that students feel supported, listened to, and safe. Among the trauma-informed approaches that counselors can create in their schools are to build trust and rapport with students and to collaborate with outside community resources to support students who have been exposed to traumatic events. By getting to know your students, you will notice when their behaviors change, and because you have built trust with them, you can approach them in a friendly way to address these changes.

In addition, provide training on trauma-informed methods for teachers, support staff and administrators at your school. This training will help them create resources aimed at the needs of teens. Additionally, educators can seek professional help for their own personal traumas so that they may better interact with students who are dealing with stressors. By ensuring that teachers and staff members have access to community resources and training about personal safety and trauma, schools are developing leaders who can help students socially, emotionally and academically.

 

4) Students need help coping with their emotions. Teens’ emotions run rampant during their high school years. Most experience a range of emotions, including anger, fear, frustration, disappointment and hurt. These emotions may mask some of the broader issues that students face and that ultimately affect their academic performance.

Some of the students in our study participated in a small group that focused on developing social skills. The single-gender support group addressed the students’ academic, social and emotional needs. The sessions offered teens a safe place to identify stressors in their lives and to discuss the emotions attached to those stressors. By talking about their emotions, students were able to identify yet other emotions that were hiding underneath their anger and aggression. Throughout this process, the teens learned how to effectively articulate their emotions and to identify the underlying factors that were fueling them.

What schools can do to help: Encourage a supportive environment and training for students, such as small support groups facilitated by school counselors, clinical counselors, school psychologists or social workers, as well as peer-to-peer support groups. Teach teens the proper social skills related to identifying their emotions, and explain that all emotions are OK to have.

Quite often, teenagers express only the basic emotions when talking to others, especially adults. However, challenging them to look deeper and to identify the true emotion can be effective. Teens need safe places at school where they can learn how to cope with their anger and the other uncomfortable emotions that they often face.

 

5) Dealing with grief is important. A final concern students reported centered on dealing with grief from the loss of a loved one. Those students in our study who had experienced the loss of a loved one or who had witnessed a friend going through such a loss reported needing a supportive outlet to deal with those losses. Students may experience various losses during their teen years, such as the death of a friend or family member, and they are often left to process their emotions about the loss on their own. If schools are unaware that students have experienced a loss, those students may go without the support that is needed to help them process their grief. A lack of support during this time can have a significant impact on teens succeeding within the academic setting.

What schools can do to help: Build rapport early in the year with students so that they will be comfortable sharing should they experience a loss. During times of loss, allow students to grieve. Provide additional assistance by forming support groups for students who have experienced loss. This type of support can be offered through collaboration with local counseling agencies, hospices or other entities that support families experiencing loss. It is also helpful to maintain a list of community resources that address grief and loss. This community resource guide can be shared with teens, parents or caregivers, and other stakeholders.

Transforming school into an emotionally responsive environment

Students who are well-equipped socially, emotionally and mentally at the beginning of their academic careers can better cope when hardships occur. As counselors, we can help our students succeed in school and in life by first learning to identify their social, emotional and mental health needs, and then providing resources such as social skills workshops and support groups for them. Additionally, we can lead by example by improving our own social, emotional and mental health through professional development workshops that emphasize social and emotional learning practices.

Remember, school is not just a place where students gain academic knowledge; it is where they prepare for life. By doing our part to create a safe and emotionally supportive environment, we can increase the odds that students will succeed beyond the walls of the classroom.

 

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Dakota King-White is an assistant professor in counselor education at Cleveland State University. Prior to that, she worked in K-12 education as a school counselor, mental health therapist and administrator. Contact her at d.l.king19@csuohio.edu.

Sade Vega is a student in health science at Cleveland State University. In 2018, she received the university’s undergraduate student research award for her research on assessing the social, emotional and mental health needs of high school students. Contact her at s.m.vega@vikes.csuohio.edu.

Nicholas Petty is the director of undergraduate inclusive excellence at Cleveland State University. Prior to working at the university, he was an administrator in the Cleveland Metropolitan School District, where he earned national attention for his innovative approaches to behavioral intervention and student motivation. Contact him at n.petty@csuohio.edu.

 

Letters to the editor: ct@counseling.org

Counseling Today reviews unsolicited articles written by American Counseling Association members. To access writing guidelines and tips for having an article accepted for publication, go to ct.counseling.org/feedback.

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Inviting young people to talk about mental health

By Jonathan Rollins March 29, 2019

Lady Gaga is known for her candor and openness when it comes to speaking about her struggles with mental health. But as her mother, Cynthia Germanotta acknowledges that she didn’t initially understand why her famous daughter felt compelled to share so candidly — and without prompting — from the stage.

Over time, however, Germanotta’s perspective changed, especially as she began noticing that when Lady Gaga recounted her struggles, there was almost a visible sense of relief on the faces of many of her fans. “What I came to realize is that [in sharing these details], she was healing and her fans were healing. … I think the fans eventually came to hear her message of resilience and courage as much as the music.”

Speaking in front of approximately 4,000 attendees during her keynote talk Friday morning at the American Counseling Association 2019 Conference & Expo in New Orleans, Germanotta said that experience was the genesis of the Born This Way Foundation, a nonprofit that she and Lady Gaga co-founded in 2012 to empower youth and to eliminate the stigma around mental health.

Today, Germanotta said, she and the other Born This Way Foundation staff members “spend our days inviting conversations around mental health.” One of those staff members, Executive Director Maya Enista Smith, joined Germanotta on stage to facilitate the keynote presentation.

Germanotta shared some of her famous daughter’s backstory, telling the audience that when Lady Gaga (real name, Stefani) was in middle school, she faced a significant degree of taunting and humiliation. This caused her to question her self-worth and resulted in struggles with depression and trauma. These experiences “followed her to high school and college,” Germanotta said, and continued to plague her into her adult life.

As she found her voice, however, Lady Gaga decided to channel that hurt into helping others. She told her mother that she wished she had been better equipped to deal with life’s struggles as a young person and had a desire to give today’s youth the necessary tools to do what she couldn’t at the time.

According to Germanotta, in research conducted through the Born This Way Foundation, access to care (particularly access to affordable care) and simply not knowing where to turn for help are among the top issues impacting youth mental health. In one of the foundation’s studies, it was found that more than 90 percent of youth said they valued their mental health (even more than said they valued their physical health). However, less than 50 percent reported feeling that they had the tools to practice good mental health or knew where to turn for help.

“It’s important to treat mental health; it’s even more important to foster it,” Germanotta said.

Part of overcoming this barrier is simply inviting young people to have conversations around mental health and then giving or pointing them to the tools they need to help themselves and their peers. One of the Born This Way Foundation’s initiatives has been developing a Teen Mental Health First Aid program, developed in partnership with young people, that will be piloted in eight schools later this year.

One of the best things that parents can do — including parents who just so happen to be counselors — is to talk to their children about mental health, Germanotta said. She acknowledged that these discussions can sometimes be awkward, but “normalizing that conversation around mental health” can be a huge source of support for young people and provide them many of the tools they are missing. She also recommended that parents model this talk around the dinner table, “being very honest and open about your own issues and stressors.” One of the main reasons that teenagers don’t turn to their parents for help with mental health struggles is because they don’t hear their parents share about their own challenges openly, Germanotta said.

As for steps that counselors can take, Germanotta again stressed that “young people are struggling with not knowing where to go for that help. … Help them find you, what you do, and what resources are available to them.”

She also said that “one size does not fit all concerning what the answer or resource might be. You really can’t be prescriptive. … It comes back to meeting young people where they are and understanding their needs.”

Finally, Germanotta gave counselors a reminder: “Check your judgment at the door when talking to young people.” Feeling judged is one of the biggest reasons that young people choose not to open up and talk to adults about their struggles, she said.

Germanotta also invited counselors to partner and collaborate with the Born This Way Foundation in reaching young people. “It’s going to take us all,” she said. “We can’t do this alone. … The hope that I have is that this issue is being more recognized every day on a larger scale.”

When Lady Gaga was in college, some of her fellow students started a Facebook page called “Stefani Germanotta Will Never Be Famous.” Perhaps they didn’t realize how hurtful their words and actions might be to a young woman’s emotional and mental health. Regardless, they certainly missed the mark when it came to prognosticating the future Lady Gaga’s worldwide level of recognition and influence.

Fortunately, Lady Gaga is passionate about using her stage not just to boost her own fame, but to preach a message of resilience, kindness and courage — and to validate that it’s perfectly OK to live with, and seek help for, mental health issues.

Germanotta recounted to ACA Conference attendees what her daughter has told her: “Of course I want to be remembered for my music, but what I most want to be remembered for is helping young people change the world.”

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Find out more about the Born This Way Foundation at bornthisway.foundation

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In her own words

Read more about Germanotta’s perspective and experience through two articles she has written:

 

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Jonathan Rollins is the editor-in-chief of Counseling Today. Contact him at jrollins@counseling.org.

Follow Counseling Today on Twitter @ACA_CTonline and on Facebook at facebook.com/CounselingToday.

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

 

Volcanic adolescence

By Chris Warren-Dickins January 14, 2019

In the early days, Caroline, a 14-year-old girl, started each session with a chin thrust indignantly at her counselor. She wanted to be seen as a warrior, and she offered answers that were blunt as a sledgehammer.

And why should she drop her defenses? She had seen too many adults — teachers, social workers, friends of the family — try to engage with her at first, and then seemingly lose interest. In the end, she felt that she was just an inconvenience to everyone around her. Why should Caroline believe that this counselor would offer a different type of relationship?

With any new client comes the challenge of forming a therapeutic relationship, but when that new client is an adolescent, there are additional factors to consider. Aside from the legal issues of capacity and consent, I discuss 10 of those therapeutic factors below.

 

1) A holistic assessment: It is important to adopt a strengths-based approach to assessment of adolescents. In addition, it is worth reviewing that assessment more regularly than with an adult client because more things are likely to change with a growing adolescent. As Urie Bronfenbrenner pointed out, a young person’s development is the result of a complex system of relationships that constitute the child’s environment. Therefore, assessments of young clients will include their developmental needs, the extent to which caregivers are meeting their needs, and their family and environmental contexts, including the influence that their school and peers have on them. The assessment should also gauge the influence of technology in the young person’s life.

2) Emotional “distance” from problems: As an adolescent, Caroline needs her counselor to appreciate that she does not have the same “distance” as adults experience from their problems. Adolescents have little control over their lives. They have to stay in the same home or school, even if these things might be the source of their depression, anxiety or other presenting issue.

3) Grasp of emotional language: As a 14-year-old, Caroline still has not developed her emotional language, so volcanic eruptions of anger or shoulder shrugs of apparent indifference are her only means of expressing how she feels. We have to see past the shoulder shrugging, which can easily be interpreted as nonchalance, and open ourselves to the possibility that young clients want to express themselves but just don’t know how to yet.

Images are a useful starting point, even if it is just looking at a series of facial expressions to try and help these clients identify the emotions they are experiencing.

4) The dominance of transition: Transition features heavily in adolescents’ lives. Each year, they are at a different stage of educational development and, each year, they experience bodily changes. On top of all of this, their ideas about who they are and how they fit in with their peers and wider society are in a constant state of flux.

At this level of fluidity, a counselor can offer Caroline some sort of stability. One source of this stability can be the therapist’s professional boundaries. The counselor can also offer Caroline the benefit of his or her life experiences, providing a deeper context than Caroline’s young perspective. But the counselor’s older years and life experience do not provide complete insight, no matter what the client’s presenting issues is, so a person-centered approach is crucial. We, as counselors, do not know Caroline’s worldview until we explore it with her, and we have to be careful not to make too many assumptions.

5) Disruption tenfold: It is hard for adolescents to experience so much transition, but it is even harder to manage at the same time as dealing with mental or physical health challenges, a chaotic home life or a sudden major change experienced by the adolescent’s parents (e.g., job loss, divorce, bereavement).

Because of the volcanic eruptions of adolescence, there is a danger that adolescents will become scapegoats in these situations. Just because adolescents may shout the loudest does not mean they are the source of the problems. Often, parents bring their adolescents for therapy, and these adults are completely unwilling to consider that the need for change might also rest on their own shoulders, rather than expecting just the adolescent to change and the whole family dynamic to become settled.

6) Discrimination experienced by minority adolescents: If an adolescent client is a member of the LGBTQ community or is an ethnic minority, it is likely that they have endured some sort of discrimination. If adolescents have to make sense of this — in addition to the transitions they are experiencing in their bodies, at school and at home — it can be challenging to deal with.

Is it any wonder that we sometimes see volcanic behavior in adolescents in the form of outbursts and defiance, screamed at us in a burning rage? If we are to help these youngsters, we have to see past the behavior that spews out like lava. We must dare to imagine what unmet needs might be fueling this volcano.

To help us, we can consider Abraham Maslow’s hierarchy of needs, and we can assess to what extent our adolescent clients may be getting their basic physiological needs met. Perhaps they are hungry, or there is the constant threat of homelessness hanging over them. Or perhaps their basic safety needs aren’t being met because domestic violence is present in the home. We can continue working our way up Maslow’s hierarchy (love/belonging, esteem and, ultimately, self-actualization) to understand what unmet needs may be fueling what appears on the surface to be irrational and unacceptable behavior.

7) Trauma-informed care: If the adolescent has a history of trauma, it is especially important to see past his or her volcanic eruptions of anger. In a 2017 article in Counseling Today about young clients in foster care (“Fostering a brighter future”), Stephanie Eberts states that therapists need to “help these children heal” by acting as a “translator” of the child’s behavior: “This includes explaining what a child’s behavior means and what motivates it, and then equipping both the child and the parents … with tools to redirect the behavior and better cope with tough emotions.”

8) Testing (to discover and take reassurance from) the boundaries: Adolescents may test boundaries more than adult clients do. Modeling behavior is important, and this is where congruence comes into play. If young clients are constantly pushing the boundaries by turning up late to sessions or missing them entirely, you can communicate the resulting emotion you are experiencing as a result of their behavior.

I like to think of this like a sonar device: Young clients are checking to see if you are still emotionally there and whether they are also still present in the interaction. You can share this with young clients, showing that certain behavior has consequences. Then you can jointly look for a way to resolve the matter.

Psychotherapist Rozsika Parker wrote about parents’ relationships with their children, but the following statements could apply equally to counselors and their young clients. Young clients “need to learn that they have an impact, that it’s possible to hurt” an adult, but it is also possible to “make it up with them.” Parker encourages adults to “show joy, hate, love, satisfaction — the full range of emotions — that will help the child to know themselves.” Parker wrote that she “heard the same note of reproach in their wails when they teethed, as in the studied criticism of me they could launch as teenagers.”

9) The resistant adolescent: As with any resistant client, adolescents need to feel that they are choosing to be in the sessions. But what happens if they are given no choice? If a therapist is working with a young client and the client’s family, and the young client chooses to leave the session early, what should the approach be?

I have heard some therapists adopt the following approach: They tell young clients that they are free to return to the session at any time but that the session will continue with the other family members. I quite like this approach because it avoids sessions becoming hijacked and held hostage by young clients, which might be a parallel process to other times in which these young clients have held more power than they knew how to handle. For example, they might have been forced to adopt a parental role with a younger sibling, or even a neglectful parent, at an inappropriately young age.

10) Mindfulness and meditation: I have seen and heard some of the criticisms of mindfulness and meditation. I struggle with this because, when I was starting out in this profession, my mentors raved about mindfulness and meditation. I need to see where this debate goes, but in the meantime, I cannot help but believe that there might be some value in mindfulness and meditation in our work with young clients.

Everything we offer our clients involves a balancing act between thoughts, feelings and bodily sensations. Society is built to engage the thinking side of our awareness, and this casts a shadow over our feelings and bodily sensations. Yet all three are important sources of information. If we focus solely on our thoughts, we are arguably functioning at only a third of our capacity. Short and simple mindfulness or meditation exercises can help young clients tap all sources of information, while also giving them a moment of relief from the constant demands of life.

 

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Chris Warren-Dickins is a licensed professional counselor in Ridgewood, New Jersey. Contact him through his website at exploretransform.com.

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.