Tag Archives: teenager

For such a time as this: Plan of action for young adults, adolescents and parents

By Esther Scott June 22, 2020

[Editor’s note: This is the third of four articles in a series on action plans for different areas of life during the COVID-19 pandemic.]

To young adults, the risk of contracting the coronavirus or suffering a negative outcome may feel remote. Research studies show that when young people talk about risk reduction, they tend to be referring to reducing social or reputational risks. As a young adult, you may be in the same boat. While the individual risks of COVID-19 may seem low for young people, it is worth stating that becoming infectious could worsen the health and financial security of your community and make it much harder for you to find work, especially if you are just graduating.

Remembering that your youth and health give you “superhero” powers will help you take a more active role in this crisis to protect yourself and those you love. As the line from the Spider-Man comics and movies reminds us, “With great power comes great responsibility.” You have the power of good health, and it is your responsibility to help solve the problem by protecting yourself and others.

Here is a plan of action for young adults, adolescents and their parents.

 

1) Obtain reliable information.

A deep understanding of how people view risk is crucial to stopping the spread of disease. Gathering a similar understanding of COVID-19 can help young people to participate willingly instead of resenting authority. It is important that you see breaking physical distancing guidelines as being risky not only for yourself and those you love, but risky for your entire community.

The same is true when it comes to understanding your economic risks. Analysts believe that young workers and new grads may be hit harder because they tend to work in the food, retail and hospitality industries — places that are experiencing harsher impacts as consumers stay home more. Obtaining reliable information will help you navigate the expected upcoming changes.

2) Control peer pressure. Prioritize safety over reputation.

One obvious reason for the prioritization of social reputation over health risk is peer pressure and the need to fit in socially. In the wake of COVID-19, there were numerous stories in the media highlighting young people who continued to gather despite social distancing guidelines. There were also reports of young adults violating shelter-in-place and social distancing orders to meet lovers and potential hookups because they felt pressured by friends to do so.

One way to evade social pressure is to plan your response ahead of time. Hosting remote meetings and parties could be one such response. With the rise of social media, distant hangouts are trending.

 

Plan of action for students and adolescents

In this difficult situation, it is best to look at the positive side: We have unbelievably valuable time to spend at home. This unprecedented situation that we are experiencing affects everyone. Adolescents too can learn to manage what they can control so that they emerge from this stronger. We can use this crisis to help them grow as resilient, autonomous human beings. Here is plan of action that can help students and adolescents make the most of this situation.

1) Keep a structured routine — a time for everything.

It is particularly important to keep a predictable routine. Develop a schedule that includes activities such as family sports, reading books, and collaborating with the rest of the family. It is important that students, especially teenagers, spend time in productive physical activities. Go out and throw the ball, shoot some baskets, go for a walk around the block or simply do some jumping jacks.

2) Continue education by reading and writing.

Two other important activities for students and adolescents during this crisis are reading books and writing thoughts. This time at home is the perfect opportunity to dedicate yourself to reading books and stories that have been on the shelf for a while. If possible, we recommend reading together as a family, including reflecting on the content of the story or answering questions that come up after reading it.

Writing thoughts or a diary with the events of the day or a gratitude journal about things you enjoy will continue to help you put these circumstances in perspective. If you graduated from high school or college this year, consider staying in school to pursue the next level of education. It could help you land a higher-paying job in the future.

3) Get involved.

Participating in household chores and taking responsibility for “their things” (their room, their clothes, etc.) is especially motivating for older children and adolescents. Allowing them to collaborate in the kitchen by researching new recipes or cooking (especially when personal assistants such as Google Assistant and Alexa are available for recipes) can also help develop growth and autonomy.

There are various ways that students and adolescents can take their place in this moment in history and make this time more enjoyable. They can write letters to the older adults in their families or communities and show appreciation for health personnel by sending prayers to them and those who are sick. It is good for young people to develop a sense of belonging in their communities and to know that their actions make a difference.

 

Plan of action for parents

Sticking to a routine is essential to keep your sanity (just as it is for your children). Maintaining a schedule can be helpful in creating a bit of normalcy in this unexpected situation and in reducing your anxiety level because your brain will feel in control.

Be a team. Keep it balanced. If you have a partner, try alternating who is looking after the kids or making meals. But most importantly, communicate your needs to your team. Remember that flexibility is key in times of crisis. Be kind to yourself; you are doing the best you can.

Although we have yet to see the full extent of the economic slowdown induced by COVID-19, analysts currently expect that we will recover once the virus is under control. So, hold on.

 

 

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Esther Scott, LPC

Esther Scott is a licensed professional counselor in Arlington, Texas. She is a solution-focused therapist. Her specialties include grief, depression, teaching coping skills and couples counseling. Contact her through her website at positiveactionsinternational.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.

School vaping cultures: Acknowledging the impact of COVID-19

By Zachary Short and Nicole Baliszewski June 4, 2020

This past January, global tobacco conglomerate Altria saw a major drop in its stock value on the New York Stock Exchange, depreciating at a value of almost 40% versus its record-breaking highs in 2017. What caused this sudden dip in one of the biggest-rebounding industries of the 21st century? It would be fair to suggest that the COVID-19 pandemic has caused some major complications for both the traditional and electronic cigarette corporations located across the United States.

As a respiratory-based infectious disease, COVID-19 poses an unparalleled threat to the health and safety of individuals across the age spectrum with significant histories of vaping or smoking. In fact, a recent study in the New England Journal of Medicine found that Chinese patients with a history of smoking were twice as likely to suffer from severe infections associated with diseases such as COVID-19 in comparison with those without any smoking history.

Having always opposed the youth vaping/smoking culture, counselors and community advocates across the nation are currently working to answer a significant question: What actions can we be taking to protect our communities from the combined threat of COVID-19 and recent vaping trends?

The truth is, now is the prime time for considering how we can influence our communities to create better post-quarantine schools for our students.

The loss and revitalization of the smoking industry

Only five years ago, health specialists with the Truth Initiative anti-smoking campaign speculated that the tobacco industry and most of the nation’s smoking addictions would expire with the Generation Z demographic. But vaping, the process of inhaling prepackaged aerosols (also known as vapor), has led to the resurgence of nicotine products within school systems.

Through a combination of peer pressure and social media campaigns, students from all backgrounds have found themselves under the influence of Altria’s newest partner, Juul Labs, maker of the Juul electronic cigarette. Largely as the result of the popularization of this flavored electronic smoking device, the number of high school students who use nicotine products has increased from 3.6 million to 5.4 million in the span of only one year, according to the Centers for Disease Control and Prevention (CDC).

How significant it would be to know that schools were free of the harmful aftereffects of adolescent smoking, leaving school counselors and clinicians available to attend to the important mental health developments that are so essential in our school systems right now. Instead, we find ourselves dealing with another truly concerning issue: According to the Truth Initiative, 1 in every 4 high school students now uses e-cigarettes.

These concerning statistics represent a call for preventative action in middle schools across the nation. A number of schools and organizations have taken such counteractions to trends in vaping by launching interventions such as confiscation, disciplinary action, and even educational programming. But the culture of vaping continues to persist as a significant concern for parents and educators.

The most terrifying thing about the Juul product so far is that it appears to come off as being innocuous to many people. Most students and parents recognize it as the small USB-shaped device that produces fruit-flavored smoke. Very few seem to grasp the long-term consequences of vaping habits. That being said, those consequences might already be here.

The individuals at risk

Based on data collected by the CDC in early March, evidence suggests that COVID-19 poses a serious threat to all individuals ages 65 and older. Fortunately for students under the age of 18, the percentage of those infected and harmed has been relatively low by comparison.

While most parents find some comfort in hearing that the student demographic is the least impacted by the pandemic, the statistics can change drastically if students are part of the vaping culture that is rampant among youth. According to data provided by the CDC for China’s mainland population facing COVID-19, individuals with respiratory issues predominantly associated with even a small history of smoking or vaping have a 6.3% case fatality rate, in contrast to 2.3% overall. Recognizing how exposure to vaping increases a person’s health concerns, imagine the increased risks that our students could face should their still-developing physiques come in contact with both nicotine products and a respiratory infection.

“What they say is about 80% of people feel the flu, but they will be OK. Where we are getting into trouble is that it can lead to severe pulmonary distress,” says Anna Song, an associate professor of health psychology and leader of the Health Behaviors Research Lab at the University of California Merced. “Smoking is a risk factor for having this disease progress, be incredibly severe, and lead to mortality.”

As we know, COVID-19 has posed widespread challenges to the health and lifestyles of the global population. Societal and educational norms have begun to deteriorate, and everyday tasks and responsibilities now come with an unprecedented health risk to individuals and their families. Of great concern to us is that the unattended trends and cultures of our school systems could be having a negative impact on our students right now. To allow these trends to persist beyond this pandemic is to continue putting our students at risk unnecessarily.

A unique opportunity for change

What makes now such an ideal time to invest in removing the harmful vape cultures that continue to linger in our school systems? Students are largely being required to undertake remote learning during this time, and that may continue for many students even as a new school year begins. The changes and circumstances that come with students’ remote learning actually promote our greatest opportunity for the development of an anti-smoking culture.

Society is recognizing that our plans, policies and preparation were inadequate to succeed in the face of an unanticipated global pandemic. Thus, things are beginning to change. Legislation is developing to create preventative actions around practices deemed unhealthy by medical specialists, and educational policy is constantly being reformed to reflect the needs and issues present in our impromptu teaching conditions. If there was ever a time to acknowledge the statistics that point to the harm that nicotine products pose to our adolescents and to advocate for the safety of our children, it is now.

Large systemic changes are challenging and often are out of our hands, but educators and parents currently have the opportunity to make a notable difference in students’ environments. During this time of partial quarantine, most families are now all in one location — the home. Our students currently find themselves in a setting where they are under the watchful eyes of their families and where smoking purchases and practices are essentially impossible.

In addition to that, they are also in a potential learning atmosphere. Through the joint efforts of educators and parents, our youth can be exposed to real educational and intimate conversations regarding the dangerous practices of smoking. These conversations can mean the world to students who currently feel that their futures and health might be dictated by vaping culture.

COVID-19 has had a harsh and unpredictable influence on our way of life, but it also presents us with a rare opportunity to support our students through one of the greatest health issues of their generation. So, making use of the present, it is time that we as a supportive community of counselors consider what we should be doing to help facilitate and emphasize this process of growth for students’ mental and physical health.

Our responsibility to intervene

As of early April, individuals within Rowan University’s Department of Psychology have been conducting their own research to confront the vaping culture that remains prevalent during the COVID-19 pandemic. Their research takes an interesting approach to behavioral analysis with younger age groups, including the development of interesting activities such as mobile- and video game-based interventions that promote smoking abstinence.

Fortunately, this is just the tip of the iceberg when it comes to the collective efforts of universities to combat vaping trends in student populations. Even educational institutions outside of higher education are recognizing the statistically supported danger that vaping is putting our students in when facing the current health pandemic. As a community, it is our collaborative responsibility to provide education and to take the necessary precautions to protect our students’ health. We are just beginning to understand the proper steps to take when working from a remote distance.

Educating the community: Providing knowledge of the increased risks and hazards of smoking behaviors is the first step to reducing nicotine consumption within our school systems. Given the myriad resources available on the consequences of vaping from the CDC, the National Institute on Drug Abuse and even university websites such as Johns Hopkins Medicine, it is the obligation of school counselors and other school personnel to appropriately share this information with our local communities. It is important to remember that this information needs to be given not only to the students we support, but also to our educational partners and to the families who are acting as our immediate support systems in homes at this time.

Promoting real conversations: With the knowledge and statistics being supplied to our students’ homes, it is more important now than ever that school systems promote real conversations with students regarding the present vaping cultures. Whether it is school counselor-to-student or parent-to-student conversations, we need to understand what the student perspectives are when they see products such as Juul in the media while also witnessing terrifying statistics regarding the spread of a global virus.

With those who are currently smoking, it is vital that we understand their concerns and interests so that we can provide them the appropriate support they need. These conversations are the optimal opportunity to promote and communicate resiliency, empathy and community support to our students. And with those who have never touched a vaping device, communicating this information and the associated risks is the best possible preventative action at this time.

Advocating for policies: To reiterate, now is a turbulent time when leaders are reflecting on educational preparations and policy and how they might be applied for future incidents. In addition to redesigning our school’s remote learning policies, we need to be working as a professional community to advocate for anti-vaping policies within our schools. It is essential that school counselors reflect on school policies regarding smoking tolerance, as well as preventative actions to take, so that they can create real opportunities to support student health.

Fortunately, states and health institutions are rallying to create a number of anti-vaping models that can be implemented or referenced by school counselors looking to better their schools. One such model is the Make Smoking History campaign, conducted by the Massachusetts Department of Public Health, to reduce the percentage of vaping disciplinary actions taken in middle school settings. This is the time to ask for and support the voices of the education community to find out what should be done for the development of our educational systems — not just on a school-by-school basis, but from a legislative perspective.

Forming support groups: Finally, acknowledging that this is a difficult time for individuals who have a dependency on smoking tools to which they no longer have easy access, we need to prepare and create remote counseling groups to support them through potential issues such as withdrawal or rehabilitation. A number of counselors may struggle with the concept of remote group counseling, but these students still need emotional and mental health support to cope with their new distancing from vaping. Counselors should utilize the medical resources and personnel within their school districts to support students in their transition to healthier living. Ultimately, it is groups such as these that we should be planning to implement more frequently in our later return to school.

The truth is that in the midst of a global health crisis, most individuals view the issue of vaping in school systems as relatively small. But the fact is that vaping is a real health issue for our youth, and in combination with the threat of COVID-19, it puts our newest generation of students at exceptional risk for loss. In a moment in history when many counselors are at home and wondering what they should be doing to support their students, imagine what significant change could occur if we all directed a portion of our efforts to acknowledging and countering the present vaping culture.

 

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Related reading, from the Counseling Today archives: “Pushing through the vape cloud

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Zachary Short is a master’s counseling in educational settings student at Rowan University. He currently works as a clinical research intern in a high school setting, where his research in student behavioral outcomes is being supported through the Mental Health Grant Demonstration Program. Contact him through LinkedIn: linkedin.com/in/shortzachary/.

Nicole Baliszewski is a master’s counseling in educational settings student at Rowan University. She currently works as a clinical intern in a middle school setting, where she seeks to provide trauma and mental health support to the special education student population. Contact her through LinkedIn: linkedin.com/in/nbaliszewski/.

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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.

Engaging avoidant teens

By David Flack May 4, 2020

Ben** is a 16-year-old high school sophomore. He completed a mental health assessment about four months ago, following a referral from his school due to behavioral concerns, poor attendance and “possible issues with marijuana and other substances.” He previously attended school-based mental health counseling in seventh grade and has been meeting periodically with a school counselor for about a year.

(** Ben is a former client who gave permission to use his story. His name and some identifying details have been changed to protect confidentiality.)

At the time of assessment, Ben was diagnosed with major depressive disorder, moderate. He also completed screening questionnaires for trauma, anxiety and various other issues. All scores came back well below clinical levels. Despite the school’s concerns regarding substances, a formal drug assessment didn’t occur.

Todd and Julie, Ben’s parents, have been divorced since Ben was 3. Ben lived with his mother until about a year ago. Todd now has full custody but frequently travels for work. Both parents have been fairly disengaged in the counseling process. In fact, Doris, Ben’s fraternal grandmother, was the only family member to attend the assessment.

At the assessment, Doris appeared overly enmeshed with both Ben and Todd. She also reported that Julie “has bipolar but won’t take any meds” and “drinks too much, at least if you ask me.” Doris also stated that Ben “probably was abused” by Julie’s ex-boyfriend but refused to provide further details. “I don’t think I should have said anything.”

Following the assessment, Ben entered services reluctantly, meeting with his original counselor for almost two months. At that time, he was referred to me because the original counselor decided, “I can’t be effective with such a resistant kid.” The counselor said Ben’s attendance was poor and that he displayed an unwillingness to engage when present, did not complete treatment homework, and “showed up high at least a few times.”

During our first meeting, Ben reported, “All that other therapist did was keep saying how her office was a safe space to talk about feelings and crap like that. You know, the bullshit therapists always say. The bullshit I bet you’ll say too.”

Numerous studies show that an effective therapeutic alliance is essential for engagement, retention and positive treatment outcomes. However, many teenage clients simply aren’t interested in counseling, let alone creating connection or building rapport with some strange adult. This is especially true when it comes to avoidantly attached teens such as Ben.

Building effective therapeutic alliances with these youth can seem daunting to even the most seasoned counselor. In this article, we’ll explore practical, field-tested strategies for cultivating rapport with avoidantly attached teens. First, though, let’s briefly review some core attachment ideas.

We aren’t sea turtles

When a mother sea turtle is ready to lay eggs, she heads to a beach and digs a hole in the sand with her rear fins. She lays her eggs in this rudimentary nest, covers them, and quickly returns to the ocean. At this point, the mother sea turtle has completed all her parenting tasks and has nothing more to do with the eggs. Male sea turtles have nothing at all to do with their offspring.

When the eggs hatch, the newborn sea turtles awkwardly scamper to the ocean, using fins meant for swimming, not avoiding predators on land. If they survive this mad dash, they’re fully ready to live on their own. No caregiver ever provides nurturing, teaches them life skills or protects them in any other way.

Humans aren’t sea turtles. In our early years, we need caregivers just to survive. If these caregivers are attentive, protective and nurturing, human babies quickly learn that the world is a safe place, their needs will be met and people are glad they’re here. These children will be securely attached. However, if their primary caregiver isn’t dependable, then this healthy attachment process can be disrupted, resulting in an insecure attachment and possibly lifelong challenges with relationships, self-esteem and personality development.

There are three styles of insecure attachment: avoidant, anxious and disorganized. Avoidant attachment is the most common style of insecure attachment, with studies indicating that up to 1 in 4 Americans fall into this category. Undoubtedly, this percentage is higher in clinical settings.

Young children who develop an avoidant attachment style predictably have caregivers who are emotionally unavailable and ignore the child’s needs. These caregivers may reject the child when hurt or sick, typically encourage premature independence, and sometimes are overtly neglectful. As a result, the child learns, “I’m on my own.”

Attachment styles are continuums, so avoidantly attached teens don’t all act the same. That said, these youth often appear defiant, defensive or dismissive. They’re likely to present as highly independent, oppositional and unwilling to change. They’re also likely to be suspicious of any empathetic gesture.

A little more about empathy

Simply put, empathy is the ability to understand the feelings of another person. As counselors, we’re taught that empathy is an essential component of all effective therapeutic relationships. I certainly don’t disagree with this. However, it seems to me that empathetic gestures are far from one-size-fits-all.

With reluctant clients of all ages, many counselors demonstrate empathy by saying things such as, “Seeking support is a courageous step” or “My office is a safe space to explore your feelings.” It’s like turning the volume up on some secret empathy knob. With anxiously attached clients, this could be quite effective. For avoidantly attached teens though, this is often overwhelming. Life has taught these youth to be cautious of such statements. So, when they hear such statements, they retreat.

I’m certainly not suggesting that we turn our empathy off as counselors. However, in the early stages of building therapeutic alliances with avoidantly attached teens, we need to turn the volume down. With this in mind, don’t congratulate avoidantly attached teens for starting counseling, especially if doing so is simply their least bad choice, and don’t declare your office a safe space. They know better.

I believe this more nuanced perspective of empathy is an essential foundation for engaging in the attachment-informed strategies that follow.

Starting out right

With avoidantly attached teens, first impressions are essential for starting out right. Here are four tips to help ensure that first meetings are therapeutically productive:

Emphasize rapport building. First meetings often involve stacks of paperwork, required screening tools and initial treatment planning. I encourage you to put that stuff aside and spend time getting to know the teen sitting across from you. You’ll have to finish all those forms eventually, but if this new client never returns, tidy paperwork and a well-crafted diagnosis won’t matter much. Besides, you’ll get better answers from teens such as Ben once you’ve developed some rapport.

Get parents out of the room. Unlike Todd and Julie, parents or caregivers almost always attend first meetings. When they do, I meet with everyone to cover the basics, such as presenting concerns, my background, and confidentiality issues. I then ask parents what they think I should know. After I get their perspective, I have them leave. That way, most of the first meeting can be focused on learning what the teen wants from services and cultivating rapport.

Focus on what they’re willing to do. Therapists love to focus on internal motivators and lofty treatment goals, but this isn’t useful with avoidantly attached teens, who want one thing — to leave and never come back. You’ll get further by helping them identify external motivators, such as fulfilling probation requirements or keeping parents happy. Helping avoidantly attached teens move toward these concrete goals proves that you’ve actually listened to what they’ve said, makes you an ally, and keeps them coming back.

Don’t hard sell therapy. When confronted with resistant clients, it’s easy to overstate the advantages of engagement. After all, if we didn’t believe in therapy, we wouldn’t be therapists, right? However, our enthusiasm may be exactly what an avoidantly attached teen needs to justify a quick retreat. Instead, objectively present your treatment recommendations, then explore the pros and cons of engaging. In my experience, most avoidantly attached teens agree to services when they don’t feel coerced.

With the first meeting successfully concluded, our next task is to cultivate an effective therapeutic alliance. Edward Bordin (1979) wrote that the therapeutic alliance is composed of
1) a positive bond between the therapist and client, 2) a collaborative approach to the tasks of counseling and 3) mutual agreement regarding treatment goals. When we strive to fully integrate these elements and genuinely embrace a teen’s motivators, we stop being an adversary and become an ally. For avoidantly attached teens, we also become a much-needed secure base — maybe their only one.

Building a strong therapeutic alliance with avoidantly attached teens requires us to focus on being trustworthy and creating connectedness.

Trustworthiness

Avoidantly attached teens have learned to continuously question the honesty of others. As a result, it is essential for us to be absolutely impeccable in our trustworthiness as counselors. It isn’t enough simply to be trustworthy though; we must demonstrate it — and not just once or twice but during every single interaction.

Brené Brown (2015) likened trust to a jar of marbles. Every time that we demonstrate our trustworthiness, we put a metaphorical marble in the jar. As the jar fills, trust grows. When it comes to building therapeutic alliance with avoidantly attached teens, there are five especially important marbles:

Authenticity. In the context of therapeutic alliance, authenticity means being our true, genuine selves during interactions with clients. In other words, we set aside therapeutic personas and canned responses. Instead, we show up as who we really are. This should be our goal with all clients but especially so with avoidantly attached teens, who are often quite sensitive to insincere behaviors or actions — a skill they learned to help them navigate difficult relationships with the adults in their lives.

Consistency. Being consistent means acting in ways that are predictable and reliable, something avoidantly attached teens probably haven’t experienced much. When we are consistent in our interactions with these teens, we are not only demonstrating trustworthiness but also modeling a new way of being in relationships. A few ways to demonstrate consistency include always starting and ending sessions on time, scheduling appointments at the same time every week, and following through on any promises we make.

Nonjudgment. Avoidantly attached teens have often learned to notice seemingly minor cues, such as a slight change in facial expression. This is a useful skill to have in situations in which care is unpredictable. With that in mind, it is important for us to avoid comments, gestures or facial expressions that could be interpreted as judgmental. This seems obvious but can be harder than it sounds, especially when a client is frustrating, evasive or baiting us — you know, like teens do sometimes.

Usefulness. Another way to demonstrate trustworthiness is to provide something useful at every session. This doesn’t mean achieving a major clinical breakthrough every week. That wouldn’t be realistic. However, there should be a tangible takeaway of some sort each time that we meet with an avoidantly attached teen. Possibilities include a helpful skill, a solved problem, an opportunity to vent or a meaningful insight — as long as it adds value to the youth’s life.

Transparency. This means being completely open about the therapy process, including our intentions as a helper and what clients should expect from services. Truly transparent therapists spend time exploring the pros and cons of counseling, reasons for discussing certain topics, and the theoretical underpinnings of proposed treatment approaches. In other words, transparent therapists strive to eliminate the mystery from the process. Like a good magic trick, knowing how it works should make it more engaging.

Connectedness

According to Edward Hallowell (1993), connectedness is “a sense of belonging, or a sense of accompaniment. It is that feeling in your bones that you are not alone.” I often describe this deep connectedness as feeling felt. In order for any of us to truly feel felt, we must believe that we are understood, respected and welcomed. We must feel as though we’re interacting with another person who has purposefully chosen to join us in this exact place and moment.

Avoidantly attached teens haven’t had this lived experience of connectedness. When working with these teens, we should always strive to model connectedness in ways that honor their implicit suspicion of empathy, while simultaneously helping them move toward more secure attachment styles.

Allan Schore (2019) refers to these as “right brain to right brain” connections. We can intentionally create such connections by using approaches that focus on emotion, creativity and attunement. It seems to me that teen therapy typically focuses on problem-solving, decision-making, psychoeducation and similar left-brain approaches, ignoring the importance of helping clients become more comfortable using their whole brain.

Here are five simple yet effective strategies for intentionally fostering right-brain connections:

Validate and normalize. Viewed in the context of his lived experiences, Ben’s distrust, oppositional behavior and even substance use were functional. In other words, Ben found value in these behaviors. In fact, he once said, “I guess what I really want is to push people away, and I’m good at it. Really good!” We can validate intentions without endorsing problematic behaviors. With avoidantly attached teens, this is often an essential step to building therapeutic alliances.

Use first-person plural language. The words we use matter. Here’s one example: Instead of using the pronouns “you” and “your,” shift to “we” and “our.” This shift results in a subtle, yet tangible, change in our interactions with avoidantly attached teens. It also helps reinforce that we’re together in the process and that the teen’s experiences are understandable. I’m not sure that clients overtly notice this word usage, but I definitely believe there is value in making the shift.

Use more reflections, ask fewer questions. Most therapists ask way too many questions. To an avoidantly attached teen, questions can seem intrusive, annoying and disingenuous. It may seem counterintuitive, but fewer questions from you will actually result in more talking by the client. Instead of all those questions, use reflections. While you’re at it, avoid cautiously worded reflections. Instead, commit to what you’re saying, with statements of fact such as, “That was tough for you.” Such statements demonstrate connection, not interrogation.

Talk less, do more. From a developmental perspective, full-on talk therapy isn’t the best fit for teens, especially for avoidantly attached ones who don’t want to engage in the first place. I suggest incorporating some no-talk approaches for building rapport and addressing therapeutic goals. The card games Exploding Kittens and Fluxx are excellent choices for building rapport. They are teen-friendly, easy to learn and filled with opportunities for making metaphors. Favorite therapeutically focused activities include collages, creative journaling and walk/talk sessions.

Be fully present. Being present means having your focus, attention, thoughts and feelings all fixed on the here and now — in this case, the current session with the current client. From my perspective, this requires more than a basic attentiveness. It requires being fully engaged, human to human, with no judgment or agenda. This level of presence can feel risky at times, for counselors and for avoidantly attached teens. However, the connectedness it brings makes the risk well worth taking.

Relationships are reciprocal

Imagine your response if a client reported being in a relationship in which the other person refuses to share personal information and frequently makes statements such as “I’m curious why you want to know that,” even when the question is fairly innocuous. Perhaps you’d amend this client’s treatment plan to include working on healthy relationships or building appropriate boundaries. I sure would. Yet, this is what we do all the time as counselors, based perhaps on an assumption that self-disclosure is inherently bad.

It seems to me that we shouldn’t expect teens, especially ones who are avoidantly attached, to be open with us if we aren’t open with them. I’m certainly not suggesting that we share every detail of our lives with teen clients, but I do believe we should be willing to disclose relevant information, answer questions asked out of true curiosity, and be as honest with clients as we expect them to be with us. By doing so, we model effective interpersonal skills, demonstrate healthy ways to connect with others, and solidify the therapeutic alliance.

When teen clients ask questions of a personal nature, some therapists view this as a form of resistance, as a way to avoid the topic at hand or as behavior that interferes with treatment. I disagree, at least sometimes. Perhaps the teen is making an initial attempt to cultivate a relationship with us. Perhaps these questions are a sign that we’re becoming a secure base for the teen. Perhaps we’re witnessing a little nugget of change. Why would we shut that down?

When we deflect all questions of a personal nature, maybe we aren’t reinforcing appropriate therapeutic boundaries or challenging client avoidance. Maybe we’re rejecting a tentative attempt at connection. Maybe we’re demonstrating that we aren’t a secure base. Maybe we’re reinforcing the client’s avoidant attachment style.

For the first several weeks, sessions with Ben were slow going. He often showed up late, sometimes refused to talk and frequently stated he didn’t need or want help. One day, I taught him Fluxx. He commented that the game was about unpredictability. “I hate that,” he said.

The next session, Ben brought his own game, Unstable Unicorns. “It’s a complicated game,” he said, “but I’m a complicated person, and you seem to understand me.”

I let that register, picked up my cards, and lost three games in a row. At the end of the session, for the first time ever, Ben said, “See you next week.”

John Bowlby (1969) described attachment as a “lasting connectedness between human beings” and stated that the earliest bonds formed by children with their primary caregivers have significant, lifelong impacts. When meeting with avoidantly attached teens, it’s essential that we remember the ghosts in the room with us. It’s essential that we intentionally earn marbles. It’s essential that we slowly, but steadily, create connectedness. When we do, we invite teens such as Ben to move toward a more securely attached way of being.

 

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David Flack is a licensed mental health counselor and substance use disorders professional located in Seattle. For 20 years, he has met with teens and emerging adults to address depression, trauma, co-occurring disorders and more. In addition to his clinical work, he regularly provides continuing education programs regionally and nationally. Contact him at david@davidflack.com.

Knowledge Share articles are developed from sessions presented at American Counseling Association conferences.

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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.

@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.