By Marcy Marklay, LPCC - Therapist, Lindner Center of HOPE Gender identity is a person's inner sense of being male, female, neither or both. Gender nonconforming refers to those who have behaviors and interests that run counter to what is expected of a male or female. Gender dysphoria refers to an individual's affective/cognitive discontent with gender assigned at birth; gender dysphoria refers to the distress that may accompany the incongruence between one's experienced or expressed gender and one's assigned gender. Transgender people are often unhappy with aspects of their bodies that do not conform to the gender they feel they are on the inside. There is a conflict between gender identity and biological sex and expectations. Transgender refers to the individuals whose gender identity is in contrast to their biological sex from birth. Gender dysphoria can occur in children, adolescents and adults. Sexual orientation is not the same as gender; it has to do with who we find attractive. Transgender individuals face discrimination and report a staggering rate of attempted suicide. It is estimated that 41 percent of transgender individuals have attempted suicide. This is greater than 25 times the rate of attempted suicide of the general population. It is estimated that 75 percent of transgender youth experience harassment; many experience physical assault and sexual violence. Anxiety and depression can often be found in transgender individuals. The needs of this community range from basic - safety, shelter, food, protection against discrimination and violence, to dealing with family, school and dating relationships, to transitioning with hormones and or surgery, and coming out concerns. It is crucial to respect them and respect the preferred name and pronouns they identify as, not to assume the gender or pronouns they use. Transgender individuals may face a lack of support or even open hostility from their family and friends, churches and Interested in touring communities. This rejection fuels high levels of anxiety and depression and makes the coming out process very difficult for many transgender people. They often have higher rates of peer isolation and hopelessness. Coming out is a process of telling others that one is transgender, or gay, lesbian, bisexual or questioning. Parents need to educate themselves and be open to understanding their transgender child. Parents may have strong reactions with feelings of loss, worry what others may think, concerns for harassment, physical harm, possible regret, too young, not believe the child is really transgender, etc. It is important to work with a trusted mental health professional. Parents have their own social, cultural and religious views that must be addressed. `It is important to keep the communication open so the transgender child or teen can understand it is a difficult transition for the parents as well. Transgender teens and their parents benefit from support groups, in person or in a safe online network. Each student needs to be in a supportive school environment. School administrators, counselors and teachers can help implement zero tolerance policies on bullying so that all students, including transgender [...]
Video gaming remains one of the most popular entertainment; the novelty and excitement of video games can be almost overwhelming. Mental health professionals and educational consultants remain concerned about video game overuse and the possibility of a gaming addiction. Therapy and intervention can help. If severe enough, time spent in a therapeutic boarding school or treatment center can allow the brain to re-set and for the adolescent or young adult to develop better coping skills. The World Health Organization (WHO) in June 2018 declared that video gaming disorder is a mental health condition and listed it in International Classification of Diseases (ICD-11). The condition is “characterized by impaired control over gaming, increasing priority given to gaming over other activities to the extent that gaming takes precedence over other interests and daily activities, and continuation or escalation of gaming despite the occurrence of negative consequences.” To be diagnosed, a person must be exhibiting symptoms for 12 months or more and be impaired by them in personal, family, social, educational, occupational, or other important areas of functioning. “I think the ICD-11 category will give us a chance to learn how to identify and diagnose the disorder,” says child and adolescent psychiatrist Victor Fornari, MD. Video games and “addiction” or “processing abuse” Like many “addictive” behaviors, gamers may be almost physically unable to stop. Video games present highly attention-grabbing graphics, changes of pace, rewards for achievement and excitement. For this reason, many teens and young adults gravitate toward all kinds of video games, including personal games on cellphones to multiplayer adventure games. “(Video games) tell us more about a brain that may have a problem with impulse control,” says T. Atilla Ceranoglu, MD, a child and adolescent psychiatrist in Massachusetts. More than nine hours of video game play in a week is considered heavy use and is also the point where researchers see changes in a child or teen’s behavior. He added that the fast pace of most video games is more attractive to young people affected by ADHD. “It rewards the impulsive streak. What I find is a video game absorbs a kid (in game play) who otherwise can’t maintain attention.” Why the WHO listing is important The WHO listing will help to prompt mental health organizations to evaluate the condition and include it in their own diagnostic manuals. Currently, the American Psychological Association is studying video gaming addiction and had considered adding it to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Future editions may include the condition after continued research. By bringing more of an emphasis to the condition, people and professionals can become better informed. Treatment approaches can be researched and, once recognized, health insurance companies will be able to include it in conditions that are covered by their programs. Why residential treatment works: “Gaming disorder does seem to respond to psychotherapy, and counseling can be quite effective,” says Petros Levounis, an addiction specialist who chairs the department of psychiatry at Rutgers New Jersey Medical School. What [...]
”Having an anxiety disorder is like being stuck in that moment when you realize you’ve leaned too far back in your chair, but have not yet fallen.” Teenage Student Many teens suffer from anxiety, in fact, there are some studies that suggest 8% of teenagers currently have an anxiety disorder and 32% will develop one. Only 1 in 3 will get treatment. In my practice, I see severe anxiety leading to school avoidance or even refusal. Even if attendance is consistent, learning can be negatively affected by the physiological changes during feelings of stress. The brain becomes flooded with hormones that virtually shut off the ability to think. Imagine trying to do a math problem as you perch on the edge of your first bungee jumping platform. It just isn’t physically possible. Learning differences often come along for the anxiety ride. 38% of middle school and high school aged kids with ADHD have an anxiety disorder. An already challenged learner now needs to overcome the increased academic demands as he or she progresses through the school years. But even kids without a learning difference may feel anxiety in school. In my practice I notice that anxiety of any sort can often lead to an outward or inward behavior that often leads to social exclusion or rejection, creating more dysfunction. The examples I see are oppositional behaviors at home or school, substance abuse, self-harm, social isolation, inability to complete school work, fighting with parents, overuse of technology, even physical or verbal abuse. So what is stress? It can be defined as perceived demands that exceed one’s perceived ability to meet them. This is often the result of confusing “needs” vs. “wants.” You can recall this from the “I love Lucy” when Lucy tries to sort chocolates on a fast-moving conveyor belt. Or, in our teens, perhaps the “I need to go to Yale” vs. “I want to go to Yale.” One scenario may create a perceived demand over ability and the other may create motivation. According to the American Psychological Association, the number one stressor for teenagers is doing well in school. Other factors are getting into a good college, their appearance and family conflict. Anxiety is when stress gets to be too much. Most of us have adapted to anxiety; we know that anxiety helps keep us safe, is a response to real danger and prevents us from repeating mistakes. In a disordered anxious state, the person feels functional impairment, like a “false alarm”, that leads to unnecessary avoidance. The measure of anxiety is the intensity of the avoidant behavior. Thus, an important part of my practice with teens is to recognize the avoidance as the treatment trigger. Incredibly, avoidance feels really good right away! It is immediately self-reinforcing. We often say avoidance and fear are good teammates. As parents, we try to help, but oo often anxiety’s coercive behavior cycle takes over. Child experiences anxiety, acts out --- Parent is an expert soother -- Child feels better, suffering is [...]
In the last couple of weeks, we have had devastating natural and man-made disasters. Our anxiety is up and our feelings are deep. This is a similar kind of feeling parents have when their children become out-of-sync. Whether due to depression, self-harm, distorted eating, substance abuse or their own anxiety, our children need to learn emotional regulation - often by needing a residential therapeutic setting. Mindfulness plays a part in this healing. Here is your Minute Mindfulness - give it a try. Ground Yourself: :: Feel your feet on the ground (uncrossing your legs and do this), imagine tree roots growing from your feet and gripping deeper and deeper into the earth ? :: Discover the sights in your field of vision. No need to even turn your head, purposefully use all angles of your eyeballs to notice for instance, colors, shapes ? :: Hear the sounds all around you, close your eyes and allow the sounds to show up in your ears (don’t strain to hear, it’s about the sounds showing up for you) ? :: Then, try to find a smell, could be that you have a stash of essential oils or scented lotion or fry some chopped onion in butter. Breathe in the fragrance.??
“Our fate is shaped from within ourselves outward, never from without inward.” (Jacques Lusseyran) Last week I was called by a couple single mothers who needed my consulting - right then. Neither had the funds to pay my fees. They both came from nonprofits for whom I do work. I was unusually busy last week. Lots of travel. Other clients to which I had to attend. But, for me, my practice is my internal voice calling. I cannot turn my back on a cry for help. I am an independent therapeutic consultant. I run my own business. Creating boundaries and sticking to business practices is very important for one who wants to have positive cash flow - and frankly, who doesn’t? It is even harder when your clients are likely to have incredible personal challenges that warrant an investment of your time and research - sooner rather than later. Still, my intellectual property is worth the cost of my fees and I know I bring incredible value to my clients. You pay accountants, lawyers, doctors and even your hairdresser for knowing their profession. Therapeutic educational consultants invest in traveling to programs, ongoing education and research and cultivating industry relationships to provide our best advice and strategy. But last week, I worked for free. Totally for free. I feel that part of what makes us human is the ability and need to connect with others. When we stray from this natural inclination because it doesn’t match our business model, I wonder how good that business feels? I have been reading The Anatomy of Peace published by The Arbinger Institute. (ISBN 978-1-62656-431-2) One of the themes is that we forget to see one another as a person, but rather an obstacle to something we want. You are driving down the road and someone in front of you slows down or wants to turn creating a delay in your travel. It is easy to create an image of an “object” that is getting in our way, rather than remember that there is a human driving the car with needs and wants just as valid as our own. When there is chaos in our families, it is often because we become focussed on our own needs and stop thinking of our loved ones as their own persons - like, if I honor my promise to cut the grass, I will be late for tennis. I blame you because I promised you I would do it and now I see you as the reason I might be late. Then I get mad and protest. Then you see me as irresponsible perhaps objectified as immature. The cycle continues. We become our behaviors, we are what we are doing, not who we are. It is our feelings and thoughts create behaviors. This is what everyone else observes. Behaviors. “Generally speaking, we respond to other’s way of being toward us rather than to their behavior. ....... our children respond more to how we’re regarding them than they [...]
As a Therapeutic Educational Consultant, parents ask me about wilderness therapy all the time. It’s a good question and especially timely as we head toward summer. Wilderness Therapy is an important year round therapeutic resource; however, summertime can be an especially strategic summer intervention for troubled teens. Many teens and young adults who struggle during the academic year are still able to work through their challenges at home. Thus, it’s “natural” to capitalize on the summer months and engage wilderness therapy for help with challenging emotions or difficult behaviors. History of Therapeutic Wilderness “I only went out for a walk, and finally concluded to stay out till sundown, for going out, I found, was really going in” ~John Muir As early as the rights of passage for many of the Native American tribes, spending time in the wilderness has had transformative effects. The Boy Scouts also capitalize on this experience, as do NOLS and Outward Bound. Though not specifically “therapeutic,” the time spent away from home and in touch with one’s owns thoughts is recognized to be in its own way, therapy. How many of us have gone camping or on a hike to have just that type of temporary meditative moment? Modalties of Programs Wilderness or Outdoor Behavioral Health are not one size fits all. There are many choices of type of therapy and program components. Examples of this are: • Nomadic • Base-Camp • Rotating academic weeks with camping and farm-life • Desert - Mountain - High Country. • Specific programs for Autism, Trauma or Substance Abuse? The Value of Therapeutic Wilderness Life in the wilderness interrupts the daily home and school routine. Even just unplugging can be therapeutic. By choosing therapeutic wilderness as a summer experience, our families shift the dynamic of life as the teen knows it. Parents show resolve that attitudes and behaviors need to change. Nature is the great outdoor classroom and is fundamental to connecting with self. Research has shown that hiking is good for the brain. Your teenager will experience measurable success and meet goals like navigating the weather and demands of communal camping, demonstrating mastery of a skill, or simply following the guidance of peers and filed guides to accomplish a team project. Peers are positive as they work together, encouraging one another and sharing their common humanity as individuals who face challenges and overcome obstacles in life. Kids learn new coping skills and ways to relate in a more productive emotional and social manner. In the woods, one must follow adult’s directions. It doesn’t work to ignore, melt down, run away, quit, yell, threaten or blame others when it comes to staying dry, setting up camp or reaching the summit. Wilderness Therapy is proven experiential intervention for children as young as 10 years, teens and young adults up to age 30. Clinical theory along with individual, group, and family therapy tie together the lessons learned in the backdrop of a wilderness setting. JET ED Consulting assists professionals and families in determining if wilderness therapy is the right choice. If so, we consult with parents and custom match their son or [...]
You’ve heard this right? There are dozens of parenting books on how to limit media. Parenting seminars on internet safety. In the program world, we are finding therapists who specialize in media or internet “addiction” or “disorders.” In fact, there are many clinical studies being done on how screen time affects the teenage brain. Some postulate that there is an increase in the dopamine release after getting a “like” or storming a castle on a screen similar to the addictive quality of other types of drugs or gambling. So, what do we do? I am a parent and step-parent. 5 kids, 4 teenagers. We are the first generation of parents who have had to figure out limits on media? But that is different from the old-fashioned curfews. What kind of media? What limits? What age is good for this or for that? How do I control the internet when the schools are asking the kids to use it for research? My kid is only happy when he/she are playing a team game on the internet – isn’t that socializing? Is is harmful to let my teenager binge-watch 30 Rock? How do you know what apps your child has or what accounts they have on Facebook or Snapchat? Most of them lie about their age. It is confusing and confounding. No one can give you all the answers, but I can give you a true story about the way a family I know has made some changes. It may give you the courage to do the same. It was radical and it was hard. It was painful. But it brought the light back to one 14 year old boy whose eyes had gone dark to reality. “ I want to sell my gaming computer.” What? Stop internet gaming by giving/selling the computer? Take all the gaming apps off of the phone and tablet? Limit media/screen time to 1 hour a day by using a parenting app or setting a specific time of evening. The, create a safe space for the “hangover” to fade. 14 year-old Billy was a pretty cool kid. Smart. Friendly. Great sense of humor. He also had an internet gaming problem. I won’t call it an addiction, but he did. He found little pleasure in any other aspect of his life. He ran away from the dinner table to go back the “group” who were playing. He talked about his “friends” who were all over the world and who were real people. He got up early, stayed up late, and despite his parents best efforts, he was able to sneak more and more time on the computer. Luckily for Billy, he had a great therapist and curious parents. Also, Billy was, as I mentioned, pretty smart. He began to question his propensity to spend hours on the internet, his smart phone and his anxiety around not knowing when was the next time he’d get to play. After several months of discussing how to limit things, he decided to [...]
What is a therapeutic educational consultant? I never knew you existed! This is what I often hear from my parents and families. I also hear this from local therapists, school counselors and substance abuse specialists. Does the following sound familiar? “I am out of ideas and running out of patience. I don’t know what to do.” “I don’t know who can help me or my family.” “My other kids are suffering, my marriage is suffering and I am suffering. “ “This has been going on for too long.” Teenagers are naturally going through stages of independent growth and exploration. But, what about the ones who start making poor peer choices, using substances that interfere with school or relationships or even create dangerous situations or legal trouble? What do we do to help teenagers who find their only relationships on a computer? How do we help a teenager who feels so depressed they discuss suicide or self-harm? Today’s teens feel acute anxiety. Do you know a young person suffering from anorexia, school refusal or the inability to leave the house? Today’s teens feel acute anxiety which can stifle what might otherwise be a brilliant young life. The first step is almost always individual outpatient counseling. Family system’s therapy can also be successful and there are certainly local short-term rehabilitation and substance abuse programs. However, by the time a family faces an acute situation like my examples above, it is doubtful a local home-based program will solve the emotional and behavioral crisis. That is where I come in. A therapeutic educational consultant is a specialist in outplacement programs for residential care and treatment. My focus in on kids 12-22. It is my job to know therapeutic programs, schools, wilderness and other types all over the country and the world which have specific methods and milieu for the presentation of the student and the family. After careful evaluation of the student including review of previous care, academics, neuropsychological or educational evaluations, I can help hit the reset button and unwind the tangled and disoriented family dynamic. There are basically three types of outplacement: wilderness (outdoor behavioral health), acute adolescent psychiatric facilities, and therapeutic/residential treatment centers/schools. Substance abuse has overlap with all of these with their own subset of programs. Those over 18 have their own special treatment options as well. There is no one course of treatment, no formula and no recipe. One size does NOT fit all. I spend about 12 weeks a year visiting each program, learning about the therapeutic modalities, the academic program, the living situation, the nutrition, the physical education and recreation. By doing such, I have first-hand knowledge of what the program offers and how it will benefit each young person as an individual. Working with me is a partnership – I bring my expertise and you bring your family and loved one. I know how scary and tough it can be for a parent to “send their kid away.” Trust me. I am one of you and [...]