Tuesday, April 23, 2019

But what does all this paperwork mean?

By now, most of us are used to having to fill out a bunch of paperwork every time we see a new provider. Doctors, therapists, and other professionals have all sorts of forms and information we ask for before providing help, and for all sorts of different reasons. We've become so desensitized to it, that many comedians and shows have joked about not reading the terms of service, instruction manual, or even assembly guide for a service or product. Others get nervous when asked for so much information... what does it all even mean?

The first form that most therapists will hand you is the informed consent form. You might already be familiar with the idea of informed consent for medical procedures, research, or law. The basic idea of this is that the participant, patient, or client has been taught about whatever they will be undergoing, and agrees to it, with full knowledge of risks and benefits. This is fairly easy to understand when it comes to something like surgery; we know that the procedure may not work, or things may otherwise not go as planned. Similarly, therapy may not go as you expect. You may have skills to practice or work to do outside of therapy, and you may begin to notice thoughts and feelings you didn't notice before, whether due to increased awareness or to things changing. This can be quite scary. Fortunately, unlike with a surgery, you're not under anesthesia; you can talk with your therapist about how things are going for you, and adjust the plan accordingly.

The informed consent form will also tell you more about your therapist and their policies. This should include things like your therapist's licensure information, fees and insurance, scheduling and cancellation policies, and terminating treatment. Most therapists also have rules around contact outside of sessions, and this can vary a lot from person to person. Some therapists are available for emergency calls 24/7, while others can't promise to pick up, but will be able to call back. Therapists also have different policies about sending texts or emails, particularly if you want to talk about things typically discussed in session.

Therapist forms will also include a section on confidentiality. Typically, whatever is discussed in session stays confidential. There are, of course, some exceptions, which your therapist should explain to you in person. Therapists are mandated reporters, meaning that if they have reason to believe there is active suicidality, homicidality, or child/elder/dependent adult abuse, there is a requirement to intervene and report this to the proper authorities. There are also other specific cases that may override confidentiality. For example, if you are involved in a legal dispute and your mental health is relevant to the case, a judge could subpoena your therapist's records for use in trial. If you are seeing a therapist through insurance, than your insurance company will need access to information like your diagnosis. If you are seeing someone through a clinic or group, the confidentiality rules may extend to other clinicians within the same group, particularly if your therapist is in training. This information should be in the informed consent, though you can always ask your therapist if you're unsure.

Different therapists also have different confidentiality policies around child, couples, and family therapy. Many therapists utilize a no secrets policy with couples or families. This is particularly the case for couples, and meant to prevent one half of the couple from trying to get the therapist to ally with them by keeping something like an affair secret. When it comes to minors, the age and specific case matter a lot in determining how much the therapist communicates to the parents. In California, a minor over the age of 12 can consent to therapy without their parents present, if the therapist deems them mature enough. Thus, some therapists may choose to limit information they give to the parents when it comes to what is discussed in session, leaving it up to the minor themselves to decide. However, in some cases, parents are more involved in therapy. A therapist may give the parents a general sense of how therapy is going or what's being worked on without mentioning details into the kid's life, or may work concurrently with the parents to ensure the home environment is suited to the kid's needs, and help the parent better advocate for their child. For younger kids, the parents may sometimes be in the room during treatment. For older kids, the therapist may ask the kid themselves what they would prefer. It all depends on the therapist's view.

Among your starting paperwork, you may have received a packet talking about privacy practices. This is likely to be similar to something you've signed at a doctor's or dentist's office before. This is due to something called the Health Insurance Portability and Accountability Act (HIPAA), which is the standard for security for protected health information. This covers a lot of how therapists and doctors handle confidentiality and make sure client records are secure. Doctors and therapists will often discuss if certain services are "HIPAA-compliant", particularly online platforms used for messaging or video chatting; some therapists have access to secure means of remote contact that can be used to communicate between sessions, or even for remote sessions. HIPAA also requires us to inform our clients on how we keep their records secure by giving them a Notice of Privacy Practices and having them sign a page saying they received it.

There are a number of other kinds of consent forms that are also relatively common, depending on the case or therapist. If you have a doctor, psychiatrist, or previous therapist you'd like your therapist to talk with, you'll need to sign an authorization form. If you switch therapists or start seeing a therapist after having seen a psychiatrist for a while, this can help a lot. This can also help with issues that are partly medical and partly psychological, since therapists aren't trained in the medical side of client issues. For kid clients, it can also help to have their therapist in touch with their teacher or other school staff, particularly if academics or school behavior is affected by their symptoms. Some therapists will also have a separate Consent to Treat a Minor form for kid clients. There are also separate forms to consent to therapy over phone or video (often called Telemedicine) and forms to consent to audio or video recording (usually for training or treatment planning purposes).

The bulk of the information required from a client is in the intake form, also called the Biopsychosocial. Along with standard client details, it will ask about current symptoms, family history, substance use, medical history, work history, and much more. One of the most common areas of confusion here is the psychiatric history. This area asks if the client or family members have ever had prior outpatient or inpatient treatment. The difference between these two is that outpatient treatment is any kind of therapy where you remain at home and show up once or more per week, while inpatient is a program where you stay at the clinic, whether a residential treatment facility or a hospitalization program. Another area of confusion is the developmental history. A lot of people don't know or remember much about their childhood development. However, issues like early childhood illness, premature birth, or developmental delays can point at undiagnosed issues, cause problems that affect social and emotional growth (ie bullying), or otherwise correlate one's mental health.

Depending on your therapist or your case, you may also be handed additional forms to fill out. If you are looking for a particular diagnosis, or your therapist specializes in one, you may be given some paperwork meant to assess related symptoms or diagnose. Some therapists have policies around checking all clients for things like trauma or dissociative tendencies, as these symptoms aren't always mentioned or recognized initially, but their presence can change how treatment is handled.


Wednesday, January 16, 2019

Why Your New Year's Resolution Isn't Working

So, it's mid January. Just a few weeks ago, you were determined to start off the new year right, so you decided to make a resolution. Maybe it's one of the common ones, like exercising more, losing weight, or getting organized. Maybe it's more specific to your life, like visiting your parents more, actually using the vacation days you've saved up, or learning a language so you can travel or communicate with loved ones. You might have started out strong, like by starting a new diet, but maybe things are starting to get difficult, and you're noticing more slip-ups as time goes on. Or maybe you haven't really started on much yet, and although you got the gym membership, you haven't been once, thinking that you have the whole year to work on this. By February, actually achieving your goal may seem impossible. By March, you may have given up, or forgotten your goal entirely.

Over half of people who set resolutions in the new year fail. It can be so tempting to say that this year will be the year everything changes, but much harder to actually follow through on that. Change is a gradual process, and the more of your life you need to change to make the resolution happen, the harder it can be. Learning a language from a book is going to be difficult if you rarely read books. Further, if your resolution doesn't excite you, the motivation to change is small. No matter how excited your best friend or partner is about their workout regimen, you're not going to be motivated to try it if the pressure is entirely external. Maybe you'll go once or twice, but it's less likely to turn into a lifetime habit or hobby if it doesn't align with your priorities.

The resolutions I mentioned in the first paragraph reflect the most common ones. "Exercise more" is the most common new years resolution, with "lose weight" coming in second. You'll notice that many of the most common goals include the word more... "save more", "travel more", "read more", etc. But "more" is not specific enough! The vagueness of resolutions are part of why they are so often doomed to fail. A goal like "call mom more" doesn't tell you when or how often to do it. Setting goals should be almost as specific as coming up with plans.

The idea of setting a SMART goal is one that came first in the business and management world, but people quickly found it useful in their personal lives. The idea is that goals should be Specific, Measurable, Achievable, Relevant, and Time-bound. This is the difference between "exercise more" and "go to the gym twice a week" or between "learn Spanish" and "gain one level in Spanish on Duolingo each month".

To make your goal more specific, look at how you want it to be achieved. Are you losing weight by dieting, exercising, or both? What part of your life do you want to be more organized? Is there a reason for the goal, like fitting into a particular item of clothing, or getting a promotion? Saying you want to be healthy is a good theme, but saying you want to quit smoking is a more specific goal.

As you specify your goal, it becomes easier to make it measurable. If you've already decided you want to go to the gym, think about how often you want to go. Do you want to start strong, and go three times a week, or do you want to start once a week and work your way up? If the latter, make sure to plan out how you're working your way up. Starting at once a week and deciding you'll go every day "someday" isn't going to get you there. Saying you'll go once a week for two months, then twice a week for two months, and continuing on from there, is being specific about being measurable (and time-bound, but we're getting ahead of ourselves).

Making sure your goals are achievable can be difficult if you're the kind of person who will drop one goal in favor of something else, or if your goals are so big that you don't know where to start. Sometimes, making your goals more specific and measurable can help make them more achievable. But if you're not a morning person, waking up at 6 to go for a run every morning may not be the best way to get more exercise. Further, look at the skills and tools you currently have. If you want to eat healthier but don't know how to cook, buying a bunch of fresh veggies won't help much if you don't know what to do with them. However, starting with a frozen veggie mix for a stir fry might be closer to your skill level.

As you make your goal more achievable, make sure you're keeping it relevant to your overall goals. This lines up with making sure it's something you're motivated to do, as I said earlier. Setting a goal to call your mom every week is great, but if you're only doing it because you feel guilty for not talking to her enough, it's going to be harder to make that happen. Further, it can be easy to get sidetracked in working towards goals. If you decide you want to read more to learn about the world, make sure the books you're reading are relevant to the overall goal of learning about the world.

Lastly, giving your goals a time bound provides a sense of urgency. Many of us operate better with deadlines; it's what we're taught in school, and what keeps us going at work. Others are more interested in forming habits. Consider if you're looking to achieve something and then be finished with it, or if you want to work something into your routine. Do you just want to go on one vacation this year, or do you want to make travel a bigger part of your lifestyle? This can also depend on whether deadlines or routine work better for you. Some people are more likely to learn a new instrument if they practice every day. Others are more likely if they have a concrete end goal of "play my brother's favorite song at his birthday in June". If you have an end goal, go back and make sure it's achievable based on your starting point. If you've never played the piano, you may not be able to learn a concerto in three months, but you may be able to learn your favorite pop song by the end of the year.

Once you have a SMART goal, it can be broken down into smaller goals. What's the next step? It could be committing to a tool or method (i.e. learning yoga at a particular yoga studio), planning out your progress over the year, or even just doing more research. What can you do to make progress on your goal today? In the next week? This month? Keeping track of these smaller goals can help a lot, so your first step might just be deciding how to track your progress. This might involve using a journal or planner, an app with automated reminders, scheduling time to work on your goal, or regular check-ins with an accountability buddy.

As the year goes on, it can be easy to get discouraged. Skipping a smaller goal, missing a deadline, or slipping up once does not make you a complete failure. Focusing on your mistakes can be easy; part of why tracking progress is so helpful is that it can remind you of how far you've come. People who diet often talk about the concept of cheat days, and I think this can be applied to any goal. If you got home too tired to meditate before bed, that can be a cheat day. This concept helps in letting the mistake be an outlier, rather than feeling like making mistakes is part of the pattern. It can fight against the thought "I screwed up once, so why even try". If your goal was to finish reading a book every month but take a month and a week to finish one, you still finished the book. If you lose 15 pounds but your goal was 20, you still lost weight.

Remember also that life can be unpredictable and get in the way. You might not have the energy to cook a large meal if you're feeling sick, and that's okay. If your career gets more hectic, you may have less time to spend on hobbies. Sometimes, life gets so hectic that it's unrealistic to keep holding the same standards for yourself. It's okay to say you can only practice guitar on weekends, or that you can no longer afford to go to Europe next year. It's also okay to say rock climbing is no longer interesting to you, and you want to drop that goal entirely. Your goals should be serving you, not the other way around. It's all about getting what you want out of life, and part of that is knowing when to lean in and when to let go.

Wednesday, September 12, 2018

Sad, Mad, and Bad: What depression looks like in children

There are a limited number of mental health problems that are thought to affect kids. ADHD and Autism Spectrum Disorders are commonly diagnosed in childhood, while mood disorders are most common in teenagers and adults. However, this doesn't mean that children don't get depressed. Children experience depression differently from adults, and thus their symptoms can look very different. This can result in depression being underdiagnosed in kids, or not diagnosed until they are much older, despite early symptoms.

The most commonly known symptom of depression is depressed mood. In children, this can look more like irritability. They may have more outbursts, break down crying more often, or not get along as well with friends and family as they used to. The next most common symptom is anhedonia, which means less interest in pleasure. Kids may be less interested in seeing their friends or participating in favorite hobbies and activities. They might even come up with excuses or feign sickness so that they can stay home from a friend's birthday party or miss an outing. Adults often experience significant weight loss or gain, though this can be difficult to track in kids; instead, we need to look at where they are compared to their expected growth and weight gain. Kids are also more likely to have bodily symptoms, such as headaches and stomach aches, and may go to the nurse's office a lot with such concerns.

Of course, this is not to say that kids never experience adult depressive symptoms. Sleep problems are common with depression in adults and kids, as are feelings of guilt and trouble concentrating. However, kids are more likely to have trouble expressing these symptoms. They might not understand depression at all, or have the words to say what's going on for them. Even if they do, they might be afraid to express it. Depressed kids often withdraw from their families. If your kid avoids telling you about their day at school, they may be avoiding telling you about their difficult feelings, too.

Suicidality in depressed kids can be a tricky subject. Just because they're kids doesn't mean they don't get suicidal ideation, but not all talk of death indicates suicidality. This is especially true in elementary age kids, who may be just processing the idea of death or suicide, and who may be repeating things they've seen in the media or heard from friends. When kids talk about death, it's important to ask about the meaning of what they say and get a clear picture of what's going on for them before jumping to conclusions. The national suicide hotline (1-800-273-8255) has a youth division, and their website has many resources specific to many common causes of suicide in kids and teens, like bullying, gender/sexuality, abusive relationships, and more.

Many kids don't feel comfortable talking to the adults in their life. In some cases, it can be as simple as making sure they know you are a safe person to talk to. Talking about your feelings can help them feel more okay being open about theirs (even something as simple as "I'm frustrated that the waiter hasn't taken our order yet" or "I'm so tired from work"). Being more explicit about the okayness of difficult feelings might be necessary for some kids to safe talking about their difficult feelings. Just make sure you don't pressure your kids into talking to you. It's like one of those finger traps: pulling hard doesn't get them to open up as well as gentle nudges do.

If your kid won't talk to you, or you aren't sure you can help them on your own, therapy can be hugely beneficial. Not only can a therapist teach your kid about their emotions and how to deal with them, but they can also help you and your child open up to each other more. Cognitive Behavioral Therapy can teach a kid how their thoughts aren't always reliable (i.e. jumping to conclusions, minimizing strengths and maximizing problems, etc). Narrative Therapy can help kids explore who they are in relation to the world around them -- which can be important for kids nearing puberty. Gestalt Therapy can help kids process any bottled up feelings. Therapy can also help kids gain the communication skills necessary to talk through problems and difficult feelings with others. Many kids don't feel comfortable talking to the adults in their life, but are willing to talk to a therapist; often times the therapist is the only person in the kid's life who doesn't have expectations for them, and this makes them safe to talk to. A therapist isn't going to have a kid wash dishes or take a math test, and most kids understand that therapists are there to listen and help.

While childhood depression sometimes goes away, it can be hard to distinguish from lifelong depression in the moment. Untreated depression can make it hard for kids to learn, make friends, and thrive in their daily lives, and can thus affect their long term development. Symptoms of depression also often overlap with symptoms of other illnesses, mental and otherwise, so it is important to bring up any symptoms your child shows with their doctor. If handled effectively, childhood depression can often recede and leave no traces in adulthood.

Tuesday, March 20, 2018

Time vs Task: Bounds of attention

I once worked in a special needs class that consisted mostly of kids with Downs Syndrome and Autism Spectrum disorder. There were many patterns I noticed that ran through both groups, but at the end of the free period when we had to draw the students' attention back to classwork, one difference became clear: their attention spans.

Kids on the Autism Spectrum would drop what they were doing as soon as they were told that it was time for lecture. To these kids, making sure everything scheduled happened on time was important; if something came up and they had to skip math, they would be distressed -- even if they didn't really like math. In contrast, kids with Downs Syndrome wanted to finish what they were doing. If they were in the middle of a puzzle, they had to finish it. If they were watching a Youtube video, they couldn't hit pause until it was over. We'd have to keep track of their activities and anticipate when a good time to pull them away. If a kid was listening to music, we'd approach them five minutes before the end of the period and allow them one more song.

This is not meant to draw boundaries between diagnoses (not every person with one of these conditions will act like the kids in my class did), but it does illustrate two very different approaches to attention: time-bound and task-bound. Someone who prefers to stick to a schedule is more likely to have time-bound attention, finishing a task when it is time for the next task, even if the previous task isn't completely finished. Others may be more task-bound, preferring to finish one task before moving on to the next.

To apply this to yourself, imagine being a child reading your favorite book before bed. You are told that it is time to go to sleep, but you are in the middle of a chapter. How reluctant are you to put the book down? Regardless of how good the book is, are you willing to go to bed before the chapter is done?

Variable answers are expected here. A gripping mystery novel is going to treat your attention differently from a comic book, in the same way that activities you enjoy feel different from those you don't. A person's willingness to move on to the next task may depend on many things, including time spent or remaining in the task, time until you can return to the task, enjoyment, and rarity of the task. You may be more reluctant to leave a party if you are talking to a friend you haven't seen in months, or if you just started playing a particular game with them, even if your attention is typically more time-bound.

Stress can come up interpersonally when one person is time-bound and the other is task-bound. If two people are putting together a puzzle and it's time for dinner, one might want to pause to eat, while the other might want to finish the puzzle first. Similarly, if a person who is time-bound is waiting on someone task-bound, they may end up waiting longer than they expected, depending on what the task-bound person is doing. It is important not to act like one of these ways of viewing attention is "correct"; they both have strengths and flaws and places where they are more or less appropriate. Just as it may hurt to stop an important conversation before wrapping up because it's "time for lunch", it would be inappropriate to drag an appointment over time if one or both parties has another appointment right after.

Next time you find yourself in a battle between the task at hand and the next task, notice where your attention is drawn and why. Notice how fluid this is -- your willingness to be time-bound when you want to be task-bound, or vice versa. Your answers may differ each time you try this, or they may show consistent patterns in your behavior. And once you've noticed these patterns, you can better examine how that changes the shape of your life.

Friday, October 27, 2017

Friendzoned: How gender affects emotional support

Some of the first questions many therapists ask a client are those meant to assess their friendships and other close relationships. This is because having a supportive community is one of the biggest strengths in those facing mental health problems. Whether it's Generalized Anxiety Disorder or grief over a breakup, having people you can lean on for emotional support can help a lot.

Women are more likely to have such social supports than men. Part of this is due to traditional gender roles and expectations. Emotional vulnerability is considered feminine, and thus more acceptable for women than men. Of course, anger is an exception here, given that it is linked with violence, which is linked with masculinity. So men are more likely to come in with anger issues, while women are more likely to come in with anxiety and depression.

The second part of this phenomenon is the difference between male and female friendships. Because emotional vulnerability is acceptable in women, it becomes an important part of the way women connect with each other. You can see this in media directed at teen girls: they support each other at best and tear each other down at worst, but it's all based in their ability to be vulnerable with each other. The trope of the girl giving her friend a makeover isn't just about looks; it's about self-esteem. The image of a group of friends watching a sappy romance movie and eating ice cream after one of them was dumped isn't just about being there for the friend; it's about empathizing and validating her emotions.

So what happens when you remove the emotional vulnerability from a close friendship? You get something close to what male friendships look like: a connection based in mutual interests, activities, and practicality. While it's not uncommon for two women with very little in common to become friends, this is far more rare with men. A guy's best friend may be someone they go to the gym with, someone they sit next to at work, or someone who reads the same books they do. A girl's best friend is likely to be someone who knows her more deeply than anyone else.

Of course, this is not to say women don't have shallow friendships and men don't have deep ones. Even media sometimes portrays men with emotionally deep relationships. Usually, however, this is referred to as a "bromance" and is played for laughs. It's not often these kinds of relationships are shown between multiple men, much less being shown as the norm. When it does show up, it's far more likely to happen between brothers, work partners (ie co-detectives), or best friends. Further, this model is based on Western gender norms, and thus might not apply to everyone in the same way. Some cultures reinforce emotional support more or less, and in different ways. Western gender norms don't account for other gender identities either. Those who are nonbinary or from other cultures might find that this applies differently, or not at all. Still, this is a useful frame to apply to others, especially in noticing different expectations for a close friendship or romantic relationship.

Speaking of romantic relationships, this often ends up being where men get most of their emotional support from. This is especially true in a heterosexual relationship, where the woman sees emotional support as part of any close relationship, not necessarily something specific to romantic situations. In a sense, a man is more likely to put all his eggs in one basket. His girlfriend can get her emotional needs met elsewhere if need be, but to him, she is likely the only person he can talk to about his troubles. This is why, statistically, the end of a long-term relationship affects men more harshly than women. If your emotional support comes only from within a romantic relationship, being single means you don't get any support. Worse still, men who struggle in their dating life have little to no support around this struggle, which in turn makes it harder to date. It becomes a downward spiral.

What about friendships between men and women? Well, this is where things get complicated. The old adage "Men and women can't be friends" probably comes from these different perspectives in what a friendship consists of. This is also why a woman whose friendship with a man is high in shared interests and low in emotional intimacy might be seen as "one of the guys". Since men usually only get emotional intimacy from romantic relationships, they think of this kind of closeness as a hint that the woman is interested in them romantically. This link is so ingrained that some men may associate emotionally close male bonds with gay relationships -- note the root "romance" in the phrase "bromance", and how often media makes fun of close male friends by calling them gay).

This is where the idea of the Friend Zone comes into play; this phrase has come to exemplify the difference between male and female relationships. A guy who feels he has been put in the friend zone by a girl probably saw the potential for a romantic relationship due to their emotional connection -- something that is rarer for him than for her. However, the girl may feel like she was seeking a perfectly normal friendship with a guy, only to be surprised that he was seeking a romantic relationship with her! In both cases, expectations didn't match up, and this can lead to the end of the relationship. The guy doesn't understand why the girl would provide and ask for emotional support while wanting to just be friends, and the girl doesn't understand why the guy would assume she was romantically interested when all she was doing was being a good friend.

It is important to note that while traditional gender roles can sometimes feel like they doom us to a certain kind of life, the world is shifting rapidly. On any middle or high school campus you can often find a few guys who prefer to make friends with girls, and vice versa -- often because of the ways they prefer to have friendships. More and more, people are picking and choosing what parts of their expected role they want to hold on to, if any. A particularly introverted woman may not want to have friendships that are about anything but shared interests, and this is okay as long as she finds other ways to regulate and process her feelings. Someone else may have a best friend they rely on for emotional support, and many other friendships based on a shared hobby. Finding something that works for you matters more than doing what other people decide is the right way to be healthy.

I want to encourage you to examine how traditional gender roles affect the way you build your friendships. Even if you don't identify as a man or a woman, the existence of these roles and friends who do or don't ascribe to them can have an impact. Someone raised a woman may feel they are expected to do emotional work for all their friends because this is what it means to be a good friend. Their friend may have been raised to see male roles as being preferable, and thus not want to be emotionally close with or show weakness to any of her friends. There are many ways people can respond to expectations, and even the "emotional closeness vs interest focused" dichotomy is overly simplistic and contains many other dynamics within it. But having emotionally close relationships (even just one or two!) is a protective factor for those with lots of life stress. If you find yourself bottling up strong emotions, needing to talk to someone but not feeling like you can reach out, consider opening up to someone a little. It doesn't need to go deep fast -- you can start with how much you hate being stuck in traffic or that you're upset you have to work on a Friday night. And if they respond in a way that feels good? Then, this might be the start of a beautiful friendship.

Thursday, October 12, 2017

The Dark Side: Emotional regulation and kids

When young kids are struggling to deal with strong emotions, it can be difficult to explain what's going on in a way that doesn't shame them for having feelings. Further, it can be hard to find ways for kids to deal with those strong feelings. Meditation, yoga, and journaling all seem like the kinds of things that would bore kids, and explaining to them why habits like these can be important is difficult -- especially for kids who struggle to think abstractly!

Most kids respond well to examples they can relate to, either in their daily lives or in fiction. This is why many children's TV shows will demonstrate a dilemma and show the main character's search for a solution. Shows aimed at younger kids may include jingles or catch phrases to remind kids of the skills the show is trying to teach (such as manners, problem solving, and conflict resolution). Connecting material kids learn to the media they enjoy engages them and helps with understanding. It is no wonder that so many teachers write math problems and spelling test sentences about popular TV, movies, and games. The same idea can be easily applied to the social and emotional skills we teach our kids.

Perhaps my favorite example of this is a metaphor connecting Star Wars and emotional regulation. In the series, Jedis (basically magical space knights) use something called The Force to harness supernatural abilities. These abilities can help them in combat, interpersonal situations, and in daily life. The Force is described as having a dark side and a light side, which can hurt or help people accordingly. Put the supernatural abilities aside, and a lot of this sounds like things you could tell a kid about their emotions.

Many kids who know Star Wars know Kylo Ren, the newest villain to be introduced in the movies. Kylo Ren is often shown to be angry and destructive. It is heavily implied that his anger outbursts are part of what drew him to the dark side in the first place. By contrast, Jedis like Obi Wan are often shown to be calm and collected. They even meditate! This can serve as an example as to how emotions (like The Force) can be destructive if you let them control you. Jedis undergo years of training to learn how to use The Force safely, just as many of us may go to therapy to learn to regulate our feelings.

Jedi meditation is described as being necessary to harness The Force, and while meditation may not work for all kids, the description of it (examining each thought or feeling and letting it go) may help with finding emotional regulation techniques that do work for them. While diaries are less common than they used to be, many kids still use different types of journals, online and off -- this is, in fact, why some kids post so much on social media. Arts and crafts can be helpful for kids who aren't as good with words, as can sports and movement (like running or playing soccer if not yoga or dance). Many activities that are built for kids can help here, but don't underestimate a kid's ability to meditate (guided or otherwise!) or write just because of their age.

Even if the Star Wars metaphor itself doesn't work, a lot of the media kids consume have deeper messages and themes. So next time you want to explain a difficult social or emotional concept to a kid, look at their favorite books, movies, and TV shows. You might find an example already woven into the story.

Wednesday, September 20, 2017

When To Go To Bed Angry

Popular advice for struggling couples is to never go to bed angry. The thought is, to work on problems when they're fresh, rather than letting them simmer until they explode. While this is great advice for some couples (enough so that some make it a policy or rule within their relationship!) it can add to the tension for others. Why? It may lead to staying up trying to talk through issues when both people would rather be asleep. While it is important to talk about things that come up rather than putting them on the back burner, trying to talk things through when one or both people don't have the energy to do so can make the problem worse, not better.

This isn't just about arguments before bed, either. On the way to dinner with the in laws, while driving up a particularly difficult road, and before work are all times when an argument might feel particularly inopportune. Being able to save something like this for later is an important skill, both for an individual and especially for a couple.

If the thought of doing this makes you anxious or upset, notice that! There may be valid concerns underlying there, and maybe just waiting for a more opportune moment to talk things over isn't the best way of handling this. Does having to wait to bring something up make you feel like you're going to explode? Do you worry that the problem is going to be forgotten about and never discussed? Are you likely to forget all the emotions around the problem in the morning, and undersell yourself? These thoughts and feelings are important to take note of, so don't just push them aside. This is all information that you can use.

Something that might help quell these fears of putting off a discussion is to record your feelings while they're fresh. Any time you put off a discussion for a time when emotions aren't as high, it can feel like you're likely to forget something or sell yourself short. Depending on how you best process information, you can try writing something down in a journal, typing something up in Word, or recording yourself talking into your phone. You can format this like a list of talking points, pretend it's a letter or voicemail to the other person, or just ramble until you have nothing left to say. Later, when it's time to discuss the problem, you can choose to show the other person your recording or writing directly, or read/listen to it yourself and tell them whatever you feel still sticks. It's entirely possible that you'll realize that you completely disagree with your past self, and that's perfectly okay! This is part of the reason why it can be good to put off discussions like this in the first place -- anger and fear can cloud discussing what's really going on.

Getting some distance from an argument can also help in making sure you don't play your normal role. If you're likely to get angry and your partner tends to withdraw in fear, keeping a calm head can help your partner stay engaged during what might otherwise be a rough conversation. Looking back over your thoughts, you may notice somethings that come up when emotions are high, such as blaming, hiding, or defensiveness. Notice what tactics you're prone to using. And next time you and your partner start to argue, see if you can change the normal course of it -- even if that just means talking about it later.