In Many Minneapolis Schools, the Therapist is Just Right Down the Hall

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When Cathy Moen’s son, Elijah, was in first grade, he was diagnosed with attention deficit hyperactivity disorder. She took him to the pediatrician, who put him on medication and suggested therapy.

The medication part was easy. But getting him therapy proved more difficult — not because Moen couldn’t find a therapist or didn’t have insurance, but because of logistics.

The appointments were always during the day, and between her work schedule and the traffic, it was nearly impossible for them to make it.

But she soon learned Elijah was able to see a therapist in his Bloomington school. More than 15 years ago, Minneapolis Public Schools helped pioneer a national model of bringing community mental health care directly to its students. Today, most of the public schools in Minneapolis — more than 50 of them — have a therapist on site, and many other districts, like Elijah’s, have followed suit.

These days, Elijah’s therapist simply walks down the hall and pulls him from class.

“This is like a godsend,” said Moen.

The family’s health insurance pays for the care the same way it would if the student were being seen in the clinic. The school program was designed so that no student in need will be turned away for lack of insurance.

The Minneapolis program has also provided a road map for schools across the country as more administrators realize that mental health is as important to students’ future success as academics. Studies have shown that students are more likely to show up for appointments when the therapists are on-site.

More and more states are making mental health care in schools a priority. At least two states have recently passed laws that require schools to teach mental health. And more are considering it.

But the benefit of having a therapist on-site goes beyond just getting students to see a therapist. In Minneapolis, it’s also helped make mental health a school-wide priority — and helped get counselors, teachers and others more involved, said Mark Sander, who helped start the district program.

A man wearing a button down shirt.
Mark Sander is the director of school mental health at Hennepin County and Minneapolis Public Schools.
Christine T. Nguyen | MPR News

“Those teachers start learning more and more [about mental health],” said Sander, who directs school mental health for the district and the county.

He said as they learn more about mental health, teachers are feeling like, “‘OK, I get it. And now, you know, I’ve got this other student who’s not diagnosed with anxiety but has some of those anxiety features. And now I know how to better support them.”

At South High School in Minneapolis, the therapists sit in the school clinic, the same one where students go if they feel sick during the day or to get a physical so they can play sports.

The issues the students bring to the therapist run the gamut from stress about grades and colleges to anxiety related to a bad situation at home.

Farah Hussein is a therapist at South. She said it’s hard being a teenager, and she tries to help.

“There’s a lot of conversations about, ‘Who am I? Where do I fit in the world? Where do I belong?’ and just a lot of distress in exploring that,” she said.

All of this has important implications for the students’ well-being beyond just their mental health.

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A group of people sit around a conference table in a school.
Collaborative mental health meetings at South include the school’s social workers, counselors, nurses, psychologists, school-based clinic therapists and occasionally administrators.
Christine T. Nguyen | MPR News
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A sign reads "Mental Health" on a wooden shelf with books.

 

Sharon Hoover, who co-directs the National Center for School Mental Health at the University of Maryland School of Medicine, said more schools are collecting data on outcomes of in-school mental health programs, and the results are clear.

“They are more likely to have good attendance and to graduate and to get improved grades. We even have documentation of having better standardized test scores when you put universal systems in place like classroom-wide social emotional learning,” she said, all of which makes for happier, better adjusted students.

Cathy Moen, the mother whose son, Elijah, is in therapy in school, said she doesn’t know if it’s the medicine, or the therapy, or just that he’s growing up, but she — and his teachers — are already seeing a difference.

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In International Falls, the last psychiatrist for 100 miles just retired

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When Dr. Jeff Hardwig started his job as a psychiatrist in his hometown near the Canadian border, he wasn’t sure there was enough work for him.

Pretty soon, it became clear that there was, in fact, plenty of work in International Falls, Minn., a town of 6,000 people. He split his time between a group family practice and community mental health center and also saw patients in nearby communities.

“Within two or three years, it was clear I was too busy to go out of town anymore,” he said.

After nearly 30 years working as the town’s sole psychiatrist, Hardwig retired in September, leaving no psychiatrists for more than 100 miles around. His departure underscores a difficult reality: A national shortage of psychiatrists is much more acute in rural and remote areas, which leaves many people without access to the kind of services they need.

And the demand for Hardwig’s services has never let up.

Wendy Dougherty, the nurse who worked with him at the clinic, said his calendar was always full.

“He never ever … in the five years I worked with him, ever had an empty slot,” she said. “And one thing about his patients, if they called and canceled, that empty slot was filled by somebody that had been waiting two months to get in.”

But, she said, he was also the kind of doctor who would always find a way to squeeze in somebody in a crisis, even if it meant missing lunch or canceling his own meetings.

‘You take all comers’

The clinic where Hardwig worked is a primary care center on the outskirts of town, part of the Duluth-based Essentia Health system. It’s a low-slung building across the street from a Menards and a Dollar Tree that offers all the basic services, including annual checkups and mammograms.

Hardwig and others agree that the need for a psychiatrist in town was there, but until he arrived, people mostly counted on their primary care doctors to handle it.

His patients’ diagnoses over the years ran the spectrum of diseases, including anxiety, depression, bipolar disorder and schizophrenia.

“I had to take care of people of all ages — all the way through to the nursing home,” he said. “You can’t really specialize if you’re in a small town. You take all comers.”

And working in a small town, he also couldn’t avoid running into his patients frequently. It might have been hard for some doctors — psychiatry is a profession that particularly prizes its discretion — but Hardwig says he didn’t mind.

“I just had sort of an agreement with my patients if they say ‘hi’ to me, I’ll say ‘hi’ back, but I won’t otherwise out them. And my wife knew not to ask, ‘How do you know that person?’” he said.

He said his patients were respectful of him, too, and didn’t try to squeeze in consultations in line at the grocery store or when he was out to dinner.

One of his longtime patients was a man named Daniel Carr, whom I met at a clubhouse run by a community mental health center where people with serious mental illness can spend their time. The cozy house has battered couches and an armchair in the living room. A Christmas tree sparkles near the front window.

Carr, who has paranoid schizophrenia, was Hardwig’s patient for 25 years. He says he misses Hardwig.

“He knew exactly about how to treat me,” Carr said.

“I had some trouble with my medicine changing a little one way or the other, but he usually knew what was best. I’d tell him what I was experiencing and he knew what to do.”

Hardwig wouldn’t talk about specific patients, including Carr. Carr said his psychiatric care has been transferred back to his primary care doctor, and that it’s been going OK so far.

But Wendy Dougherty, the nurse who worked with Hardwig, said some of the primary care doctors have been less than enthusiastic about taking on the psychiatrist role.

“Jeff took care of the hard ones,” she said. “The schizophrenics, the bipolars … these docs kind of put up their hands and say, ‘Oh, my God, I don’t know what meds to give them.’”

The psychiatric nurse practitioner Hardwig worked with is still at the clinic and handles some of the harder cases, but she’s planning to retire soon, too.

A shortage in nearly every county

International Falls is hardly alone in not having a psychiatrist — particularly in remote areas.

More than 90 percent of psychiatrists only work in urban areas, even though more than 20 percent of Americans live in rural areas. In Minnesota, nearly every county — aside from the Twin Cities metro and Rochester area — is considered to have a shortage of mental-health professionals as determined by federal guidelines.

Hardwig said the hardest part of working in such a remote area was that he didn’t have a continuum of care to work with.

“There just isn’t that inpatient bed when you need it. We have only one crisis bed and we haven’t had that the whole time I’ve lived here. We don’t have residential treatment,” he said.

And International Falls is luckier than some places because there’s a community mental health clinic in town. (Hardwig partnered with it until his retirement, and the nurse practitioner still does.) The clinic is looking to expand in the near future. There’s also a mobile crisis team in town that can help with emergencies.

Still, recruiting mental-health care providers, even those who aren’t psychiatrists, to remote areas is challenging. Paul Mackie, a professor at Minnesota State University, Mankato, has studied the problem. And he said the only way to recruit and retain people in remote areas is to grow them from scratch. That is how Hardwig, who grew up in International Falls, ended up there.

Mackie said there are already physical medicine programs that train people for practice in rural areas. And he said now we need to do the same for mental health, too.

“We need to be a lot more thoughtful about who we’re recruiting and how we’re recruiting them,” he said. “We can have that conversation around what does a rural practitioner look like and look for that person and encourage them.”

But that takes time. People who graduated from high school this year won’t be done with medical school until 2027. And then they still have to complete their residency and any other specialty training.

So in the meantime, International Falls — and communities like it — are doing what they can. Hardwig’s old clinic has hired a child psychiatrist who sees her patients remotely over Skype-like technology.

Finding people to work on-site is proving much trickier, though. It was two years ago that Hardwig told the clinic he was planning to retire. It’s been looking for a replacement since then. But nobody has applied for the job.

SOURCE

Holiday Tips

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I recently saw a meme on social media that said “It’s almost time for my normal anxiety to turn into my fancy holiday anxiety.” I had to chuckle when picturing anxiety showing up in a glittery ugly sweater or draped in all things sparkly. Humor aside, it shows that during the holidays, our existing anxiety (or depression) does not just “take a holiday” but rather increases due to stress and societal pressures.

This time of year can be an incredibly stressful and frustrating time. On one hand, we fill our days to the brim with spending time with family and friends, social events, potlucks, baking, preparing meals, finding the right present within your means, and many other tasks guised in the name of the holidays.  All of this “fun” can turn to chaotic quickly. Then on the other hand, some of us may have unwelcome reminders or memories associated with the holidays or feel more alone during this time as we watch others join together and celebrate. Whatever the reason for your distress, here are some helpful strategies to help manage the rise of our fancy anxiety (or depression) in finding ways to relax during the busy time of year or help with our perspective on the season.

  • Self-soothe – Using all 5 senses, focus on what you notice. Cast any judgments away and focus on the experience in the moment. Here are some examples.
    • Taste – slowly eat and notice different flavors in a favorite holiday treat or dish
    • Smell – light a candle or smell a pine tree or cup of tea
    • Sound – listen to your favorite holiday music, point our different instruments or lyrics you might have over looked
    • Sight – watch the fireplace flicker with light or notice the holiday lights all around
    • Touch – when baking or wrapping gifts, bring attention to the different textures you feel
  • Pay it forward – doing something kind for others or contributing can make us feel good about ourselves and give perspective. This could be anything from holding a door open for someone, greeting someone with a smile, adopting a family for the holiday, or volunteering. It does not need to be a large act to bring a sense of contribution to your holiday.
  • Be intentional about breaks – Set aside 15 minutes to check in with yourself and pause from all of the holiday excitement. Read a favorite book, do a meditation, sit in silence, or snuggle up with someone you love.
  • Simplify and slow down – With your to-do list growing, it may feel like you need to be in multiple places at once; however, what we know about the brain is that it cannot think 2 things at once. So, focus your entire attention to the task at hand rather than jumping from task to task (aka multitasking).
  • Follow traditions (or make your own new ones) – Partake in something that brings you meaning for the season, whether this be a family tradition, baking Grandma’s cookies, or finding something new to do this time of year (i.e., sledding, ice skating, driving around to see holiday lights, etc).
  • Put down the phones – I know, I said it. Just hear me out. Often times social media can impact our level of stress by comparing ourselves to others, especially when those others seem to have it all together. They have the catalog ready decorations, Martha Stewarts holiday food spread, or gifts we cannot afford. This can lead us into a down spiral. So, try to limit your access to your phone and engage with those around you.
  • Reach out to someone– The holidays can be a lonely time for some. Sometimes we can still feel lonely in a room full of people, feel so far away and disconnected from others, or feel forgotten. Use all of your willingness to reach out to someone or connect. Whether that be grabbing a cup of hot cocoa with a friend, attending a service, volunteering, or making a phone call to someone you have lost touch with in the past. We are social creatures and need human connection.
  • Be real with yourself – This includes preparing to spend time with family or friends. You likely already know who is going to be the Grinch, who is going to over indulge in the holiday punch, who is going to bring up politics, and who is going to ask about your love life. Just because it is the holidays, does not mean we are going to change who we are or the roles we play. Have an action plan for how you are going to deal with the likely interactions or dynamics.
  • Life in moderation – Life is about balance. Enjoy the holidays by partaking in the indulgences and socialization. Moderation is key. Listen to your body and the signals it is giving you.
  • Gratitude– Research is growing on the importance and efficacy of practicing gratitude in daily life. Our brains are inherently negative so being intentional about shifting out of the holiday stress (and negativity) can help bring perspective and renew our enjoyment of the season.
    • Write down things you are thankful for in life. Focus on the small things (i.e., clean water, fresh air, etc). Nothing is too small to be grateful for in life.
    • Reflect one thing you believe you did well over the past year.
    • Compare yourself to a time in your past when you might have handled the holiday stress less effectively.
  • Permission grant yourself – The holidays are not always candy canes and sprinkles. Often times we hold ourselves to high expectations and forget we are in control of our own actions. Grant yourself permission to: take time outs/breaks, have fun, do things “out of order”, celebrate differently than family/friends/the past, start a project and stop, be honest with people (and yourself), or have days that are “humbug” or just okay.

 

Feel free to make these tips your own by adding your own personal flair to them. It is important to find what works for you and your fancy holiday distress.

 

Happy holidays,

Dr. Alison Dolan

7 Ways Loneliness (and Connectedness) Affect Mental Health

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Loneliness is finally starting to get at least some of the attention it deserves—we may not be as “on it” as other countries, like the U.K. with its Minister for Loneliness, but we’re getting there. Like the push to dissolve the stigma around mental health issues, there’s been a similar increase in people’s honesty about their social connection, or lack thereof. And it turns out that people are pretty lonely these days. The percentage of people saying they have few or no confidants has risen precipitously in recent years. So if you’re feeling lonely, you’re…well, not alone.

As the research shows just how important social connection is for our health and mental health, and how detrimental loneliness can be, the value of speaking out—and changing our habits—becomes all the more clear. Here are some of the ways in which loneliness hurts us and social connectivity helps us, psychologically and physiologically. 

Loneliness is contagious

A fascinating study looked at how loneliness is present in communities, and found that it spreads through a contagious process in which people seemed to “catch” loneliness from one another. As people became lonelier, they moved to the edges of social networks, creating a kind of domino effect. For instance, when one person reported an increase of one day per week of loneliness, his or her close friends also reported an increase. As the authors write, “efforts to reduce loneliness in society may benefit by aggressively targeting the people in the periphery to help repair their social networks and to create a protective barrier against loneliness that can keep the whole network from unraveling.”

Other work has shown that people who become lonelier over time also begin to trust others less, which creates a vicious cycle of loneliness and social isolation. These types of studies suggest that social connection is precarious, and vulnerable to different forces, making it all the more important to do what we can to keep our networks together and oneself involved.

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Past Trauma May Haunt Your Future Health

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Adverse childhood experiences, in particular, are linked to chronic health conditions.

A rocky childhood. A violent assault. A car accident. If these are in your past, they could be affecting your present health.

These are all examples of traumatic events — which, in psychological terms, are incidents that make you believe you are in danger of being seriously injured or losing your life, says Andrea Roberts, a research scientist with the Harvard T.H. Chan School of Public Health. Research shows that these events can trigger emotional and even physical reactions that can make you more prone to a number of different health conditions, including heart attack, stroke, obesity, diabetes, and cancer.

Understanding trauma

Traumatic events encompass anything from a sexual assault or childhood abuse to a cancer diagnosis. Child abuse is particularly likely to affect your adult life because it occurs at a time when your brain is vulnerable — and it often occurs at the hands of people who are supposed to be your protectors, says Roberts. “By abuse, we often mean things that are a lot milder than things people typically think of as abuse. It might include being hit with a hard object, like a whip, a belt, or a paddle,” says Roberts. “The behavior doesn’t necessarily need to be illegal to induce a traumatic response.”

A child’s perception of events is as important as what actually occurred. “While a child’s life may not have actually been in danger, the child may have seen it as life-threatening,” says Dr. Kerry Ressler, a psychiatry professor at Harvard Medical School.

People who experience traumatic events sometimes develop post-traumatic stress disorder (PTSD), a psychiatric condition that affects 5% to 10% of the general population, says Dr. Ressler. It’s more common in women, affecting twice as many women as men. And it also occurs more frequently in people who have certain risk factors, including those living in poverty, soldiers in active combat, and first responders, he says. PTSD can develop after a person experiences violence or the threat of violence, including sexual violence. It may affect people who have a close relative who experienced those things as well, says Dr. Ressler. These traumatic events are generally incidents that are considered outside the ordinary and are exceptional in their intensity.

Exposure and risk

Your risk for mental and physical health problems from a past trauma goes up with the number of these events you’ve experienced. For example, your risk for problems is much higher if you’ve had three or more negative experiences, called adverse childhood experiences (ACEs), says Roberts.

These include

  • physical abuse
  • sexual abuse
  • emotional abuse
  • physical neglect
  • emotional neglect
  • witnessing domestic violence
  • substance misuse within the household
  • mental illness within the household
  • parental separation or divorce
  • incarceration of a household member.

Another kind of trauma

While severely traumatic events are believed to have the greatest effect on long-term health, other stressful events that don’t necessarily meet the psychological definition of trauma can still cause problems. This might include a sudden death in the family, a stressful divorce, or caring for someone with a chronic or debilitating illness, says Roberts. These milder events might lead to a mental health disorder, such as anxiety or depression. “Trauma pushes your ability to cope, so if you have a predisposition toward anxiety, for example, it may push you over the edge,” says Roberts.

In addition, incidents like these can also produce PTSD-like symptoms in certain people. “When people go through traumatic or complicated grief, they can experience pretty similar symptoms to those they might experience with trauma, such as intrusive thoughts,” says Dr. Ressler.

Medical conditions resulting from trauma

Most of the research related to trauma and chronic disease risk has focused on childhood trauma, says Dr. Ressler. Early childhood trauma is a risk factor for almost everything, from adult depression to PTSD and most psychiatric disorders, as well as a host of medical problems, including cardiovascular problems such as heart attack and stroke, cancer, and obesity.

These effects likely reflect two factors:

Behavioral changes resulting from trauma. People who are suffering from traumatic memories may try to escape them by participating in risky behaviors such as drinking, smoking, drug use, or even overeating for comfort. “Those can all be used as a coping mechanism, a way of dealing with emotional dysregulation that occurs when someone has been traumatized,” says Roberts. These habits, in turn, lead to health problems.

Physical effects related to trauma. The problem goes beyond unhealthy habits. Experts believe that there is actually a direct biological effect that occurs when your body undergoes extreme stress. When you experience something anxiety-provoking, your stress response activates. Your body produces more adrenaline, your heart races, and your body primes itself to react, says Roberts. Someone who has experienced trauma may have stronger surges of adrenaline and experience them more often than someone who has not had the same history. This causes wear and tear on the body — just as it would in a car where the engine was constantly revving and racing, she says. Stress responses have also been demonstrated in people who have experienced discrimination throughout their lives. “It ages your system faster,” says Roberts.

Chronic stress can increase inflammation in the body, and inflammation has been associated with a broad range of illness, including cardiovascular disease and autoimmune diseases, says Roberts. Early trauma disrupts the inflammatory system. This can lead to long-term aberrations in this system and chronic health problems triggered by constant inflammation. Typically, the more trauma you’ve experienced, the worse your health is.

Barriers to getting help

People who have experienced trauma may also struggle with getting help. “One of the most common outcomes of trauma is avoidance,” says Dr. Ressler. “It makes sense. If you experience something traumatic, you want to avoid thinking about it and going to places that remind you of it.” Unfortunately, health settings — with their doctors, therapists, and counselors — are triggers for many people because when someone experiences a traumatic event, he or she often ends up in the health care system.

In addition, if you’ve experienced trauma, you may believe that health care providers will want you to talk about it and dredge up feelings from the past. For these reasons, people who have experienced trauma may avoid medical care.

Some people may be in denial about the role past trauma is playing in their life. “I would say that a lot of people are unaware of how trauma is affecting them,” says Roberts. One of the hallmarks of trauma is the fact that people often use defense mechanisms to protect themselves from stress. Denial is one of those, as is trying to normalize past problems. “People may say things like, ‘oh, everybody I know got hit as a child,'” says Roberts.

Seek out resources

To get more information about trauma and PTSD or to find treatment resources, here are three very good, well-vetted websites from leading professional organizations:

Getting help

If you suspect that past trauma is affecting your life, there is help. This is a treatable problem. “You don’t have to be stuck,” says Dr. Ressler. “There is a good chance that you can move past this.”

Taking steps to address the problem may also help others in your life. Very often people who have experienced trauma pass problems on to others in their family through a process called observational learning, he says. So, helping yourself may help those around you. Consider these steps.

Work with a therapist. A trained therapist can help you reframe what happened to you and help you move past it. “One of the most successful treatments is exposure therapy, where the idea is to expose yourself in small doses to the thing that was most traumatizing, with someone there to support you,” says Roberts. Treatment may also include medication to address any mental health disorders you are experiencing.

Take care of yourself. There are numerous lifestyle measures that can help you reduce stress and anxiety. These include yoga, tai chi, and meditation. Regular exercise can also help you manage stress and other symptoms.

Reach out to others. Research has shown that maintaining strong social ties with friends and family members is crucial to good mental health.

“Unfortunately, all of these things are hard to do when in depressive states,” says Roberts.

That’s why many people may need to start with therapy, and then add other strategies later on.

 

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How to Address Your Teen’s Issues with Poor Motivation

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Getting your teen to improve his or her focus.

“If the eye is patient enough, it will get a clear view of the nose.” – Anonymous

When people think about issues related to poor concentration, they immediately think about distractions. This is even more the case when it concerns teens. Things that come to the mind of the casual observer, are smart phones, social media and troubled peers.

A quick Google search for how to improve your teen’s lack of focus, will bring up issues like attention deficit hyperactivity disorder (ADHD/ADD), depression, nutrition and strategies for developing a more efficient schedule. These topics and recommended strategies are appropriate and effective for helping your teen improve his or her issues with focus, but they cannot be effectively applied until one important issue is addressed.

Motivation.

That’s right. The primary reason young people struggle with poor focus and concentration is a general lack of motivation to do anything meaningful. The teen who lacks motivation will often gravitate towards activities which greatly stimulate neuro-chemicals associated with the brain’s reward system.

Activities such as video games, food, mind altering substances, alcohol and sex. These are things bored teens are likely to engage in habitually, in order to feel alive. This is because, in the absence of motivation to succeed, the teen is faced with a difficult reality consisting of a monotonous chore and a daily schedule. Even things like daily showers can seem time consuming and tiring to a teen who struggles with low motivation. It is also important to note that these issues are also symptoms of depression with a teen.

Before we begin processing on how to get teens more motivated, it is important to come to an understanding on what motivation is. According to Wikipedia, the term motivation is derived from motive. Motive means a need that desires satisfaction. So, for a teen to be motivated, he or she must be actively pursuing a need which desires satisfaction.

Saul McLeod/Simple Psychology
Maslow’s Hierarchy of Needs Chart
Source: Saul McLeod/Simple Psychology

Maslow’s Hierarchy of Needs.

Typically, we understand needs to be intrinsic materials necessary to keep us alive, such as food, water and shelter. However, an expanded discussion on the issue of needs would be based on the famous work of Abraham Maslow, regarding his hierarchy of emotional needs.

According to Dr. Maslow’s theory, there are two types of needs people strive for. They are deficiency needs and growth needs. Deficiency needs are comprised of basic needs and psychological needs. These are physiological needs, which have to do with food, water and shelter. Followed by the need for safety and security. The physiological needs and the safety needs are known as basic needs.

Next are the psychological needs, which have to do with the needs for a sense of belonging and feeling accepted. This is also followed by the need for esteem, which has to do with prestige and status in society. According to Dr. Maslow, people are only motivated to get these needs met, when these needs are deficient in their lives. Once these needs are met, people are no longer motivated in getting them met, which opens the door for addressing growth needs.

Then there are the self-fulfillment needs, which Dr. Maslow describes as self-actualization coming from having achieved one’s full potential. He also describes this as growth needs. Unlike deficiency needs, people become more motivated as their growth needs are met.

So, a teen who practices the courage to do his best in understanding calculus, becomes more motivated the more he succeeds and subsequently more focused. Further, teens who are experiencing success in achieving their potential, are also very disciplined in their home life. For example, they are disciplined in following through consistently with their assigned chores and personal hygiene.

It has been theorized that teens who struggle with depression, have experienced very little success in effectively getting their psychological needs met. This topic will be addressed in another post.

Often Motivated.

Upon examining Maslow’s hierarchy of needs, it is easy to conclude that most teens don’t have low motivation. Rather, most teens are preoccupied to getting their deficiency needs (acceptance and recognition) met, rather than their growth needs (success in academia) met.

Such a phenomenon is easy to witness with teens from low socio-economic backgrounds, such as an obsession in getting their physiological and safety needs met. However, with teens from middle class backgrounds and up, their focus is often on their psychological needs. For example, relationship with friends, close friendships and status among peers.

When teens are focused on getting their deficiency needs met, they are not going to be focused on issues regarding self-discipline and mastery. For a parent to help his or her teen become more focused on growth needs, he or she will have to teach his or her teen how to effectively get their deficiency needs met.

Conflict of Beliefs and Values.

This may be easier said than done, as today’s teenager is often exposed to new values and beliefs through social media. Meaning, that these values and beliefs are often in conflict with the teaching of the parents.

So, efforts to help the teen address his or her deficiency needs may result in a stalemate between parent and teen. Which then leads to a recurring problem with a lack of focus due to poor motivation with issues like school work, personal hygiene and chores.

The solution for a situation like this will be for parents to seek therapeutic services to assist their teen in effectively getting their deficiency needs met, in order to focus on his or her growth needs.

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The Burnout We Can’t Talk About: Parent Burnout

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New research demonstrates parental burnout has serious consequences.

Parents Admitting to Burnout: That’s New

New research published in Clinical Psychological Science suggests that parental burnout can have serious consequences. In two longitudinal studies, 918 and 822 participants were analyzed, respectively. The studies involved the completion of three online surveys per year.

Results indicated that parental burnout has much more severe implications than were previously thought. Burnout was associated with escape ideation—the fantasy of simply leaving parenting and all its stressors—as well as with neglectful behavior and a “violence” category that included verbal and psychological aggression (e.g., threats or insults) and physical aggression (spanking or slapping) directed at children.

The truly remarkable result of this study is that parents responded honestly at all. In earlier research on this topic, the researchers grappled with whether parents would ever respond honestly to questions related to burnout, and whether the construct has any validity if no one will admit to it. It’s human nature to avoid responding honestly to questions that make you look bad, even anonymously! We call this the impression management bias.

What is Burnout?

As defined by the study, burnout is an exhaustion syndrome, characterized by feeling overwhelmed, physical and emotional exhaustion, emotional distancing from one’s children, and a sense of being an ineffective parent. Freudenberger (1974) first coined the term in reference to staff workers. Proccacini and Kiefaver wrote about it in 1984, and then the concept kind of disappeared. Until recently, however, parental burnout hasn’t been systematically studied. I think that’s because the entire concept is taboo.

The thing is, parents aren’t supposed to be able to burn out! We are taught, both explicitly and implicitly, that parenting is so rewarding, fulfilling and wonderful that one smile from a beloved child will instantly fulfill a parent, that the task is so joyful that the occasional difficulties (Meltdowns! Dirty diapers. 2 AM wakeup calls. Dirty diapers at 2AM!) are barely noticed. That’s just plain untrue, and it’s a myth that can harm parents.

Imagine working for this kind of boss: The demands seem to exceed the capacity to satisfy them, and the standard for success is always shifting, with high stakes and a lot of emotional pressure, and no real standard for success. Tasks with no end-date, where the finish line is always shifting, and tasks you can’t escape – those are the perfect conditions for burnout. Teachers experience it. Entrepreneurs experience it. And parents definitely experience it, but they haven’t been able to talk about it.

Oh sure, parents can talk about how work-life balance burns them out, we can talk about the gender gap regarding the mental load of running a home and parenting kids, we can talk about how being a working parent is stressful. But until recently, we haven’t been able to talk about how parenting itself can burn the parent out.

It’s not accidental that burnout makes us think of a depleted battery. When we’ve burned through all of our emotional fuel, there’s no more left. We all know the “supposed to-s” and the “should-s”. Parents are “supposed to” love the act of parenting so much, it recharges them on its own. Parents “shouldn’t” mind being woken up at 2AM, coming late to work, being passed over for promotion because of split priorities, or being the target of teenage angst.

You Can’t Give What You Don’t Have:

It’s true. Our kids rely on us and are frequently helpless. The parenting relationship is crucial to children’s psychological development. Attachment, or the lack thereof, can be damaging. That’s why it’s so threatening to even consider the possibility that parents can burn out. But if we can’t think about it, we can’t do anything to address it.

The thing is, we can’t give what we don’t have. If we’re disconnected from ourselves, we can’t give attachment, love, and nurturing. If we’re under stress, we can’t always respond with patience and model compassionate caring in the face of challenges. Since we are the parents, it’s up to us to know when that’s happening, when burnout is reaching critical levels, and what to do about it.

Neurodiverse Children and Burnout:

The problem is particularly severe when parenting a challenging child. In my practice, I treat parents and families of children with psychological diagnoses. When you’re parenting a child whose presenting problem is anxiety, OCD, ADHD, depression or an Autism Spectrum Disorder, the potential for burnout is so much higher. (For more on parenting a neurodiverse child, click here.)

The world misunderstands challenging children, and it’s up to us to explain them to everyone. Simple tasks, like getting our kids on the school-bus, to brush their teeth, or to eat dinner become massive jobs requiring Herculean effort. Homework time with kids isn’t anyone’s idea of a good time. Try doing homework with a child who erases every letter that isn’t shaped perfectly, or who can’t stick to a task for more than three minutes straight. Then multiply a few siblings, who just have the neurotypical struggles and life demands. Add in some soccer practice, maybe a boss asking for some at-home work and throw in a toothache for good measure. For some people, this would be a nightmare. For others, it’s just called “Tuesday.”

Self-Care IS Child Care:

So many times, when I’m teaching parenting classes, I ask the participants what their self-care was that week. I get responses like this:

Self-care? Who has time for that? I am so consumed dealing with my son. Besides, he needs so much. How can I justify taking time away from something he needs, just to pursue something I like?

Based on this research, I ask parents how often they have escape fantasies, and all agree that they fantasize about their parenting load being lightened. Because this is an interactive class, we’ve already all spoken about the times that stress has led to less-than-optimal parenting strategies, like yelling, or a harsh consequence. (To learn about strategies to predict child behavior, click here. To learn more about using science to inform parenting, click here. To learn more about effective parenting strategies, click here.)

I point to the cell phones recharging on my power bank.

Every parent in this room has a cell phone currently recharging on that power bank. Just like we all know that the cell phones need to be recharged, so do we. When our batteries deplete, we have to refill them. 

Jrg Schiemann/123RF
We have to recharge our own batteries, before our kids can recharge from us!
Source: Jrg Schiemann/123RF

Personally, I ask myself each week about certain “banks” that need to be filled. Before others can recharge from me, I need to fill up my banks.

I tell my own children when my “cuddle bank” is empty, and I want them to come to me to help refill theirs. I have a “play” bank, a “nurturing food” bank, and “engaging/interesting pursuits” bank, a “sleep” bank, and an “unscheduled time” bank. When one of these banks is running low, I’ve learned to refill it. Let’s not call that self-care. Let’s call that the highest form of child-care – being present. Ironically, it’s that sense of a present parent, that connection, and that attachment, that is associated with the healthiest outcomes. The scariest finding in the research above – burnout prevents parents from being emotionally present with their children. (To learn more about being present and using mindfulness in parenting, click here.)

In 1953, child psychoanalyst D.W. Winnicott spoke about being a “good enough” mother. Ironically, in the pursuit of being a “perfect” parent, we tend to burn ourselves out. Social media, with all the images of bento box lunches, Pintrest boards of “fun” braided hairstyles, and moms who brew their own homemade keffir don’t help. Let’s not be “perfect,” or even “great.” Let’s serve peanut butter and jelly for dinner, but have the energy for a cuddle! Let’s be real, because we can burn ourselves out on the path to ideal.

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How a Toxic Work Environment Affects Your Mental Health

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Not only is incivility in the workplace on the rise, but according to a recent study, it is compromising one of our most critical assets—our mental health.

The authors of the study, published in the Journal of Occupational Health Psychology, looked at the correlation between toxicity in the workplace and symptoms of insomnia, a common symptom of clinical depression. They wanted to know how, or via which mechanism, incivility in the workplace negatively affected employees’ sleep quality, as there has been limited research into this factor.

What Is Workplace Incivility?

Workplace civility, as described by McKinsey and Company, is “the accumulation of thoughtless actions that leave employees feeling disrespected—intentionally ignored, undermined by colleagues, or publicly belittled by an insensitive manager.” It has also been defined as “low-intensity deviant behavior with ambiguous intent to harm the target, in violation of workplace norms for mutual respect.”

Why Quality of Sleep Matters

Sleep is a critical factor in our overall well-being, including our work performance. It has long been established that poor quality of sleep has significant implications for both our physical and psychological well-being.

For example, insufficient sleep increases a person’s risk of developing serious medical conditions, including obesity, diabetes, and cardiovascular disease. Additionally, lack of sleep over time has been associated with a shortened lifespan.

Effects of Negative Rumination

In examining the indirect effects of workplace incivility on symptoms of insomnia and thus overall health, the determining mechanism was found to be negative rumination, or the mentally replaying of an event or disturbing interaction with a co-worker long after the workday has ended.

“Workplace toxicity leads to adverse effects in part by stimulating people to ruminate on their negative work experiences.” according to the authors. “Negative rumination represents an active cognitive preoccupation with work events, either in an attempt to solve work problems or anticipate future work problems.”

Given that most of us spend the better part of our days and our energy at work, increasing hostility in the workplace doesn’t bode well for our emotional or physical well-being. Research over the past 20 years has associated toxic work environments with increased depression, substance use, and health issues among employees. Further research has shown that organizations are suffering as well. Some of these adverse effects include decreased productivity, lower levels of employee commitment and increased turnover.

Coping Techniques to Reduce Effects of Workplace Incivility

The good news is that sufficient recovery or coping techniques may be able to mitigate the negative effects of a toxic work environment on employee well-being. In particular, relaxation and psychological detachment. The ability to psychologically detach from work during non-work hours and relaxation were shown to be the two mitigating factors that determined how workers were affected or not by a negative work environment.

Employees who were better able to detach psychologically are able to relax after work and sleep better even in the face of workplace incivility. Below are descriptions of these recovery experiences and how they were shown to reduce the negative effects and enable employees to thrive in the most toxic of work environments.

Psychological Detachment

Psychological detachment represents an avoidance of work-related thoughts, actions or emotions. Some of the items used in the study to measure employees’ levels of psychological detachment in the evenings including the following: “I didn’t think about work at all” and “I distanced myself from my work.” Those who were able to detach themselves mentally from this cycle do not suffer as much sleep disruption as those who are less capable of detachment.

Detachment can be fostered through a variety of specific activities, including exercise. Planning future events such as vacations or weekend outings with family or friends are examples of positive distractions outside of work.

Relaxation

It should come as no surprise that prioritizing work-life balance was shown to be another effective buffer against the detrimental effects of workplace incivility. Relaxation has long been associated with fewer health complaints and less exhaustion and need for recovery.

As hypothesized by the authors of the study, relaxation during non-work time served as an important moderator of the relationship between negative work rumination and insomnia symptoms. Additionally, it has been identified as a moderator between work characteristics and occupational well-being, between time demands and exhaustion, and between job insecurity and need for recovery from work. Relaxation provides an opportunity for individuals to halt work-related demands, which is critical for restoring individuals to their pre-stressor state.

Some activities outside of the office that can foster recovery include volunteering, meditation, taking a walk, listening to music, and spending time with friends and other positive social supports.

How Organizations Can Address Workplace Incivility 

Based on the results of the study, the authors suggest the following interventions that companies can address to reduce workplace incivility.

  • Raise awareness
  • Ensure protection for employees
  • Ensure accountability
  • Train and model appropriate behavior
  • Train supervisors on aggression-prevention behaviors
  •  Improve emotional resilience skills
  • Offer training on recovery from work, mindfulness practices, emotional/social intelligence skills

A Word From Verywell

You may not be able to control certain events during work hours or the characteristics of your workplace environment. However, what you do have control over is how you choose to cope. Most importantly, finding time to relax, spending time with friends and family, and engaging in activities that will shift your focus away from work during non-work hours.

If you find that you are still experiencing distressful symptoms and that they are interfering with your functioning, it may be a good idea to speak to a therapist who can help you learn additional strategies for coping.

If despite having done all you can still nothing has changed, it might be time to consider the possibility of removing yourself from the toxic environment and looking for a new, more fulfilling and less distressful job. Your health may depend on it.

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