How To Respond to a Grieving Teenager

How To Respond to a Grieving Teenager

It is graduation time which means graduations and also end of the year parties. Unfortunately, this also means teenage deaths due to car accidents, accidental drug overdosages and accidents. When this occurs no one knows what to say or do. Many patients have asked me about what to do in these situations. While doing research regarding grief for patients, I found this information from the grief center. I think it is very good information and very easy to understand. Therefore, I will present the information in three sections.

The 10 Best and 10 Worst Things to Say to Someone in Grief

Sheryl Sandberg’s post on Facebook gave us much insight into how those in grief feel about the responses of others to loss. Many of us have said “The Best” and “The Worst.” We meant no harm, in fact we meant the opposite, we were trying to comfort. A grieving person may say one of the worst ones about themselves and it’s OK. It may make sense for a member of the clergy to say, “He is in a better place” when someone comes to them for guidance. Where as an acquaintance saying it may not feel good.

You would also not want to say to someone, you are in the stages of grief. In our work, On Grief and Grieving, Elisabeth Kubler-Ross and I share that the stages were never meant to tuck messy emotions into neat packages. While some of these things to say have been helpful to some people, the way in which they are often said has the exact opposite effect than what was originally intended.

The Best Things to Say to Someone in Grief

1. I am so sorry for your loss.

2. I wish I had the right words, just know I care.

3. I don’t know how you feel, but I am here to help in anyway I can.

4. You and your loved one will be in my thoughts and prayers.

5. My favorite memory of your loved one is…

6. I am always just a phone call away

7. Give a hug instead of saying something

8. We all need help at times like this, I am here for you

9. I am usually up early or late, if you need anything

10. Saying nothing, just be with the person

The Worst Things to Say to Someone in Grief

1. At least she lived a long life, many people die young

2. He is in a better place

3. She brought this on herself

4. There is a reason for everything

5. Aren’t you over him yet, he has been dead for awhile now

6. You can have another child still

7. She was such a good person God wanted her to be with him

8. I know how you feel

9. She did what she came here to do and it was her time to go

10. Be strong

Best & Worst Traits of people just trying to help

When in the position of wanting to help a friend or loved one in grief, often times our first desire is to try to “fix” the situation, when in all actuality our good intentions can lead to nothing but more grief. Knowing the right thing to say is only half of the responsibility of being a supportive emotional caregiver. We have comprised two lists which examine both the GOOD and the NOT SO GOOD traits of people just trying to help.

The Best Traits

Supportive, but not trying to fix it

About feelings

Non active, not telling anyone what to do

Admitting can’t make it better

Not asking for something or someone to change feelings

Recognize loss

Not time limited

The Worst Traits

They want to fix the loss

They are about our discomfort

They are directive in nature

They rationalize or try to explain loss/li>

They may be judgmental

May minimize the loss

Put a timeline on loss

The above information is meant to be used as a guideline. Everyone goes through the grieving process in their own way. It is very important to understand that point. It is also important to remember while the above is a guideline, the most important thing is your intent. So if you say a worse thing but you said it out of love the person will understand. The guideline will hopefully make you more comfortable to offer support to your grieving loved one or friend. Because someone who is grieving need people to talk to without people feeling awkward. Also everyone is around immediately after the death and through the funeral services. Most people then go back to their normal lives. However, those who were really close to the person are still grieving and trying to figure out how to proceed with life. So don’t forget the person who is grieving can use emotional support for the first year especially. Therefore, do not forget to call, send a card or stop by occasionally. Especially around the holidays and birthdays.

Dr. Michael Rubino has over 20 years experience treating adolescents, children and their families. For more information regarding Dr. Rubino visit his website http://www.rcs-ca.com or on Twitter @RubinoTherapy

Improving Communication with Your Teenager

Improving Communication with Your Teenager

As a psychotherapist works with teenagers and their parents, I have heard a common complaint from both teenagers and their parents. Both complain about difficulties with communication. Teenagers feel that their parents don’t understand them. And parents tell me they feel like they cannot communicate with their teenagers.

I have stated in prior articles that if parents want to have good communication with their children, they must work on the parent-child relationship early. The earlier the better. If you wait until your child in a teenager, it is very difficult due to the brain development during puberty. When children are born their brains are not fully developed. Their brains, reasoning and communication skills continue to develop as a child grows. Parents need to be prepared for these changes.

I recently read a blog by Dr. Denny Coats which deals with this issue. He breaks the issue down to thee points for parents to understand and work on. I think these three points make it easy for parents to understand what is occurring and what they need to do. So hear they are:

1. Improve your communication skills

You can get away with almost any way of communicating during early childhood; but once adolescence arrives, reacting in the typical way not only won’t get you the results you hope for, it will erode the relationship. In my opinion, five skills matter most.

Listening. If learning only one skill is all your busy life permits, this is the one you should focus on. Learn all you can about listening and set a goal of to continuously improve the way you listen for the rest of your life.

Encouraging your child to think – analyzing, evaluating, learning from experience, problem-solving, decision-making, goal-setting, planning, and organizing. Yes, you’re a lot smarter than your child and you can the thinking for them, just as you’ve done during early childhood. But these mental skills take time and quite a lot of repetition to master, and your child will need them to succeed in a career, life and relationships.

Giving effective feedback – both praise and constructive feedback. Your child will need it, but you need to offer it in a specific, positive way, so that it both guides and encourages.

Dialogue. When you have differences of opinion, arguing is the instinctive reaction. The problem is that it resolves nothing and tends to alienate the child. You can learn to share and probe each other’s thinking, instead.

Conflict resolution. When your child wants something that is unacceptable to you, it’s possible to explore other alternatives that satisfy both your needs and those of your child.

These are the skills you’ll need to deal with daily challenges and opportunities and to have the dozen or so “talks” every parent should have with their growing child. Search my blog for articles about these skills. The online self-paced Strong for Parenting program has videos, articles and tip sheets about these skills. Begin experimenting with one skill at a time and learn from your experiences using it with your family.

2. Get smart about the brain development that will happen during adolescence.

It will be invisible, slow, silent and relentless, with enormous consequences. So much depends on the kind of thinking your child exercises during the teen years, and there’s much you can do as a parent to optimize the result. I wrote the free ebook, The Race against Time, to help parents appreciate what’s going on and what they can do.

3. Acknowledge that during adolescence, you’ll be raising an adult, not a child.

Yes, prior to puberty, you are definitely dealing with a child. And after puberty, you won’t be dealing with an adult. Your kid will be a no-longer-a-child-but not-yet-an-adult, what we call an adolescent.

During those six or seven years before he or she leaves home to go to college, start a career, enter military service, or even start their own family, your child hopefully will construct the foundation for the mental skills that will be needed for adult life. And aside from academic learning, teenagers have plenty of social and life skills to learn. if you think of your child as an “apprentice adult,” you’ll deal with them on that level, expect more of them and give them opportunities to learn the skills and wisdom they’ll need. If you realize you’re helping your child become a successful, responsible, happy adult, you can get a lot done. And believe me, for too many teenagers much of this development is haphazard or nonexistent.

So start now. Start improving the communication skills that matter. Help your child practice the mental skills that will give them a superior mind. Start thinking of your tween as an “emerging adult,” so that month by month and year by year you can help them prepare for adult life.

Dr. Michael Rubino has over 20 years experience working with teenagers and their parents. For more information regarding his work or private practice please visit his website at http://www.RubinoCounseling.com or Facebook page http://www.facebook.com/drrubino3.

Facts about Children and Guns

Facts about Children and Guns

With the recent shootings around the world and San Diego, I hear many children and teens talking about their safety at school and around town while they are playing. Many teenagers seem to believe if they have a gun that will keep them safe. While research this issue I read an article by Cody Fenwick regarding children and gun violence. His article was very alarming. September was dedicated to suicide prevention and October is dedicated to the issue of bullying so this month and last month were dedicated to safety issues involving teenagers and children. Therefore, it seems appropriate to address the issue of guns because they are a popular method of suicide and they can be used to bully kids too.

Many of us feel because we live in Pleasant Hill, Walnut Creek or Lafayette that our children and teenagers do not have to worry about gangs or gun violence. Unfortunately, this is not the truth. According to a new research study in the Journal of Pediatrics, guns continue to be the third-leading cause of death for Americans younger than 18 years old, killing around 1,300 children and teenagers a year in the United States. In addition, almost 6,000 children and teenagers are injured per year. Many teenagers are permanently disabled from these injuries.

The study examined data from the Centers for Disease Control and Prevention and the Consumer Product Safety Commission between 2002 and 2014. The study found that boys, especially older boys such as teenagers and minorities, were much more likely to be the victims of gun violence. The study did not say anything about where the boys lived. The facts are children who are male and teenagers, are at a higher risk for becoming a victim of gun violence. Therefore, teenagers in our area are at risk of becoming a victim of gun violence.

The study does indicate there has been a decrease in accidental deaths such as boys cleaning a gun. However, the rate as a method for suicide has increased. I have mentioned before that suicide is the third leading cause of death for 10 year old boys. This study confirms that statistic and indicates the preferred method of suicide for boys and teenagers are guns. According to Katherine Fowler, one of the lead researchers at the CDC, “Firearm injuries are an important public health problem, contributing substantially to premature death and disability of children.” Understanding their nature [guns] and impact is a first step toward prevention.”

When we look at these numbers, can anyone argue against taking steps to protect our children? Can you imagine a 10 year old boy using a gun to kill himself? Can you imagine a 10 year old boy feeling that his life is so bad at the age of ten that death seems like a better option than living?

The study indicates that in recent years guns were responsible for a large number of adolescent, males who were murdered. The study documented that deaths in the category of murder for boys under the age of 18 years old decreased to 53 percent. This is a decrease yet the rate is still 53%. The other causes of gun-related deaths include:

• 38 percent — suicides

• 6 percent — unintentional deaths

• 3 percent — law enforcement/undetermined cause

The study found 82% of deaths by guns were boys. This means 82% of gun deaths were boys who were children or teenagers. Putting it another way, this means these boys were not even 18 years old yet at the time of their deaths. The study also found that white and American Indian children have the highest rate of suicide using a gun.

We also like to think that the United States in one of the most advanced nations in the world. However, the statistics show that the United States has the highest rate in the world for children under 14 years old committing suicide. Again, the United States has the highest rate of children under 14 years old using a gun to commit suicide. That number scares me and is appalling to me. However, as an adolescent and child psychotherapist, I do not doubt it. I have heard 6 year old boys seriously discussing suicide.

Furthermore, I hear teenagers routinely talking about needing to carry a knife or gun with them for protection. They tell me you never know when you will be jumped and you need to be able to protect yourself. In fact, a few years ago a teenager was shot on his front door step in Danville over a marijuana deal. When I mention to teens the risks they are taking, they tell me there is no guarantee they will live until 30 years old. They would rather die protecting themselves than doing nothing.

As a society, we need to look at these numbers and ask ourselves some questions. What are we going to do in order to improve gun safety? Most importantly, why are children as young as 6 years old thinking about suicide? Also what are we going to do so that children who are suicidal have access to mental health care? This is our problem because it does happen in Pleasant Hill, Walnut Creek and Lafayette.

Dr. Rubino has 20 years experience as a psychotherapist working with children and teenagers. For more information about his work or private practice visit his website at http://www.RubinoCounseling.com.

Mother’s Day is not A Happy Day For Every Child

Mother’s Day is not A Happy Day For Every Child

Many people assume Mother’s Day is a happy day for people because they can honor their mother. However, for some adults, it is not a happy day. For some people their mother may have died when they were children. For some people their mother may have left them when they were children and they had to live in foster care. For others, their parents separated and their father raised them and they rarely or maybe never saw their mother. Therefore, Mother’s Day may not be a happy day. Also for children who were raised in foster care all their lives, today typically is a very difficult day.

While this may not be a happy day for adults, it also can be a very difficult day for children too. Some children may be dealing with the death of their mother. As I stated above, some children may have a mother who left the family and are not involved with them any longer. Seeing the television commercials or having other family members tell them that it still can be a good day can be difficult for them.

I work with many of these children in psychotherapy. Many don’t express their feeling, but they tend to deal with the emotional pain by acting out. They may be very oppositional during the week and the day as away to express their feelings. Other children may isolate and not want to be involved with anything having to do with Mother’s Day.

I have had parents ask me how they should handle Mother’s Day when a parent has passed away or left the family. They understand that it is a difficult day, but they do not know what to do in order to help their children.

My recommendation is let the child cope with the day in the way they need to. Try not to make an issue about the day. The other thing I recommend to a parent is to talk to their child. Acknowledge that Mother’s Day may be difficult but it is just one day. They may have a rough day today but tomorrow is another day. I also recommend to a parent, when a parent has passed away, to ask the child if there is anything they may want to do. A child may want to release a ballon with a note, they may want to visit the cemetery or they may want to do something for an aunt or another female role model in their life. If they do have an idea, go with what they want to do. If they don’t have an idea, let them know that is okay. If they come up with an idea then you can do it. If they do not have an idea, then remind them it’s just one day that you all need to get through and tomorrow will be better.

This approach can help children whose mother has left the family. Many children may believe their mother will return one day. Confronting this belief around Mother’s Day is not the time to confront it. However, if they have an idea regarding how they want to honor their mother, allow them to do it.

Hopefully this will help parents understand the issues their children may be dealing with on Mother’s Day and make it easier for everyone.

Dr. Michael Rubino is a psychotherapist with over 20 years experience treating children and teenagers. For more information about Dr. Rubino’s work or private practice visit his website http://www.RubinoCounseling.com or on Facebook at http://www.Facebook.com/drrubino3.

Issues related to Teenage Concussions

Issues related to Teenage Concussions

Many high school students look forward to participating in high school sports and other physical activities as part of their high school experience. While school may be ending for the year, many athletes will be practicing over the summer for next years games. Football is one example of a sport where the players practice the entire summer in order to be ready for the next school year’s season. Typically most people look at the fun and the positive experience these activities provide for students. However, high school athletes do get hurt, sometimes seriously. High school athletes do suffer broken arms and legs, but they also suffer concussions, traumatic brain injuries and spinal cord injuries. Parents are now learning that “basic” concussions in teenagers are more common than people think and can create more problems that people think. A concussion can cause physical impairment such as not being able to walk or emotional issues such as a teenager suddenly having anger problems or depression. Unfortunately, this year we had example of these issues, when a wrestler from College Park High School suffered a spinal cord injury and was paralyzed.

As a result of these head injuries, many teenagers develop Post Concussion Syndrome after a concussion. Teenagers can have violent mood swings, difficulties concentrating and with memory. This can cause problems at school and with family and friends. I have seen teenagers who get so depressed by these changes that they become suicidal. Post Concussion Syndrome can last a year and often physicians do not warn parents or teenagers about this syndrome. This makes matters worse because they feel like they are crazy because they don’t understand why they have the symptoms. Also these symptoms can create problems at school that the student may need accommodations for in order for the student to understand the classes.

We have been hearing more and more about concussion in professional sports in recent years. We have also seen professional athletes walk away from their careers because they are not willing to risk the after effects of multiple concussions. A fact that some in professional sports do not want to be publicized. Will Smith stared in a movie regarding a professional football player and how his life significantly changed after several concussions. The National Football League tried to stop this movie from being made and shown, but they lost.

However, we do have examples. Mohammad Ali is the most notable example of how multiple concussions can change a person and leave them disabled. Also a news anchor for ABC News documented how his life changed after receiving a traumatic brain injury while covering the war in Afghanistan.

Concussions, Traumatic Brain Injuries and Spinal Cord Injuries also occur in teenagers. Teen athletes such as football players routinely suffer concussions, traumatic brain injuries or spinal cord injuries. Many of these athletes suffer permanent brain damage such as difficulty remembering things or emotional issues such as mood swings. Also a number of high school athletes do die from concussions every year.

A research study from Boston University released shows that boys who play football before the age of 12 years old are more likely to have memory problems and problems making decisions as adults. This study also shows that boys who play football before age 12 are three times more likely to develop clinical depression as an adult. The study suggests the reason this occurs is because around the age of 12, a child’s brain is undergoing a great deal of development at this age. Robert Stern, one of the authors of the study, explained that “the brain is going through this incredible time of growth between the years of 10 and 12, and if you subject that developing brain to repetitive head impacts, it may cause problems later in life.”

Another MRI study, by the Wakes Forest School of Medicine, showed that boys between the ages of 8 years old to 13 years old who played even just one season of football showed signs of diminished brain function.

High school athletes are not the only teenagers at risk for concussions or other serious injuries. Teens in general are at risk because teens are willing to engage in risky behavior such as jumping off something or racing cars. Many teens feel they are safe. They hear about these issues but think it would never happen to them. However we never know who it will happen to. Therefore, parents you need to educate and monitor your teenager’s behavior. If you have a teen athlete, you may need to make the decision to stop them from playing a sport if they have suffered a couple concussions. This is not easy but you must think of their lives after high school.

Also boys are not the only ones at risk for concussions. Girls are at risk for concussions and other serious injuries. In fact, some studies show that cheerleaders are at a higher risk of getting a concussion than football players. Cheerleaders do not use helmets and have no head protection. Also many people assume a child needs to be knocked out in order to sustain a concussion. This is not true. You can sustain a concussion without losing consciousness. So football players are not the only one at risks. Any high school athlete is at risk – boy or girl. Anything that causes a jarring of the head can cause a concussion. Our brain sits in fluid in our skull. Therefore any jarring force can cause the brain to hit the side of the skull and cause a concussion. This is why all high school athletes are at risk for concussions.

I have included a link to a YouTube video where a physician describes the basic information about what happens to a brain during a concussion and the process of recovery from a concussion. This is a must see for any parent https://youtu.be/zCCD52Pty4A.

In addition to this video I have included a fact sheet from the CDC regarding information about concussions for you to review http://www.cdc.gov/headsup/pdfs/schools/tbi_factsheets_parents-508-a.pdf.

I have also included this link from the CDC which helps parents, coaches and schools https://www.cdc.gov/headsup/.

Parents need to talk to their teenagers’ school and coaches regarding making sure that they use the latest safety equipment for their sport. Parents may even want to research what the latest safety equipment so if your teen’s school is not using the latest safety equipment, you can inform the school. The ultimate goal is we want high school sports to be fun and safe for high school students.

Dr. Michael Rubino has over 20 years experience working with teenagers and their families. For more information on Dr. Rubino’s work or private practice, where he treats Post Concussion Syndrome, please visit his website at http://www.RubinoCounseling.com or follow him on Twitter @RubinoTherapy.

20 years After the Columbine Shootings

20 years After the Columbine Shootings

This week marks the 20th anniversary of the Columbine High School shooting. Unfortunately, we have not changed many gun laws and the mass shootings continue. On the 17th anniversary ABC interviewed the mother of one of the shooters about the warning signs she missed. If it was only that easy, but it is not. A great deal was missed by many and there is plenty of blame to go around. The parents did not create the Columbine shootings, but they must live the rest of their lives with what their sons did that day.

First in our society, there is a huge negative stigma regarding mental illness and psychotherapy. I see many teens who would benefit from psychotherapy, but the teenager resists because only “crazy” people go to therapy and they are not crazy. The parents often don’t force the teen to go to therapy because, “he is too big for me to force him to come”, or “if he is going to go I want him to want to go. I think forcing him may cause more damage.” So parents are allowing teens to make the decision about psychotherapy because people believe it is not that important unless you are crazy. If their son’s pedestrian said their son needed surgery, the parents would not allow their son to decide about having or not having surgery.

Another issue facing parents is that belief that only crazy people go to therapy. They don’t want their child or family to be seen as the “crazy one or the weird one.” In these situations, I often hear well we will think about it and try changing things at home and if we feel we really need help we will call. Typically, I receive the call when their son is in juvenile hall for a number of crimes. They are calling too late.

The other problem is the school systems. I work with parents who are reporting symptoms of depression and their son feeling overwhelmed by school or being bullied at school. They ask the school for help, but the school acts like the parents are over protective. When I become involved and let the school know the student needs help and will need an IEP (Individualized Educational Plan), the school down plays the behavior or blames the parents. They don’t want to do an IEP because it will cost the school money. I have seen schools tell parents all kind of lies to avoid giving a student an IEP and what the school is forgetting is the help the student desperately needs.

Finally, our health care system is to blame also. One Thanksgiving Day, I was paged by a parent I never met. She had been given my number by the County Hospital. She brought her son there because he was suicidal. The hospital told her they had no more beds for suicidal teens and could not help. She had my service page me begging for help. Her son definitely need to be hospitalized. There was nothing I could do on an out-patient basis. I gave her several numbers to hospitals in the areas and told her if all else fails go to an ER room because they cannot refuse to treat.

I have seen this with other teenagers that I have treated. Parents are begging and pleading for help. Their insurance company won’t pay for in-patient treatment or only pay for two weeks when it is a 60 day program. The cost for the treatment programs is often $10,000 a month. A price most families cannot afford. At times when they do receive the insurance authorization, they cannot find an in-patient program with an opening because there are not many of these programs. These parents are doing everything they should but because of society’s view point that mental illness is not real, they find it very difficult to get their children the help they need.

A good example is the shooting at UC Santa Barbara. The parents knew their son had emotional issues and had been trying to get him help. When he went to school in Santa Barbara and his mother found a file on his computer, they knew people were in danger. They called everyone they could think of but were dismissed as over reacting.

An act such as Columbine doesn’t happen because one parent ignored symptoms. An act such as that occurs because parents, friends, family, teachers, school and our mental health system missed warning signs and failed to make the teenager get help. Mental health does deal with life and death situations not just someone crying. Mental health issues are just as serious as what occurs any Friday night in ER rooms in hospitals all over the country.

ABC asked the mother to look at herself, I am asking you to look at yourself and our approach to mental health. Columbine happened 20 years ago and every year since we have had more school shootings and more deaths. When ABC News interviewed the mother of the shooter in 2016, according to the CDC, we already had more students deaths by school shootings in 2016, than in the preceding 17 years. In one year more deaths than when you add up the preceding 17 years. This is a very scary, and sad statistic. We need to look at ourselves and ask, what are we going to do to help prevent these senseless killings, not the mother of the Columbine shooter. We as a society must change. The life you save may be your own or your own child’s life. New Zealand showed us that change can occur. Within three weeks of the shooting, all assault weapons had been banned in New Zealand. It’s 20 years later and the United States has done very little to implement safer gun laws. However, we do terrorize school children by undergoing routine mass shooter drills. What are our priorities?

Dr. Michael Rubino specializes in treating high risk teenagers, and teenagers and children who have survived traumatic events and their families. For more information on his work or private practice visit his websites at http://www.RubinoCounseling.com, http://www.rcs-ca.com or his Facebook page http://www.Facebook.com/drrubino3.