Helping Kids Cope with Today’s World

Helping Kids Cope with Today’s World

We are expecting children and teenagers to cope with and adjust to a a number of teenagers. One main issue is the pandemic and Coronavirus. They have had to deal with remote learning and then all of a sudden they are expected to go back to school. In addition to the changes in school many teenagers are dealing with the deaths of parents, grandparents and other people close to them. In addition they were locked in their houses for a year without being able to see friends. This is a lot for children and teenagers to adjust to.

Now we are starting to reopen the Country and children and teenagers again have to cope with mass shootings again. Therefore, they are dealing with more people dying and afraid that they may be killed too. As of today, June 13th, there have been 270 Nass shootings. This is a significant increase from 2019. We have experienced a 65% increase in Nass shootings since 2019 and the year is only half over (Gun Violence Archive).

Teenagers and children are also seeing a tremendous increase in violence in our Country. Hate crimes against Asian Americans have increased significantly and so have hate crimes against people who are Jewish (CDC). In addition there is violence occurring around people having to wear face masks in certain situation. A flight attendant on Southwest Airlines had her front teeth punched out of her mouth by a passenger because she asked him to wear a masks. Besides people arguing about face masks, they are arguing about the Coronavirus vaccinations which ever Public Health Professional states we need to overcome this pandemic. However, we are hearing people purpose crazy ideas such as the vaccinations will make you magnetic and Bill Gates has placed mico chips in the vaccines. The pandemic is scary enough without people making up insane conspiracies that may scare children.

Add to these issues such things as the violent attack on the US Capital Building and we have children and teenagers living in a chaotic environment. To add to the pressure we are expecting children and teenagers to simply adjust to all the chaos. We expect them to ignore it and go on like nothing has changed. Children and teenagers are expected to be able to achieve at school and not act out due to the chaos in their lives.

It’s not realistic and it’s not happening. There is a significant increase in the number of teenagers and children reporting anxiety disorders and depression. Additionally, we have seen an increase in the number of teenagers committing suicide and dying from drug overdoses. Teenagers and children are desperately looking for a peaceful environment. In my office we have seen an increase by a factor of 20 of teenagers and children seeking therapy due to the chaos. We must provide teenagers and children with mental health care and sane gun laws to help them cope with this chaos they are experiencing.

I have included a link to an article which provides suggestions parents can try to help their children and teenagers cope with the chaos we are living in currently. https://www.kqed.org/mindshift/57946/striving-or-thriving-steps-to-help-kids-find-balance-and-purpose.

Dr. Michael Rubino is a psychotherapist with over 20 years experience treating children and teenagers and trauma victims. For more information regarding his work visit his website http://www.RubinoCounseling.com or his Facebook page at http://www.Facebook.com/drrubino3 or his podcasts on Spotify or Apple.

Teenagers Learn About Life by Making Mistakes

Teenagers Learn About Life by Making Mistakes

Dealing with teenagers, at times, can be very difficult for parents, especially when teenagers think they have all the answers. In my experience as a psychotherapist who has been working with teenagers as for over 20 years, I am a strong believer in allowing teenagers to learn from their mistakes. When they make mistakes there are consequences that follow these mistakes. From my experience, teenagers need to be allowed to make mistakes and learn from the consequences. I know some parents try to warn their teenagers about potential mistakes. However, many teenagers feel they know more than you. Therefore, allowing them to make mistakes is the only way some teenagers learn that their actions have considered .

As I just stated, teenagers being allowed to make mistakes helps to teach teenagers that their actions have consequences. They also put responsibility for the mistake on to the teenager. Therefore, they cannot blame parents or teachers for their mistakes. They have to deal with the consequences of the choices they made. They cannot blame you because they made the choice not you.

As a way to help teenagers learn from their mistakes is to set up a behavior contract. A written contract which specifies the consequences for your teenager when they make a mistake saves a lot of arguments. A written construct signed by you and your teenagers which spells out their consequences, if they make a mistake or poor decision can save you and your teenager a lot of arguments. Also it helps your teenager to take responsibility for their actions because the contact focuses on their choices only.

While I believe contracts and consequences work well with teenagers, some parents have difficulties. I often hear from parents that their teenager doesn’t care about the consequences or the contract. The parents find this very frustrating. Therefore, I have listed below suggestions that can help you improve the odds of a contract and consequences working with your teenager.

1. Use Consequences That Have Meaning

It’s almost never effective to give your child a consequence in the heat of an argument. Often, parents will be either too harsh or too lenient, because nothing appropriate comes to mind immediately. I advise parents to sit down and write a Consequences List and then discuss it with your teenager. If they are included in the process, the likelihood of success is higher. When compiling a list of consequences, remember that you want the consequence to be things that will get your teenagers attention, because you want your child to learn from the consequences. If, like most teens, your teenager acts like they cannot live without their cellphone, don’t hesitate to use losing use of their cellphone as a consequence. It’s also important to think about what you want him to learn—and this lesson should be attached to the consequence. So let’s say your teenager swears at his younger siblings all the time. Obviously you want him to stop swearing and use more appropriate language. Therefore, an effective consequence would be that he would lose his cellphone for 2 days. This gives him time to think about other ways he can handle his behavior. You may even try talking with him about other ways to handle himself instead of swearing.

2. Don’t Try to Appeal to Charge A Teenager’s Behavior with Speeches

Yes as a parent you are trying to teach and educate your teenager about how to act and treat others as adults so they can function in the world. However, remember your teenager thinks they know everything about today’s world and you are out of touch with today’s world. Therefore, if you try lecturing or speeches, they automatically tune you out and don’t listen to what you are saying. When everything is calm, you might try mentioning to them that you would like to talk with them. An informal conversation, especially with boys, tends to be more effective than a lecture.

3. Make Consequences Black and White

When you give a consequence, the simpler you keep things, the better. Again, you don’t want to get into legalese or long speeches. What you want to do is lay out your consequences for your teenager’s inappropriate behavior very clearly. It’s often helpful if he knows ahead of time what will happen when he acts out. Just like there are speeding signs on the highway, the consequences for your teenager’s behavior should be clear to him. Therefore, using a contract allows you to make it clear to your teenager if they make this choice then here is the consequence. Also by having them sign the contract, they cannot say they were not aware of the rules. Also it removes you as the bad guy. You are not imposing a punishment, you are simply complying with the contact that you made with your teenager. I often point out to teenagers that the contract is an insurance policy for them. If they make a mistake, their parents have to stick with the contract. Therefore, if their parents were really upset at the moment and wanted to remove their cellphone for ever, but the contract only states a week, their parents have to go with the week. This often helps with getting teenagers to accept the contract.

4. Have Problem-Solving Conversations

I think it’s vitally important to have problem-solving conversations with your teenager after an incident has occurred. Obviously, you want to wait until everyone is calm. When everyone has settled down then try a conversation about what they can do differently or help they can ask for if a similar situation occurs and this may help them avoid making a mistake and getting into trouble again in the future.

Conversations like these are how you get your teenager to think about alternative solutions to problems which can help them make better choices. Also reminding them that they can ask for help can be a tremendous help. Often teenagers think that they must solve all their problems on their own. Teenagers, especially boys, look at asking for help as a sign of weakness. It is helpful to remind them that no one has all the answers and at times the mature thing to do is to ask for help. Therefore, asking for help is not always a sign of weakness.

5. Don’t Get Sucked into an Argument over Consequences

Don’t take the bait every time your teenager is trying to argue with you. Most teenagers verbal skills are not fully developed. However, most teenagers know if they can get you into an argument that the original topic will get lost and you end up arguing about something else. It’s not that teenagers have this planned out in their heads, but as I said their verbal skills are not fully developed. Therefore, they feel more comfortable in an argument because those skills are developed and they have some idea how to handle the situation. Therefore, if you are getting pulled into an argument call a time out and say you prefer to discuss the issue when you are both calm. This will surprise them and hopefully cause them to think about the situation.

6. Don’t Teach Your Child How to “Do Time”

Many parents get frustrated and ground their kids for long periods of time in order to make the punishment stick. Personally, I think that’s a mistake. If you simply ground your child, you’re teaching him nothing. But if you ground him until he accomplishes certain things, you can increase the effectiveness of the consequence. So if your teenager loses his video game privileges for 24 hours, he should be doing something within that time frame that helps him improve his behavior. Simply grounding him from his video games for a week will just teach him how to wait until he can get them back. He is not learning anything about the mistake he made and he is also learning nothing about how he could have handled the situation differently. Again, we want consequences to be learning experiences. A consequence that doesn’t fit the crime will just seem meaningless to your child, and won’t get you the desired result. Remember, you don’t want to be so punitive that your child simply gives up. That will never translate to better behavior.

7. Engage Your Child’s Self-interest

Learn to ask questions in ways that appeal to your child’s self-interest. So for example, you might say, “What are you going to do the next time you think Dad is being unfair so you won’t get into trouble?” In other words, you’re trying to engage his self-interest. If your child is a teenager, he won’t care about how Dad feels. Adolescents are frequently very detached from that set of feelings. They might feel guilty and say they’re sorry later, but you’ll see the behavior happen again. So learn to appeal to their self- interest, and ask the question, “What can you do so you don’t get in trouble next time?”

8. How Will I Know If a Consequence Is Working?

Parents often say to me, “My child acts like he doesn’t care. So how do I know if the consequence I’m giving him is actually working?” I always tell them, “It’s simple—you’ll know it’s working because he’s being held accountable.” Accountability gives you the best chance for change.

9. Some Things Should Never Be Used as Consequences

In my opinion, there are certain things that should never be taken away from kids. For instance, you should never prohibit your child from going to the prom. Not ever. That’s a milestone in your child’s life; personally, I think that milestones should not be taken away. Your child is not going to learn anything from that experience. Unless the mistake was so big such as robbing someone then you may need to go that far. I recommend using your own judgment regarding how your teenager acts before making this a consequence.

The same approach should be taken for sport. Teenagers can learn a great deal from sports. However, if they make a severe mistake missing a practice or a game maybe an appropriate consequence. However, removing them from the team all together maybe a mistake. However, remember the coach has the ultimate power over his players. Many teams have a code of conduct that players must follow. Therefore, if they violate the coaches rules, they maybe removed from the team. This will impact them more than if you did it.

10. Don’t Show Disgust or Disdain

When giving consequences to your teenager, you need to be consistent and firm, but don’t show disgust or disdain. If you are attacking them as a person, their sense of self is not fully developed yet. As a result, you may inflict a wound to their self-esteem that may cause more problems than you intended. You are trying to raise someone who can function as a healthy adult, not somebody who feels they’re a constant disappointment to you. It’s very important to shape your behavior so that your child knows you’re not taking his mistakes personally. Remember, the look on your face and the tone of your voice communicates a lot more to your child than your words do. Positive regard is critical for getting your message across.

It’s important to remember that life is very tough for many teenagers, especially with Nass shootings and the Coronavirus. Going to school is difficult, both academically and socially, and there is tremendous pressure on children and teens to perform today. Personally, We need to remember that and teenagers should be recognized and respected for what they have to deal with in today’s world. Think of it this way: what you’re really trying to do is work on your child’s behavior to get him to try to do different things. So if your child misbehaves and you ground him from everything indefinitely, you’re losing sight of all the other things he did right—and he will, too.

Consequences have shown to be an effective way to help teenagers learn what is appropriate and not appropriate. It is an approach I strongly believe in. Hopefully these tips will help you use consequences effectively with your teenager.

Dr. Michael Rubino has over 20 years experience working as a psychotherapist with children and teenagers. For more information about Dr. Rubino’s work or private practice visit his website www.RubinoCounseling.com or his Facebook page www.Facebook.com/drrubino3.

How Many Children and Adults have to Die before We Act?

How Many Children and Adults have to Die before We Act?

During the past several months there has been a significant increase in mass shootings and people being killed by guns. We just had another mass shooting today in San Jose, California and 8 people were killed. Additionally, This past weekend over 250 people were killed by guns. The weekend before there were approximately 200 people killed in mass shooting or by a gun. Additionally, I hear many children and teens talking about their safety at school and around town while they are playing or hanging out. Many teenagers seem to believe if they have a gun that will keep them safe. While researching this issue of gun violence, I read an article by Cody Fenwick regarding children and gun violence. His article was very alarming. Since there has been a significant increase in mass shootings 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. In addition teenagers who cannot tolerate the bullying they have to endure every day often use a gun as their method of suicide. Some may use a gun to act out their frustrations too.

Many of us feel because we live in Pleasant Hill, Walnut Creek, Lafayette or Orinda 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 by guns. Many teenagers are permanently disabled from these injuries. For teenagers who commit suicide, guns are the second-leading cause of death. The CDC has recently moved suicide as the third-leading cause of death for teenagers to the second-leading cause of death. This is a scary fact that the rate of teenage suicides are increasing not decreasing.

The study in the Journal of Pediatrics 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 regardless of where they live. 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 no longer the third leading cause of death for 10 year old boys. It is now the second leading cause of death for boys 10 to 18 years old. 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? At the age of 10, he has given up hope for a decent life. This is a sad fact.

The study also 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 or there will be a mass shooting 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 which went bad. When I mention to teens the risks they are taking, they tell me there is no guarantee they will live until 30 years old anyway. 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? How are adolescent boys getting access to guns? 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, Lafayette, Orinda and Danville.

Finally, we are only in the month of May and the number of Americans killed to date is more than in 2019 (CDC). We are seeing mass shootings increase, violence against Asian Americans and Jewish Americans and police killings. What is happening in the United States? We are the only Country in the world dealing with mass shootings. However, we claim to be the most advanced nation in the world. Maybe Congress needs to look at these numbers and think about their actions. Denying the attack on the US Capital was not violent is crazy. We have videos of people assaulting the Capital Police and demanding to hang the Vice President. The Republicans in the House of Representatives remove Represetative Cheney from her leadership post because she won’t lie and say that Biden did not win the Presidential Election. Finally, you have a Republican representative comparing the requirement to wear masks in the House Chambers because everyone in the House of Representatives is not vaccinated to the Holocaust and the Republican Party does nothing. Someone who speaks the truth is removed and someone who makes racist, homophobic and anti Semitic statements is praised. This may be one part of the issue. We need to support people who are treating other people appropriately and we need to speak out and refuse to allow people who are treating people like garbage to continue to be allowed to treat people like garbage.

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 www.RubinoCounseling.com or his Facebook page www.Facebook.com/drrubino3.

Gifted Children can have Learning Disabilities Too

Gifted Children can have Learning Disabilities Too

Many parents are very happy to hear that their child has been classified as “gifted.” They assume that their child will do very well in school and have a very bright future because they are “gifted.” While “gifted” children may excel in certain academic areas, often they have difficulties in other social situations or academic areas. These children are called twice exceptional children. Research by John Hopkins estimates that one out of five children are twice exceptional or 2E which is a more common term. Therefore, John Hopkins estimates that there are approximately 700,000 2E children in the United States.

Wikipedia defines 2E children in the following way:

A 2e child usually refers to a child who, alongside being considered gifted in comparison to same age-peers, is formally diagnosed with one or more disabilities. Although 2e can refer to any general disability, it is often used to refer to students with learning disabilities, although research is not limited to these areas, and a more holistic view of 2e can help move the field forward. The disabilities are varied: dyslexia, visual or auditory processing disorder, obsessive-compulsive disorder, sensory processing disorder, autism, Asperger syndrome, Tourette Syndrome, or any other disability interfering with the student’s ability to learn effectively in a traditional environment. The child might have a diagnosis of attention deficit hyperactivity disorder, or diagnoses of anxiety or depression.[6] Often children with 2e have multiple co-morbid disabilities than present as a paradox to many parents and educators.

Many people may find this hard to believe, however, as a psychotherapist who specializes in treating children and teenagers, I have seen many “gifted” children who do have the disabilities listed above. A common issue I have encountered is that “gifted” children often have difficulties making friends and dealing with social situations. If they had not been classified as “gifted”, parents would see that they do meet the criteria for Asperger’s Syndrome. Another common issue I have seen in psychotherapy with “gifted” children is that they have difficulties organizing their ideas and maintaining sustained attention. These children meet the criteria for ADHD.

One of the primary difficulties for these children is since they have been classified as “gifted,” many schools do not want to offer support services for a “gifted” child who has ADHD or a processing problem. Because they are not receiving the academic support they need, many of these children suffer with depression, anxiety and low self-esteem. These children often become very frustrated and start to act out at home and at school. They are trying to tell the adults in their lives that everything is not okay and they need help. I have seen this many times with “gifted” children that I see for psychotherapy. It also creates a great deal of stress for the parents. They can see their child is having difficulties and the child is complaining about difficulties, but the school tells the parents the child is doing fine because they are “gifted.”

The research from John Hopkins University shows us that the two are not mutually exclusive. A child can be “gifted” in one area and have a learning disability in another area of life. Therefore, a “gifted” child may need a 504 plan or an individualized educational plan (IEP). Therefore, if you are the parent of a 2E child and you notice that your child is having difficulties at school, do not be afraid or nervous to advocate for your child. To make this easier, I have included a link which discusses misconceptions about 2E children, 7 Myths About Twice-Exceptional (2E) Students http://u.org/2hp0dNU. I am also providing a link to a newsletter for an organization which helps parents with 2E children and advocates for them, https://www.google.com/url?sa=t&source=web&cd=3&ved=0ahUKEwiv8PmrxYDYAhUH6oMKHbmyD10QFggiMAI&url=http%3A%2F%2Fwww.2enewsletter.com%2Farticle_2e_what_are_they.html&usg=AOvVaw35GmKdn_P9FJzqMBPkMMrD.

If this sounds like your child do not panic. Arrange to have your child evaluated by a mental health clinician who is familiar with 2E children. They can help you develop a treatment plan and let you know if your child needs accommodations at school. If your child needs accommodations at school do not pay for any psychological testing for your child. According to California law, the school district has the right to test the child first. They do not have to accept outside testing, if the district has not tested the child. If you disagree with the school district’s testing, say so and request a second evaluation. This evaluation is completed by a professional not associated with the school district and the school district pays for the testing not you.

Dr. Michael Rubino is a psychotherapist with over 20 years experience treating children and teenagers. In fact, he specializes in treating children and teenagers. If you want to know more about Dr. Rubino’s work or private practice visit his websites www.RubinoCounseling.com, www.LucasCenter.org or his Facebook page http://www.Facebook.com\drrubino3.

As Schools Reopen the Issue of Bullying Returns Too

As Schools Reopen the Issue of Bullying Returns Too

As more people in the United States are vaccinated for the Coronavirus, we are seeing the number of cases and deaths significantly decline. While we have not over come the Coronavirus yet, we are able to start to resume many everyday activities. One of these activities is reopening schools and children and teenagers returning to school.

Before the pandemic most kids and teenagers complained how they hated school and wanted to stay home. However, after a year of remote learning most kids and teenagers want to go back to the classroom and also see their friends again. However, as kids return to school a common issue will return. The issue is kids being teased and bullied. In the 21st century bullying doesn’t just happen at school it now occurs on line and via texting too.

Often when a child is being bullied they do not say anything to their parents until the bullying is really bad. They are afraid, especially boys, that you will see them as weak. They are also afraid that you will be disappointed in them for not defending themselves. Parents it’s important that you understand that you have not said anything or done anything to create this feeling in your child. Our society teaches children these messages, especially boys. Children receive these messages about being strong and solving their own problems from television, music, and video games. This is what the documentary “The Mask You Live In”, is trying to address. It is on Netflix and it might be helpful if you watch it.

It is very important to take bullying very seriously these days. It is no longer just one kid calling another kid names. The bullying today occurs at school and may include threats of being killed and it goes beyond school. Now bullies can continue their bullying via text messages, emails, Facebook, Twitter, Instagram and Snapchat. So the bullying becomes non-stop. It can really make someone feel worthless and that they would be better off dead. One example of a child being overwhelmed by bullying is a 13 year old boy, on the east coast, who committed suicide because he could not tolerate the bullying any longer. The boy committed suicide to escape the bullying. He is not the first child to commit suicide due to bullying. One 15 year old girl committed suicide due to bullying and she left a note to be placed in her obituary. In the note she asked kids to be kind to each other. Some kids are turning to drugs and alcohol to numb the pain and we are seeing a significant number of accidental overdosages resulting in teenagers’ deaths. We assume they were accidents, they could also be suicides staged to look like accidents. Also suicide has recently been moved from the third leading cause of death for kids 10 to 18 years old to the second leading cause of death for kids. Therefore, if kids have been commuting suicide to escape bullying, the rate of bullying has most likely increased significantly.

Bullying is not just an elementary school issue. It occurs in High School and College too. A few years back a college student committed suicide because his roommate secretly filmed him in his dorm room with another guy having sex. When the tape was posted on the college’s email for others to see, the boy was so ashamed because he had not made it publicly known that he was gay. He was so upset and humiliated that he ended up committing suicide.

As the rates for bullying in middle schools increase so do the number of suicides and drug use increase. However, this issue also occurs in elementary school and elementary students are committing suicide or starting to use alcohol and marijuana. We know it is a very serious problem in Elementary schools because suicide it is no longer the third leading cause of death for 10 year old children. Suicide is now the second leading cause according to the CDC statistics. Also fifth graders are beginning to use alcohol and marijuana.

Additionally, I am seeing more and more elementary students in therapy because they are being bullied on line or at school as schools reopen. Many of these children are embarrassed because they feel they should be able to stop the bullying. They are also embarrassed and often don’t want me to tell their parents because they believe they must of done something to deserve being bullied. I explain to them they do not deserve it and they should not have to stop it on their own. I also explain that their parents would want to know so they can help them. I need to emphasize that Mom and Dad won’t blame you or be ashamed of you. It is amazing to see how relaxed these children become when I tell them this about their parents.

What should a parent do? One thing is parents should watch for the following warning signs that your child is a victim of a bully:

Avoiding activities they used to enjoy

Loss of friends or avoiding social situations

Problems sleeping

Complaining of stomachaches or headaches

Loss of appetite

Declining grades

Missing or damaged clothing or belongings

Self-destructive behaviors like running away from home

If you notice any of these or just have a sense something is wrong then talk to your child. However, when you talk to your child reassure them they did nothing wrong, there is nothing wrong with them and you are not upset or disappointed with them. Try to develop a game plan of how you are going to deal with it together and ask how you can be supportive. Also ask your child to promise you if they feel really sad like they want to hurt themselves that they will talk to you before they do anything. You may think this is ridiculous, but I use a no suicide contract with many children that I work with and they honor it. The contract lets them you know that you care about them and it is okay to talk about their feelings.

The other thing you can do as a parent is go to your child’s school and ask what is the school’s policy on bullying. You can also ask how the school watches for bullying, how is the policy enforced and what is being done to prevent bullying. You may ask the school to contact or you can volunteer to contact a group such as Challenge Day. This is an international organization that addresses bullying and they are located in Concord, California. I have seen their work and it is fantastic and kids love it.

Another thing you can do as a parent is start talking to your child about bullying on an occasional basis. This gives you a chance to let them know it’s not their fault and to develop a plan of action if it does occur. You should also discuss drugs and alcohol at the same time. I work with kids all day long and at times I am still shocked at how young kids are when they are starting to get involved with drugs and alcohol.

Keeping an open line of communication with your child is very important if you want them to come to you. Research still indicates that children are more likely to turn to their friends when they have a problem. This is good that they have this emotional support, but their friends don’t have the answers or solutions that they need. Remember it is best to speak to your child when you are in a calm environment and no one else, such as brothers or sisters, are around. Also remember the word HALT. It stands for:

Hungry

Angry

Lonely

Tired

If you sense your child is experiencing any of these feelings it is not a good time to talk. When you talk with your child you want it to be productive and for your child to feel like they are not being judged. Therefore, sometimes it is better to put off a conversation so you don’t end up in an argument. This is more likely to close the line of communication with your child.

I have mentioned several times that being bullied is not their fault. What I have seen from working with children who are bullies, abusive men and reviewing the research is that bullies really have very low self-esteem. In fact many times they lack a sense of themselves. The only way the feel important or alive is by putting someone else down. They do this because they are afraid the other kids might be able to figure out how lousy they feel about themselves. It is often said the best defense is a good offense. They hope that by acting like the big guy on campus that other people will see them as the big guy and they are able to keep their secret. Kids usually do this because it was done to them too.

Therefore, we need to remember the bully is usually a kid who has been abused too and is crying out for help. If we are going to stop the problem of bullying we need programs to help the bullies too. They are only repeating what they have been taught.

One last comment, I saw a school install a “buddy bench.” If anyone had been bullied, having a bad day, feeling lonely, all they had to do was sit on the buddy bench. Another student or teacher would then go over and ask how they could help. There was no shame associated if you sat on the buddy bench. It was presented as a brave choice. The school was using it as part of their program to stop bullying at school. This fantastic idea came from a 10 year old student. Children often have fantastic answers and we need to listen.

Dr. Michael Rubino specializes in working with children and teenagers. He has over 20 years experience working with children and teens especially those who are victims of trauma. For more information about Dr. Rubino’s work or private practice visit his website at http://www.rubinocounseling.com or his Facebook page at facebook.com/drrubino3 or his podcasts on Spotify or Apple.

Teenagers Continue to Experience Vicariously Trauma Daily

Teenagers Continue to Experience Vicariously Trauma Daily

Many people tend to assume only people who were directly exposed to a trauma will experience issues related to the trauma and may develop Post Traumatic Stress Disorder (PTSD). However, this is not the truth. Many people may not have lived through the trauma, but they may know someone who did or they were exposed to very explicit images of the trauma or have been hearing about the trauma a lot on the news. It may also trigger memories of a trauma they experienced in their lives or in their family. This can cause what is referred to as vicarious trauma. Vicarious trauma is when someone is traumatized by an event but they did not experience the event themselves. Simply knowing about or hearing about the event is traumatizing to them. This is happening to many children and families in the United States. However, when are we going to pay attention to the way children in the United States are being traumatized over and over?

If this sounds confusing, let’s look at what children and teenagers have been dealing with and living through the last few years. This last year teenagers and children have been living with the trauma of the Coronavirus. Their schools were closed without warning and so were the sports and other after school activities stopped suddenly. In addition they were not able to hang out with friends and had to go to school remotely.

In addition to these changes, many children and teenagers had family members they could no longer see, such as grandparents and many had family members who died due to the Coronavirus. However, they were not able to attend funeral services and say goodbye. Over 525,000 Americans died to the Coronavirus. All of those people had family members and friends who are grieving for them still. A fact we tend to overlook. However, children and teenagers are dealing with it daily especially if they lost a parent, grandparents or a sibling.

While children and teenagers are still dealing with how poorly the Pandemic was handled by the government, now many are being told we are reopening states including schools. Therefore, they no longer have to deal with remote school now they will be back in their classrooms. This brings up anxiety about how school will be because they still need to be cautious so they don’t contract the Coronavirus. Many children and teenagers have told me they are very worried about being exposed to the Coronavirus or their parents being exposed to the Coronavirus.

In addition to the Coronavirus, children and teenagers now have to worry again about mass shootings. We just started opening the Country and already there have been two mass shootings. This brings up the anxiety and vicarious trauma children have been exposed to regarding school shootings for years. They have been increasing every year since 2010 (CDC) and in 2019 by November there had been 336 mass shootings averaging out to a mass shooting every 1.2 days (Gun Violence Archive). These are overwhelming statistics for adults and we are expecting children and teenagers to cope with them. The students know there have been no changes to the gun laws. Therefore, they are having to return to school and worry about mass school shootings.

Look at what they are returning to when they return to school. Today in most United States schools, the classroom doors are kept lock while class is in session and no one can enter a school campus without checking in with the main office and they must wear an identification badge while on campus. In fact, all school employees must wear official school identification badges while at work. Many elementary students noticed these changes and have asked why the door must be locked? Students are told it is for their safety. The school is preventing any people who do not belong at the school from getting near the students. No one mentions someone with a gun, but children have heard about and remember all the mass shootings and they know why the door needs to be locked. I have many elementary students mention this to me during their therapy sessions.

Now when we were in school we had fire alarm drills in case there ever was a fire in the school. No one thought much about them. Some students felt the fire alarm was too loud but no one really worried about a fire happening at school. We never worried about it because we never heard about any school fires and people dying.

Today students face more than fire alarm drills. Schools routinely have active shooter drills. During these drills students are taught to shelter in place and to remain very quiet so the shooter will not enter their room. Therefore, besides having heard about and remembering mass school shootings, school students know they are returning to a place where they could be killed. They know they are practicing what to do in case there is a shooter at their school trying to kill them. Therefore, they worry about could a shooting happen at their school and could they die. As a result of these fears, the CDC has documented that anxiety disorders and depression had significantly increasing in children since school shootings increased and they have documented a further increase in anxiety and depression due to the Coronavirus.

To add to the trauma students now face, if there is an incident, such as a bank robbery, involving someone with a gun near a school, the police put the school on lock down. The students must shelter in place and they don’t know if the person with the gun will come to their school or not. This creates a significant amount of anxiety for children and many are traumatized by the incident. Here is another incident causing trauma for children and teenagers. How many do we expect them to cope with at their ages? When will we provide mental health care for the children, teenagers, their parents, the school staff and the first responders? All of these people are being exposed to trauma regarding the Coronavirus and mass shootings on a regular basis. This creates traumatic reactions and exacerbates old traumatic reactions.

Another issue which adds to this trauma is gun control. Since the shooting in Florida many students have been actively campaigning for sane gun control. However, nothing has been done to enact sane gun control laws. High school students know nothing is being done and elementary children are hearing nothing is being done about guns. This makes them worry because they know guns are still out there that can be used to kill them. The shooting which occurred in New Zealand cause high school and elementary students to wonder why our Country does nothing about gun control. Our government has done nothing even though students and parents are demanding safe gun laws. While our government debates the issue, more students were killed and may be killed. Just look at the two mass shooting this past week. However, New Zealand in a matter of 3 weeks after a shooting banned all assault weapons. This makes students wonder why we have not done anything when we have a bigger problem with mass shootings. Also it doesn’t make them feel safe at school because they do not feel like a priority. Some people will say children and teenagers are not aware of such issues. However, remember with their Smartphones they have instant access to the news and this generation of teenagers are politically active.

Working with teenagers and children I have seen that anxiety and trauma reactions have

increased significantly for children. Also children are afraid of returning to school because they might be killed. These are responses to the mass shootings. Every time there is a mass shooting children become more anxious and afraid. We had two mass shootings this last week and as I am writing this article another mass shooting is occurring in the Florida Keys. We have just started to open the Country and we already have had 3 mass shootings. This will exacerbate previous traumatic reactions and create new ones. We are expecting children and teenagers to cope with the Coronavirus and mass shootings at the same time. For those children and teenagers not directly effected by the virus or shootings, they still have to cope with the issues which results in vicarious trauma.

Furthermore, if we want to reduce the vicarious trauma children and teenagers experience, we must be honest and not lie to children and teenagers. Remember, they have their smartphones phones and easy access to news and videos clips of the news. The best example is when the US Capital building was attacked by people trying to prevent President Biden from winning the Presidential Election. There have been Republican Congressmen and Senators saying they were safe and down playing the event. However, police were killed and injured and people were chanting “hang Pence”. To me that doesn’t sound safe. Additionally, despite the video showing these protesters breaking windows, spraying police with pepper spay and beating officers with flag poles, the former President Trump went on television saying the protesters were hugging the police, waving hello and walking calmly into the Capital. This type of blatant lie causes teenagers not to trust authority figures because they may be lying and it can cause them to second guess what they saw in the video. This creates a situation where teenagers do not know who to trust and this exacerbates their fear and traumatic reactions because they feel they have no one to trust. Children and teenagers need the truth in age appropriate terms. The truth is easier to handle than their emotions.

Summing up, children and teenagers in the United States have been traumatized and vicariously traumatized by mass shootings and the Coronavirus. As we start to open up the Country, they continue to have to deal with the Coronavirus and mass shootings. Therefore, they continue to be traumatized and vicariously traumatized. Many will need psychotherapy to help them with these issues. The American Association of Children and Adolescent Psychiatry has put out the following guidelines. If you notice any of these signs or symptoms in your child or teenager it explains how to start to talk to your child or teenager and how to find the appropriate psychotherapist for your child. It is important to get a therapist who specializes in anxiety disorders and trauma issues http://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Talking-To-Children-About-Terrorism-And-War-087.aspx.

One final aspect about vicarious trauma that has emerged regarding mass shootings and the Coronavirus is suicide. Family members and survivors of mass shootings are feeling survivors guilt and as a result committing suicide. There was a report of 3 people who committed suicide who either survived a mass shooting or their child died in one. This has been occurring for a long time. It has been occurring since Columbine. Family members feel they can no longer cope with the pain. Survivors can’t cope with the guilt of surviving. Family and friends of some one who was killed or injured in a mass school shooting have had their lives changed forever! People, family members and first responders, especially hospital workers dealing with the Coronavirus are also committing suicide. They are dealing with depression, anxiety and trauma reactions on a daily basis. However, we do not have adequate mental health resources to help these people. Also people assume after a few months, most people may be grieving but can handle their situation. This is not true. They are experience anxiety and trauma that for many of them is very confusing. This only increases the anxiety and trauma. The children experiencing the shooter drills are also confused by their anxiety and traumatic reactions. They do not know what to do and this causes isolation and the feelings increase.

We must eliminate the stigma associated with mental health issues. We also need to make sure that anyone who is even remotely exposed to a mass shooting (including first responders and emergency room physicians) or anyone who has had to deal with the Coronavirus have access to mental health care. Not just for a month or two but for as long as they need psychotherapy and they should be able to receive the therapy without worrying about the cost.

We have a generation of children growing up with anxiety and traumatic reactions. If we don’t help them now, they will only get worse as time goes on. May be we need to take a lesson from New Zealand and how they responded to a mass shooting. They banned assault weapons after one shooting. We have been having shootings for 20 years and have done nothing, why? We have a great deal of information about the Coronavirus and we are arguing about wearing masks. Why?

Dr. Michael Rubino is a psychotherapist with over 20 years experience treating children and teenagers and specializes in treating trauma. For more information about his work or private practice visit his website www.RubinoCounseling.com or his Facebook page www.Facebook.com/drrubino3 or his podcasts on Spotify or Apple.

The Pandemic has Exacerbated Teenage Camouflaging Behavior

The Pandemic has Exacerbated Teenage Camouflaging Behavior

There is a behavior that is becoming common in teenage and tween girls that has been identified by an adolescent psychologist who specializes in treating teenage girls. The behavior that has been identified is called “Camouflaging.” This behavior left unidentified can lead to low self-esteem, depression, cutting, abusive relationships etc. It is becoming very common in teenagers right now. When I was a guest co-host on the Street Solider Radio Show on KMEL, and the teens were talking about how they change the beliefs and how they change how they dress because they are afraid of being rejected by their friends is Camouflaging. Covering up their outside person so no one can identify the true person inside. Friends are a very important issue for teenagers right now. Remember due to the Coronavirus most teenagers have not had contact with their friends in over a year. Many teens are worried about how their friends have changed over the year and are afraid of losing their friends.

Therefore, Camouflaging is when an adolescent girl changes how she looks in terms of make up and how she dresses, her opinions and things about herself she is willing to deny or things she will start doing in order to be accepted by her friends. The real problem occurs when the girl is changing so much about herself or does it for so long that she forgets or losses track of her real self. Besides changing how she feels, she may forget her core beliefs and do things she doesn’t believe in.

While this behavior has been identified in girls and the research appears correct, I believe this behavior applies to boys too.

Many adolescent boys change the way they dress, their beliefs and the way they act to be accepted by their friends. I hear many of these boys telling me in therapy that they feel lost. They tell me they no longer have an idea of who they really are or believe in or feel. These boys often turn to alcohol, drugs, sex and cutting. They usually turn to these behaviors to numb out their lost feeling or to try to remember their real selves. Often they turn to these in order to forget the shame and guilt they have due to something they did in order to fit in with their friends.

As a result, many teens start acting like someone they are not just to be accepted. This fear of not being accepted and forgetting their real self because they has been covering their true self up for so long or denying their true feelings for so long can result in boys and girls having low self-esteem and/or feeling depressed. It can also result in girls or boys getting involved in emotionally or physically abusive relationships because they don’t feel they are entitled to anything more. They no longer love themselves so how could anyone else love them.

As I stated this behavior can result in low self-esteem and depression in addition to behaviors as cutting, eating disorders, drug use, becoming sexually active etc. Often boys and girls cut just so they can feel as I stated above. The constant denying of their emotions or values can cause boys and girls to lose a sense of their true feelings. Therefore, cutting can occur so boys and girls feel or can cope with denying themselves. Denying their feeling or who they are can result in boys and girls feeling very confused or lost. Therefore, they look for behaviors that help them remember who they are or will numb out the list and confused feelings. They also seek behaviors that help them deal with changing their beliefs. Again this can trigger eating disorders, drug abuse or other self-destructive behaviors. This helps numb out the confusion and disappear of denying their feeling and trying to forget their true self. This can cause feelings of depression and anxiety too.

What should parents look for in their teens? If your son or daughter tries to stop wearing his or her glasses or if he or she all of a sudden changes how he or she dresses or acts these are possible warning signs. Another change could be not doing as well in their classes because they are afraid of looking too smart. Basically, if you see signs indicating that your teenager is trying to deny who they are so they will be accepted by others. It’s more than the common issue of trying to be accepted by friends, they are forgetting themselves and beliefs to fit in.

While it is normal for teenagers to make changes in their attitudes or how they dress, we are talking about something that goes far beyond normal self-expression. We are referring to changes where a teenager is trying to deny who they are because they feel they are unacceptable.

This is what we are talking about. If teenagers are changing their hair or how they dress as a way to express themselves that is normal teenage behavior. However, if teenagers are doing it just to fit in and they end up losing a sense of their true self this is camouflaging.

As I stated, Camouflaging results in depression or low self-esteem because the teenager is forgetting their true self. If they are doing it as a way of trying to experiment with their self expression, the teenager is happy and confident as stated above. This is the main point to understand. Experimenting with their dress and beliefs etc. is normal for teens and helps teenagers identify themselves, however denying or camouflaging their feelings results in teens losing themselves and many behavior problems. This is the main thing for parents to watch for in their adolescents behavior.

If you go onto Yahoo and look up Camouflaging you will find a segment on Good Morning America about Camouflaging. In fact, here is the link to the GMA segment https://gma.yahoo.com/video/parents-worry-tween-teen-camouflaging-122935763.html?soc_src=copy. Also if parents look at the February issue of Teen Vogue, you will find an article about Camouflaging.

Dr Michael Rubino has over 20 years experience working with teenagers and their families. Dr Rubino is considered an expert psychotherapist in the treatment of teens. For more information about Dr Rubino and his private practice visit his website at www.rcs-ca.com, www.RubinoCounseling.com or www.RubinoCounseling.com or his Facebook page at www.Facebook.com/drrubino3 or his podcasts on Spotify or Apple.

When Do We Address the Issues Impacting Teens and our Nation?

When Do We Address the Issues Impacting Teens and our Nation?

As we start to re-open the Country issues we have not been paying attention to are reemerging. Those issues are mass shootings and hate crimes directed at people of certain races. This past week 6 South Korean women were killed in Atlanta by a mass shooter. Additionally people died in the hospital. The statistics we have from the Gun Violence Archive for 2019 through November of 2019 indicate there were 336 mass shootings that year.

The official statistics for 2019 indicate1347 people were killed in mass shooting and 1,684 people injured in 2019. Additionally, these statistics don’t account for how many families have been changed forever and how many first responders are dealing with traumatic reactions.

At the beginning of 2020, we started to focus on the Pandemic and were not focusing on mass shootings. We have over 500,000 Americans who have died due to the Coronavirus. Therefore, in addition to people grieving and dealing with traumatic reactions due to mass shootings, we have added over 500,000 American families who are grieving and dealing with traumatic reactions due to the Coronavirus. In addition to family members, again we have first responders who have been emotionally impacted by the Coronavirus virus.

Finally, the other issue we have had going on, but not paying attention to are hate crimes directed at Asian Americans. Donald Trump blamed China for the flu and assigned a racial slur to it. As a result, many Asian Americans have been yelled at, spit on and killed. There are numerous older Asian Americans who have been attacked walking on the streets and have died from their injuries. Again, we are adding to the Americans grieving. We have Americans involved with mass shootings, the Coronavirus and Asian Americans all grieving and dealing with traumatic reactions. We have a tremendous amount of people grieving and coping with trauma in the United States, but what are we doing about it?

In 2019, former President Trump said he would address the mass shootings in the United States. He said we would definitely be taking action and there would be universal background checks. He then made a public statement from the Oval Office that there would be no universal background checks. The President stated the background checks we currently have are enough to keep us safe. He also publicly stated that the people who helped him win the election would not be happy with universal background checks. He had been speaking to the chairman of the NRA that day. Therefore it appears, the money the NRA donated to his campaign was more important than the children of the United States.

The former President initially said he would support sane gun laws and the he decided that the issue was simply a mental health issue. By doing so he did not help the issue and he reinforced the negative stigma about mental health in our country. When he referred to a mental health issue, he called the people “sick” and stated they need to be locked up. The research clears shows that people with mental health issues pose a danger to themselves by cutting or committing suicide. The research clearly shows that people with mental health issues are rarely dangerous to society. The Director of the American Psychiatric Association issued a statement stating the same information (2019).

Mental health issues are not the primary reason for mass shootings, hate is the primary issue. In fact the FBI was able to arrest three men planing mass shootings. One of the men arrested issued a statement that he was planing the shooting because he hated anyone who was not white. He was also at the Charlottesville protest and stated to a reported he believed in only a nation for white people and was advocating killing anyone who was Jewish. This man is not being labeled as mental ill. He is being charged with charges related to a Hate crime. Again in order to be charged with a Hate crime you must be attacking someone because you hate them due to their ethnicity, religion, sexual orientation etc. The Klu Klux Klan has held rallies and have been accused of killing people for years, but no one in the group is labeled mentally ill. The KKK is labeled as a hate group.

As children start to resume going back to their schools and they come into my office saying they are afraid of returning to school due the mass shooter drills and the possibility of a mass shooting, what do I say to them? How can I say we are doing everything we can to protect them, when our government is not doing anything. We have not passed any sane gun laws. How can I say don’t worry when every day in 2019 there was a mass shooting and more students were killed at a school? Children today also hear the news easily and they will know that I am lying. Remember, most teenagers and middle school students have access to the news very easily because the news updates pop up on their phones. In order for therapy to work, the children and teenagers need to trust me. If I lie, they will not trust me. Again, with the issues I cited for this year alone, how can I tell a child there is nothing to worry about.

The other issue is how do parents get children and teenagers to come to a psychotherapist’s office. Former President Trump has been on national television stating all mass shooting is due to mental illness. He refers to the people as “sick puppies” and that they need to be “locked up in asylums.” Teenagers and children will be worried that their parents are taking them to my office to be locked up. Many teenagers need psychotherapy for mental health issues such as depression. According to the CDC, one out of five children need psychotherapy. Anxiety disorders and depression have increased significantly during the Pandemic. Cutting is also at epidemic rates in teenagers and children. I have children as young as 10 who self- mutilate. Also suicide was the third leading cause of death for kids 10 to 18 years old. In the last few months, the CDC changed suicide from the third leading cause of death to the second leading cause of death. There are many children who need psychotherapy, but will be afraid of being locked up or called a “sick puppy” by their friends and they will fight their parents about going to therapy.

Also what about the people who experienced a mass shooting or lost a loved one to the Coronavirus, their family and friends and the first responders, their lives have been changed for ever. They are going to need years of psychotherapy to cope with their PTSD. However, besides being labeled as a victim, they are not going to want to be looked at as a “sick puppy” because they need therapy. This is what they will think and feel because of how the former President and republican senators have responded to mass shootings and such things as masks. We already have survivors of mass shootings and the Coronavirus committing suicide because they cannot stand the pain associated with their grief. We have seen the same thing from veterans committing suicide because they did not have access or were embarrassed to seek psychotherapy. When will we learn? When will we stop demonizing mental health?

Since the former President refused to act, we need to learn from the high school students from Parkland, Florida shooting and take action ourselves. Remember by acting you may be saving the life of your child or a loved one. Call the Senators for your state and demand sane gun laws and if they are too afraid of the NRA, you will vote against them in the next election. Next, demand they make decisions about the Coronavirus based on the medical experts. Several states reopened for Spring Break even though public health experts said it was too soon. The result, Florida again is seeing a significant increase in the number of Coronavirus cases. Finally, demand that Congress take steps to protect Asian Americans.

There have already been 3,800 Asian Americans attacked this year and most victims were women (NBC news). These number is probably lower than reality because most Asian Americans tend not to report these attacks to the police because they fear for their safety. A majority of the victims are older and many of them were killed. Why have Asian Americans been attacked so often this year? The former President Trump has blamed China for the Coronavirus. Many of his followers have misinterpreted Trump’s racist remarks as a reason to blame Asian Americans for the Coronavirus Pandemic. This is absurd because there are strains that came from Europe in addition to China. The Asian Americans did not create or cause the Coronavirus and they are Americans just like the rest of us are Americans. Therefore, they are entitled to the same rights and protection. However, most Asian Americans are now worried about their grandparents leaving their houses. Again we have more Americans grieving and dealing with traumatic reactions. When are we going to learn that we are all in this together and need to work together to solve these issues?

No American should be afraid to go outside because they may be shot, catch a deadly virus or attacked because of their ethnicity. We have a number of Americans who are suffering emotionally and need professional mental health care. We need to focus on providing mental health care to those who are in need of it and also how we are going to work together to solve our issues in the United States.

Some people will say I have no right to be writing this article. However, I see and hear the kids crying daily because they are afraid of being killed or their parents being killed. I also am trained in Critical Indent Debriefing, certified as a first responder therapist and specialize in treating trauma victims. I am tired of hearing how the first responders lives are being changed and the night terrors they experience. I am not afraid of the NRA stopping sane gun laws. We have a huge problem with hate and race in our Nation that must be addressed. Also we also do not have adequate mental health services in our Nation. This is why the suicide rate went from the 3rd leading cause of death to the second leading cause of death for kids. Mental health issues are not causing the mass shootings! If it was we would have had the problem in the 1970s and 1980s, but we didn’t.

Dr. Michael Rubino is a psychotherapist with over twenty years experience treating children and teenagers. He is also trained to treat victims of trauma, he is certified as a first responder therapist and to do Critical Incident Debriefing. For more information regarding Dr. Rubino visit his website http://www.RubinoCounseling.com or Facebook page www.Facebook.com/drrubino3 or his podcasts on Spotify or Apple.