For Teen Girls Dealing with Depression after Violence A journey of healing for girls, their parents and/or other caring adult mentors
Together . . .
A Journey through Depression for Teen Girls
By Kathy Manis Findley Executive Director Safe Places 1609 Broadway Little Rock Arkansas 72206 2011 by Kathy Manis Findley
The cover art for this booklet is entitled Going Together created by artist Kristiana Pärn with acrylic paint on wood. Ms. Pärn graciously granted permission to use her art for this booklet. Please visit her website to view her other beautiful art at http://kristianaparn.com/drawings.htm. Giving you the rights to publish my work in your booklet would make me very happy. I admire what you are doing for these little young women. I'm thankful for being able to help through my artwork. - Kristiana Pärn, September 12, 2011
Funding for this booklet was made possible in part by the U.S. Department of Health and Human Services (HHS), Office on Women’s Health. The views expressed in written materials or publications and by speakers and moderators at HHS-sponsored conferences, do not necessarily reflect the official policies of the Department of Health and Human Services; nor does the mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.
Together . . .
A Journey through Depression for Teen Girls I.
Stopping the Pain How do I stop the pain? I know I was sexually assaulted, and I know that was a terrible thing for me to go through. But that was over a year ago. I still can’t move on with my life. I can’t go to school sometimes. I can’t stop crying. What do I do now that depression has taken over my life nothing makes the pain go away?
A physical or sexual assault, chronic sexual abuse, violence by a dating partner, stalking, bullying or harassment . . . these are only a few of the violent traumatic experiences which can upset and distress any person. They arouse powerful and disturbing feelings in us. Those powerful and awful feelings sometimes settle with time, and sometimes settle even without professional help. But sometimes even professional therapy can fail to resolve a depression that has descended on a person after experiencing violence. We hope that this booklet will be useful for persons who are having that experience.
This booklet may be useful to you if: you have been through a traumatic experience and want to understand more about how you are feeling you know someone who has been through a traumatic experience, and want to get a better idea of how they might be feeling. It describes the kind of feelings that people have after a trauma, what to expect as time goes on, and how to help yourself find a way to feel healthy and whole again. It discusses some ways of coping and coming to terms with what has happened.
So what is a traumatic event? There are many types of events that cause trauma including accidents, illnesses, bereavement, military combat, natural and man-made disasters, being taken as a hostage and many other events. This booklet discusses trauma that occurs after violent personal assault, such as a physical attack, sexual assault, robbery, or mugging. It also describes trauma that comes after experiencing chronic violence such as child abuse, sexual or physical abuse, harassment, bullying and many other forms of emotional, verbal or physical abuse.
What happens immediately after trauma caused by violent victimization? Immediately after this kind of traumatic event, it is common for people to feel shocked, or numb, or unable to accept what has happened. Shock - when in shock you feel: stunned or dazed or numb cut off from your feelings, or from what is going on around you. Denial - when in denial, you can't accept that it has happened, so you behave as though it hasn't. Other people may think that you are being strong or that you don't care about what has happened. Over several hours or days, the feelings of shock and denial gradually fade, and other thoughts and feelings take their place.
What happens next? People react differently and take different amounts of time to come to terms with what has happened. Even so, you may be surprised by the strength of your feelings. It is normal to experience a mix of feelings. You may feel: Frightened … that the same thing will happen again, or that you might lose control of your feelings and break down. Helpless … that something really bad happened and you could do nothing about it. You feel helpless, vulnerable and overwhelmed. Angry … about what has happened and with whoever was responsible. Guilty … that you could have done something to prevent it. Sad … because of the loss of your innocence and sense of safety. Ashamed or embarrassed … that you have these strong feelings you can't control, especially if you need others to support you. Relieved … that the assault is over and that the danger has gone. Hopeful … that your life will return to normal. People can start to feel more positive about things quite soon after a trauma.
What else will I notice? Strong feelings affect your physical health. In the weeks after victimization, you may find that you: cannot sleep feel very tired dream a lot and have nightmares have poor concentration have memory problems have difficulty thinking clearly suffer from headaches experience changes in appetite experience changes in sex-drive have aches and pains feel that your heart is beating faster
What should I do? Give yourself time It takes time - weeks or months - to accept what has happened and to learn to live with it. You may need to grieve for what (or who) you have lost. Don’t be afraid to recall what happened to you and let the memories come to your consciousness It is better to face the reality of what happened rather than wondering about what might have happened. Be involved with other survivors Try to find a support group where you will feel safe talking about what has happened. It can help to spend time with others who have been through the same experience as you. Ask for support It can be a relief to talk about what happened. You may need to ask your friends and family for the time to do this - at first they will probably not know what to say or do. Take some time for yourself At times you may want to be alone or just with those closest to you. Talk it over Bit by bit, let yourself think about the trauma and talk about it with others. Don't worry if you cry when you talk, it's natural and usually helpful. Take things at a pace that you feel comfortable with.
Get into a routine Even if you don't feel much like eating, try to have regular meals and to eat a balanced diet. Hobbies can help. Exercise can help - but start gently. Do some 'normal' things with other people Sometimes you will want to be with other people, but not to talk about what has happened. This can also be part of the healing process. Take care of yourself After a trauma, people are more likely to have accidents. Be careful around the home and when you are driving.
What should I NOT do? Don't bottle up your feelings Strong feelings are natural. Don't feel embarrassed about them. Bottling them up can make you feel worse and can damage your health. Let yourself talk about what has happened and how you feel. Don't worry if you cry. Don't take on too much Being active can take your mind off what has happened, but you need time to think, time to go over what happened so you can come to terms with it. Take some time to get back to your old routine. Don't drink or use drugs Alcohol or drugs can blot out painful memories for a while, but they will stop you from coming to terms with what has happened. They can also cause depression and other health problems. Don't make any major life changes Try to put off any big decisions. Your judgment may not be at its best and you may make choices you later regret. Take advice from people you trust.
Since I am depressed, shouldn’t I get professional help? Family and friends will probably be able to see you through this difficult time. Many people find that the feelings that they experience gradually reduce after about a month. However, you may need to see a professional if your feelings are too much for you, or go on for too long. You should probably get professional help from a victim advocate or a counselor if: you have no one to share your feelings with you can't handle your feelings and feel overwhelmed by sadness, anxiety, or nervousness you feel that you are not even beginning to return to normal after six weeks
you have nightmares and cannot sleep you are not getting along with those close to you you stay away from other people more and more your work is suffering those around you suggest you seek help you have accidents you are drinking or smoking too much, or using drugs to cope with your feelings.
What are post-traumatic stress responses? Following a traumatic event, some people experience post-traumatic stress disorder (PTSD). Many people exhibit some of the symptoms of PTSD and while they may not have the disorder, they are experiencing some of the symptoms. Symptoms that are most commonly experienced include: re-experiencing the trauma through vivid and distressing memories or dreams avoiding situations that remind them of the traumatic event feeling numb, as though they don't have the same range of feelings as normal being in a state of 'alertness' - watching out for danger. If you are experiencing problems that might be PTSD, you should seek professional help.
What professional help is available? Your doctor might suggest that you talk with someone who specializes in helping people cope with violent victimization. They are called victim advocates and they have the experience to help you get through some of your anxiety and depression. Sometimes counseling or psychotherapy can help. You may find that there is a support group for people who have been through a similar trauma. It can be helpful to hear that others have had similar feelings and experiences.
II.
For Parents or Other Adults who Care Working through adolescent depression, especially after violence or abuse has occurred, should be much more like a journey than a series of classes or workbook exercises. Perhaps on chapter can be a beginning, and then the time will not be right to go to another chapter. When healing from victimization, time can be a friend if you take the time necessary and avoid rushing the process with your daughter.
Together is designed to be a journey taken by an young girl who is experiencing depression along with a parent, guardian or a trusted adult mentor. 1 Together is positive in nature and takes a casual and non-threatening approach to the learning and growing process. It is designed to encourage growth and change for both the adolescent and the parent. It is also designed to build trust between the Together partners, giving them options of agreeing to bring in a few other persons along the journey, as long as they agree upon who can strengthen the journey and ease its path. Together has many other positive characteristics. First of all, it is not presented as “treatment” for depression or a once-and-for-all “fix” for a very real challenge the young person is experiencing. Remember that being the victim of violence does not necessarily mean that a young person will need mental health care. Because Together is not presented or conducted as a series of therapy sessions, it is nonstigmatizing. As a result, it provides an important vehicle for reaching depressed adolescents and their parents who often resist seeking professional help. Secondly, Together builds upon the idea of the inner resilience that a young person already has within themselves. The situation for a young person does not have to depend on the dark clouds that can feel so threatening around her. Yes, violence or abuse can bring those threatening clouds into a teenager’s life, and storm clouds can feel very threatening. But a healthy approach is to acknowledge the presence of those dark clouds, not to minimize them or in any way or “shame” the child for not being able to ignore them and put on a happy mask. Then make sure the child knows that there is always a rainbow somewhere in the vicinity of the storm clouds. In the presence of dark clouds and/or rainbows, the most important component is always the inner resilience of a young person. Research does not yet show us which child has an abundance of that resilience and which child may not. Nor is research able to explain why resilience just kicks in for some adolescents and changes their 1
Hereafter, we will refer to the adult partner as a parent, although other family members, guardians, etc. can be just as effective in this role.
emotions for the better. However, the most important thing to remember is that every child holds some resilience inside of herself. It was placed there as a gift of human creation. Girls especially seem to be able to find hope in seemingly hopeless situations. Together leads the child and parent into an exploration of that resilience and leads them to work together to discover new ways to release it and harness it into doing its magic healing. Parent partners must hold on to that truth: that resilience is already inside your daughter. Who but you are in a better position to help her find it and get access to it on the way to the cloudless sky and the rainbow’s promise? Remember that Together is an ideal journey for depressed teenagers who might not have access to the services available through clinics, mental health centers, and therapists in private practice. It is not a replacement for mental health counseling, but it offers a positive way to deal with depression when such counseling is not available or as an adjunct to counseling. Although it is intended for use with an adolescent or even a younger child in partnership with a caring parent or mentor, it can be easily modified for use in a group process, particularly with sets of children and their parents.
The Role of Parents in Helping their Daughters with Depression – Just Be Present It is very important, and perhaps essential, to include at least one parent or another caring adult in helping children and adolescents deal with depression. Because your daughter is still dependent upon her parents, she has less control over their environment than adults. Therefore, positive change for depressed children requires some change in the parents, in the entire family or at least in a child’s support system of at least one adult. This curriculum is one way to involve parents in the process. Together has two specific goals. The first goal is to encourage parents to reinforce and support the positive emotional changes their teenagers make. The second goal of Together is to reduce negative interactions between parents and teenagers, particularly mothers and daughter. Recent surveys of depressed adolescents suggest that conflicts with parents are the most significant cause for episodes of depression. 2 A new and very significant family stress point such as a violent victimization of a teenager can escalate the normal, ongoing conflicts between children and their parents. Do not be afraid of the escalated tension or stress caused by the violence that has occurred. Instead, use it as a stepping stone for increased quality of the parentchild relationship. It definitely can become that for you and your daughter, and can even serve to create a closer relationship through caring, compassion and simply the extra time you spend together going through the series of chapters in this booklet. The journey may seem long and rocky from where you are today, but move ahead in hope of a smoother path and a brighter day for your family. 2
Asarnow, J.R., Lewis, J.M., Doane, J.A., Goldstein, M.J., and Rodnick, E.H.Family interaction and the course of adolescent psychopathology: An analysis of adolescent and parent effects. Journal of Abnormal Child Psychology, 1982,10,427-442.
Suggestions for Parents Consistency is important. This curriculum has been especially designed to include a minimum number of sessions so that your commitment to completing it is not so overwhelming. However, depression is usually a long-term issue. Therefore, completing this short curriculum with your adolescent is only the beginning of your journey to a healthier place for your daughter and yourself. It is a first step, but a positive one, and your Safe Places advocate will suggest next steps that will reinforce the progress you have made.
I have so many questions . . . Don’t worry. Questions are a part of learning. Here are some common ones, but you will have others. Safe Places staff can help with any questions you have, now and along the way. 1. What is the cause of depression? Depression can be caused by more than one factor or situation. Stressful events can have a negative impact on your daughter’s mood. Violence or abuse can be an extremely negative factor that leads to depression. Genetics may also play a role. It’s helpful to think about depression in this way: We all have specific skills we use to cope with various problems or hassles in our daily lives. Teenagers, like all of us, may become depressed when their coping skills are insufficient or ineffective for the kinds of problems they are experiencing. 2. Does depression mean that my child is mentally ill? No. Depression is not necessarily a disease or an illness; it is usually a problem in living that involves not being able to deal with feelings of sadness or failing to learn adequate coping strategies. Adolescents may become depressed when they are not able to cope with the stress and problems they are experiencing in their everyday lives. When violence occurs, the ability to cope is further compromised. 3. Am I to blame for my teenager being depressed? Parents are understandably very upset when their child is harmed by violence, and that can lead to depression for the parent as well. If you feel that you may have contributed to your daughter’s depression because of your reactions, just be honest. Find someone that you can talk to and trust your teenager to understand that this is hard on you. Just remember that if your daughter has been harmed, the pain primarily belongs to her. Your feelings, though valid and very real, are secondary. Own your own feelings and deal with them rather than piling them on top of a child who is hurting in her own way. Interactions between children and their parents always present difficult issues at times. Remember your daughter is growing up and becoming more independent. At the same time, you may feel that your role in protecting her or providing discipline is important. This course is designed to give parents the information and training you need to become actively involved in helping their adolescents overcome depression. It is not about placing blame on parents for what their child may be experiencing. Even if some things have happened for which you tend to blame yourself, it is most important to let those go. Apologize to your daughter if you feel you need to and then assure her of your love and move on. Say, for instance, you feel like an impending divorce or an altercation in your family may have been a source of your child’s depression. Remember that life always brings
difficult and unfortunate situations to any family. While depression is sometimes situational in that it is triggered by a precipitating event, one thing you can never promise your daughter is that life will never present difficult situations. Blaming yourself or something you might have done is completely unproductive. It will not help lift your child’s depression and it is not the single cause of it. Yes, providing a stable environment free from all conflicts and triggers would be a wonderful goal, but may not be a realistic one. The hope for this course is that it will acknowledge the presence of difficult life circumstances and stressors, and provide new ways to cope that helps alleviate depression. If you find that that you are consistently and persistently blaming yourself for your daughter’s depression, please meet with your Safe Places advocate to discuss your feelings. 4. My teenager didn't tell me that he or she was depressed. You may be somewhat surprised that daughter is depressed. Depressed teenagers may describe many symptoms of depression when they are asked directly, but they don't necessarily offer this information voluntarily, especially to a parent. Adolescents are often reluctant to talk to adults, and this includes parents. Working on through this booklet together will help you find out more about how your teenager is feeling. 5. How does this booklet help? Doesn’t my child need antidepressant medications? Relatively little is known about adolescent depression, but the research that has been conducted so far indicates that there isn't any one treatment for depression that is 100% effective for everyone. Studies suggest that depressed adolescents who complete a process such as this one with a parent or mentor show significant improvement. Remember that medication for treating depression seldom alleviates the problem completely. Going through this booklet intends to teach your daughter to play an active role in controlling her mood and to engage the parent as an actively supportive partner in the process. 6. What's the purpose of the parent group? Along with the process of going through this booklet with your daughter, we believe that a parent psycho-educational group held by Safe Places staff will provide you with the support you need to help yourself and your depressed child. Whether you are attending the parent group to help you come to terms with your child’s victimization, to learn more positive parenting and communication skills, or to learn to deal with your child’s depressive moods, we believe that you will benefit greatly from it. It will include, not only the expertise of the Safe Places facilitator, it will also include peer support from other parents who are going through similar circumstances. The purpose is to encourage you as a parent to reinforce and support the changes your daughter makes, to reduce the level of conflict between parents and teenagers by teaching effective communication and problem-solving skills, and to help you deal with whatever negative situation or situations may have occurred in your family.
7. What are your qualifications? Safe Places staff persons are trained in working specifically with victims of sexual violence, child abuse, family violence, homicide, human trafficking and other violent crimes. As a result of victimization, many of our clients deal with depression and we have years of experience in working with depressed young people and adults. If you and/or your child need a therapist, we are knowledgeable about the qualifications of local therapists and are happy to refer you to an appropriate one that can meet your needs. 8. Are adolescents told that the Safe Places group leader has more knowledge or authority over their actions than their parents do? We treat adolescents as young adults, but we would never tell them to defy the authority of their parents. The communication and problem-solving skills that we teach are intended to improve the relationship you have with your child. It is true that sometimes a child will develop a strong bond with his or her Safe Places advocate, particularly if they have received one-on-one counseling, but we know that the parentchild bond is critical and we do everything possible to strengthen that bond. 9. How do you know my daughter will benefit from this treatment? What can we do if this group doesn't help? We cannot predict which adolescents are most likely to benefit, but we do believe strongly that most of the adolescents who complete the chapters in this booklet will show significant improvement. After you complete the chapters in Together, we will check in with you and your adolescent to find out how things are going. If your teenager's problems are continuing, or seem to be getting worse, we will refer you to someone who may be able to help. 10. Will this interfere with my teenager's schoolwork? Going through Together should not interfere with your daughter's schoolwork or school activities. As mentioned earlier, the chapters are designed to allow you to take your time and complete them when there is ample time. This may actually improve your adolescent's performance at school, because depression has been shown to be associated with poor academic achievement. 11. Are there any good books I can read about teenage depression? Here are some titles that may be useful to you:
McCoy, K. Coping with Teenage Depression CA Parent's Guide. New York: New American Library, 1982.
Lee, E., and Wortman, R. Down Is Not Out: Teenagers and Depression. New York: J. Messner, 1986.
Lewinsohn, P., Muñoz, R., Youngren, M., and Zeiss, A. Control Your Depression. Englewood Cliffs, New Jersey: Prentice-Hall, 1986. (Note: The focus of this book is on adult depression, but the concepts are very similar to those taught in the adolescent course.)
A Bit More Information for Parents Did you know that up to 30% of teenagers meet the criteria for major depression but only 20% ever receive the help they need? Untreated depression can sometimes lead to self destructive behaviors such as substance abuse, self-mutilation, risky sexual practices, poor school performance, and even violence such as suicide or homicide. Sometimes it’s hard to see it. Depression in teens is often complicated by the fact that subtle signs of depression may go unnoticed. The “typical” symptoms of crying spells, fatigue, and appetite changes may not be present in a teen who is depressed. But there are signs to look for.
Signs Your Teenager May Be Depressed 1.
They would rather be alone . . . isolated.
If your daughter is spending more time alone and not enjoying social activities, it may be cause for concern. It is also common for depressed teens to start withdrawing from established friendships and start hanging with a different set of friends.
2.
Sleeping more than usual
Teenagers do sleep a lot. However, sleeping more than usual can be a sign of depression or a teen self-medicating to treat depression. Teens may resort to substance abuse in an effort to numb the pain, or “sleep the pain away”. Never ignore excessive sleepiness. Don’t always assume that it is “normal”.
3.
Unexplained Scars
Never ignore unexplained scars on the hands, feet, arms, or legs. Teens, especially girls often resort to “cutting” when trying to express their pain.
4.
Increased Irritability
Bursts of anger and mood swings filled with rage are not normal teen behavior. It may be a sign that your daughter is depressed. Talk to her about seeking help if you notice extreme frustration, anger, or violent tendencies.
5.
Unusual Behavior at School
Failing grades, a lack of participation, or disruptive behavior can all be signs of depression. It’s important to communicate with teachers, counselors, coaches and other care-givers when you notice behavior changes in your teen.
6.
Drug and Alcohol Abuse
Depressed teens are more likely to turn to substances like drugs and alcohol in an effort to avoid the pain of depression. Never assume your daughter is “just experimenting” or that it is “just a phase”. Seek help if you suspect substance abuse.
7.
A Sense of Hopelessness and Helplessness
Phrases such as What’s the point?; Nobody cares anyway; It would be better if I weren’t here, are all statements that point to a sense of hopelessness. These are major signs of a depressed teen. Additionally, a fascination with death, dying, or suicide including writing poems, stories, or songs about it can be clues to a teen that is struggling. Never ignore these signs. Address them immediately.
8.
Giving Away Belongings
If you notice your daughter getting rid of prized possessions or belongings, seek help right away. This is often a sign that a teen is considering suicide. According to the CDC, suicide is the 3rd leading cause of death in teens and adolescents aged 15-24.
9.
Unexplained Aches and Pains
Depressed teens will often complain of stomachaches, headaches, or other generalized malaise. During menstrual periods, your daughter’s discomfort may be worse than usual. If there is no medical explanation for these symptoms, consider depression as a cause.
10. Crying Spells Excessive crying and sadness is not normal, even for teenage girls. Don’t mistake depression in your teen for “raging hormones”. Depressed teens often have a sense of worthlessness, low self-esteem, and are highly self-critical. This may result in crying spells because teens may be overly sensitive to criticism or rejection. If you are concerned that your daughter may be depressed, seek medical attention immediately. Never assume the symptoms of depression will resolve on their own. Visit a primary care physician or specialist for a depression screening and exam. If there is a diagnosis of depression, there are many treatment options available including counseling, support groups, therapy, and in some cases medication. Unlike adults, teens are often unable to seek help for themselves. It is up to parents, teachers, coaches, family members, and other caregivers to recognize the signs of depression in the teens you love. Address these issues now, before it’s too late.
After Violence, Victimization Depression after being victimized is still just depression, right? Not exactly. After being the victim of abuse, bullying, violence, etc. your daughter may want to forget what happened and get back to “normal life.” A teenager can convince you of that by acting as if what happened is over and done with. If you are upset because your child has been victimized, as most parents are, your child may be trying to pretend everything is OK because he or she wants you to stop being sad or upset. Be honest with your feelings. But understand that your daughter may not want to talk with you about what happened and certainly may be reluctant to tell you how she really feels about it. It’s very important for you to help her find another person to talk with. This is where a victim advocate can be a valuable resource. The victim advocate’s role is not that of a mental health professional. That fact in itself may be a plus in your teen’s willingness to talk. Assure your teen that the victim advocate is not a psychiatrist or a therapist, but is someone who has a great deal of knowledge and understanding of the feelings that occur after being a victim of violence or abuse. Let your daughter know that conversations with a victim advocate are safe and confidential.
Teen Depression-Urban Legends 1. Depression looks the same in teens as it does in adults. This is untrue. Depression in teenagers can often vary greatly from adult depression. While sadness, withdrawal, and an overall slowing of thoughts and actions are often associated with adult depression, teens can have symptoms of increased aggression, anger, rage and agitation. Make sure you aren’t missing the signs of a hopeless teen by looking for a sad teen. You may find an angry teen instead. 2. My teen would tell me if he or she were depressed. This is not true. It is hard for an adult to recognize when they are suffering from depression. It’s even harder for a teenager. They are often struggling to understand the emotions they are feeling, let alone the causes for those emotions. 3. Mood swings are just a normal part of being a teen. While it is true that adolescence is a difficult time for both parents and teens that are navigating the transition into adulthood, it is never normal for your daughter to have long lasting emotional changes. If your teen is persistently sad, angry, withdrawn, or is experiencing significant changes to the mood or behavior, seek the help of a professional. 4. Symptoms of depression will go away on their own. It is never OK to assume that symptoms of depression will resolve without help. Always seek professional help to determine the severity of depressive symptoms and if treatment is necessary. Depression is a major risk factor for violence such as homicide and suicide.
III.
About My Personality: A System of Three Parts
Inside the FEELINGS & EMOTIONS circle below, list some of the feelings and emotions you have had in the past week. Do the same for the other two circles: The ACTIONS circle and the THOUGHTS circle.
About My Personality . . . For Parents Before working through this dialogue with your child, take some time to complete the same assignment your daughter completed
In the FEELINGS & EMOTIONS circle List some of the feelings and emotions you have had in the past week. Do the same for the other two circles: The ACTIONS circle and the THOUGHTS circle. Compare your daughter’s feelings, actions and thoughts with yours and take some time to discuss the ways in which your reaction to what has happened might be different from your daughter’s reaction. Don’t minimize her reactions, but don’t minimize yours either. A goal of this chapter is for both of you to get a better understanding about each other and about your emotional reaction to what has happened. Your daughter may not have considered that your emotions might be just as strong as hers are.
IV.
Emotions . . . Actions . . . Thoughts . . . Can you control your feelings and emotions? Your actions? Your thoughts? Which of these three parts are the easiest for you to control? Why?
Which of these thoughts are DEPRESSIVE and which are POSITIVE? Circle or .
I can never do anything right.
I like being with people.
I did pretty well on my test.
My clothes look stupid.
Nothing will ever change.
Tomorrow will be a better day.
Which of these actions are DEPRESSIVE and which are POSITIVE? Circle or .
Having fun with friends.
Sleeping all day.
Being nice to someone.
Not talking at all in a group.
Doing your nails.
Playing sports.
Which of these feelings are DEPRESSIVE and which are POSITIVE? Circle or .
Relaxed
Angry
Agitated
Stressed
Afraid
Calm
No matter where your feelings are, they can either spiral down into a more depressive and sad feeling or spiral up making you feel better and better.
DOWNWARD SPIRAL
UPWARD SPIRAL
Feeling unhappy Feeling great Spending more time alone
Feeling very sad
Becoming less active
Feeling more depressed Doing almost nothing
Doing very well in school
Feeling even better
Having some fun
Doing something well
Doing something positive
What are some things that cause a downward spiral for you?
What are some things that cause an upward spiral for you?
Emotions, Actions, Thoughts . . . For Parents Talk about upward and downward spiraling and how it affects you in many of the same ways it affects your daughter. Together, work on the two questions above. Be honest about the things that cause a downward spiral for you. And then LISTEN, LISTEN, LISTEN to the things that cause a downward spiral for your daughter. Then do the same for the caused of an upward spiral for each of you. You may both be surprised at the ways events affect one another. And you just might be able to build some mutual understanding and compassion for each other. Don’t forget, though, that this is about your daughter’s depression. If it becomes about you, find a trusted friend to vent your feelings.
V.
Thoughts: How They Get Started
Some Common Negative Thoughts Check all the negative thoughts you are having right now.
I'm confused. There is no love in the world. I am wasting my life. I'm scared. Nobody loves me. I'll end up living all alone. People don't consider friendship important anymore. Boys will never like me. What's the use? That was a dumb thing for me to do (or say). I'll probably have to be placed in a mental institution some day. Anybody who thinks I'm nice doesn't know the real me. Life has no meaning. I'm ugly. I can't express my feelings. I'll never find what I really want. I'm not capable of loving anyone. I am worthless. It's all my fault. Why do so many bad things happen to me? I can't think of anything that would be fun. I don't have what it takes to be successful. I'll never get over this depression. Things are so messed up that doing anything about them is useless. I don't have enough willpower. Why should I even bother getting up in the morning? I wish I were dead. I wonder if they are talking about me. Things are just going to get worse and worse. I have a bad temper. No matter how hard I try, people aren't satisfied. Life is unfair. I'll never make any good friends. I'm afraid to imagine what my life will be like in ten years. There is something wrong with me. I am selfish. My memory is lousy. I am not as good as ________________ . I get my feelings hurt easily.
Some Positive Thoughts Check all the Positive thoughts you are having.
Life is interesting. I really feel great. I'm having fun. I have great hopes for the future. I think I can do a good job at this. I have good self-control. I have enough time to accomplish the things I want to do in life. I like people. People like me. Boys like me. I have a good sense of humor. There are some things that I'm very good at. I'm pretty lucky. I deserve to have good things happen. I have some very good friends. I can learn new skills to gain control of my mood. I can find a solution to most of the problems that come up. Other people think that I'm fun to be with. I'm a good listener. I'm OK the way I am. Even if things don't always go my way, I'll live through it. I have some skills (sports, reading, art, etc.) that I'm good at. I'm doing all right. Even if it's a rainy day, I can keep myself busy. I often receive compliments for doing something well.
Do you have more negative thoughts or positive thoughts? Total number of positive thoughts = _______ Total number of negative thoughts = _______ How do positive or negative thoughts get started for you?
After I got hurt, I just started to feel awful. Violence and abuse always leaves wounds and scars and sometimes it takes time to feel better. Whether you experienced a physical assault, a sexual assault, or even emotional abuse, you can experience all kinds of emotions that can lead to depression. When that kind of deppressive feeling takes over, it can seem as if it is taking over your life. Consider this kind of event: A person who used to be a friend turned on you and started saying bad things about you at school and then on Facebook. It really hurt. As a result of that event, you starting thinking that whatever the person said about you was probably true. Here’s how actions, thoughts, emotions and behaviors take on a life of their own. ACTION: My former friend said: She sure is starting to look fat and ugly ACTION SPREADS TO OTHERS: Other friends listened and repeated it. Then three or four people said I looked fat and ugly. THOUGHT: I started to think that it was true: I really do look fat. I really am ugly. EMOTION: I am embarrased and ashamed because I am fat and ugly. BEHAVIOR: I am angry and I will fight anyone that says anything about me. OR I am so devastated that I plan to starve myself so I won’t be ugly.
My friend said I was fat and ugly.
I am ashamed because I am ugly.
Counter a Negative Thought with a Positive One
Can you write a more rational thought for each of the irrational thoughts below? 1. “I need the love and approval of every important person in my life (especially my parents).”
2. “I have to be popular or smart (the smartest) all the time in everything I do in order to feel like I'm worth something.”
3. “People (including me) who do even one thing that I disapprove of should feel guilty, and should be punished severely.”
4. “My unhappiness is someone else's fault. I can't help feeling the way I do.”
5. “It's terrible when things aren't the way I'd like them to be.”
6. “When something seems dangerous or something could go wrong, I must constantly worry about it.”
7. “After being abused, I will never trust another person for the rest of my life.”
Thoughts: How they Get Started . . . For Parents Take some time to go through this chapter. Start with listing your own positive and negative thoughts and then comparing yours with the ones your daughter listed. Engage in a conversation about how negative thoughts get started and how much they can affect the way a person feels about life and about themselves. Go through the next section that discusses how to counter a negative thought with a positive one. Going through some of the irrational statements that follow will be a good exercise for you to go through with your daughter. It’s important to discuss the reality than every person has negative thoughts at times. It’s also important to talk about how negative thoughts make your daughter feel. Work on the following exercise together, identifying specific activating events and
the negative thought that the event causes. Talk about how to form counterthoughts. Finally, identify the results (feeling) of a negative though and a counterthought. See the example below.
VI.
What do my feelings mean?
It’s important to make the connection between abuse and your emotions. After you were victimized, you probably had immediate and very strong emotions. Other emotions came later, and some emotions come and go. It’s important for you to know this:
Every emotional reaction to your traumatic event has a purpose. You may be able to identify your feelings and emotions. But it may be much harder for you to understand them. Sometimes feeling these strong emotions hurts so much that you want to block them out by getting busy or distracting yourself. Remember that your emotions belong to you and that they have a message to send to you. A part of healing involves listening to the messages of your emotions. It is not wrong to feel what you feel. Your emotional symptoms are a reaction to what has happened to you. Yes, they can make you feel bad all over again. But you can learn to learn from your emotions in a way that helps you grow and heal.
So let’s reflect for a few minutes? Think back for a moment to the time of your abuse, the time when the violence happened. Try to remember how you felt. Name several emotions you felt during that time.
What emotions did you feel later? Days later? Or weeks, or even months?
For each emotion that you listed, ask yourself where the emotion came from and why you think you felt that way?
What is one positive thing I learned from my emotional reaction?
How could this emotion hurt me if I use it in a negative way?
What do My Feelings Mean? . . . For Parents It’s important for you to help your daughter know this:
Every emotional reaction to your traumatic event has a purpose. While she might be able to easily identify her feelings and emotions, it may be much harder for her to understand them. Where do the emotions come from? Do some of them seem irrational? If so, is there a reason for that? Help her understand that feelings and emotions are in us for a good reason. They are there to send us a message about ourselves. Healing requires listening to our emotions and learning more about ourselves in the process.
VII.
Now . . . What about my relationships?
My Relationship Circles Spend some time looking at your relationship circles. Identify the people who are close to you and place them in the inner circle. Draw them with stick figures and write their names. Think about what makes you feel a close relationship with these people. Are there people who used to be in your inner circle who are no longer there? If so, why? Now identify the people who may be a part of your life even though you do not feel close to them. Place these people in the outer circle. Why are these people in this circle?
My Relationship Circles . . . For Parents Important Note: This is an important session to work through together. Before working through this dialogue with your child, ask to meet with a Safe Places advocate to talk a bit about close relationships and boundaries that are healthy for your child? Some of the discussion may surprise you, such as why a child may NOT actually consider that her/she has a close relationship with you or another family member.
Your Child’s Relationships Ask your child to identify his or her relationships by drawing stick figures and/or writing names in the Relationship Circles Diagram talking about who is in the close relationship circle and who is in the circle of more casual acquaintances. Do not rush this discussion. It may take another session at another time to help your child work through some of the following questions:
Who are the people who are closest to me?
What makes each of them close?
What does the relationship give to me? How does it enhance my life?
Is this a positive relationship? Why or why not?
Is there anyone in my circle of close relationships that does not need to be there? Why or why not?
Is there any close relationship I have that is not good for me?
Can I move people out of my circle of close relationships? Should I do that with any person? If so, why?
If I determine that someone should not be close to me, how do I change that?
If someone is in my family, does that mean they have to be in my close relationship circle? Why or why not?
Who are the people that are less close to me? Why are they not as close?
Is it OK for these people to be in my outer relationship circle? Why or why not?
Are there persons in my less close relationships that I would like to be closer to?
Can I make that happen? If so, how do I do that?
Is it healthy for me to try to get closer to some of the people I have identified? If so, who are they and how can I work on those relationships?
How can I benefit from having any particular person as a closer friend/ family member, etc?
VIII. I feel so sad all the time. Will it ever stop? The more you understand the emotions that are making you feel so sad, the closer you will get to feeling like life is worth living again. Everyone has upsetting feelings at times. Even when things seem to be going well, you might feel depressed for no apparent reason. Sometimes our emotions have minds of their own, and you probably want to control your upsetting feelings. So an important first step is to think about the feelings you are having and which ones you have most often. All humans are capable of hundreds of feelings, even thousands of feelings. Most people have ten or twelve feelings that they commonly experience throughout the day. The list on the next two pages lists some feelings that you might identify with and some you might not have at all. This is just a very small list of feelings of every kind. Take a few minutes to circle the feelings below that you commonly have.
injured, abandoned, comfortable, soiled, betrayed, embarrassed, abused, exhausted, panicked accepted, deceived, rage-filled, accused, overlooked, admired, adventurous, affectionate, frustrated, affirmed, distracted, afraid, aggravated, aggressive, agitated, reassured, alarmed, balanced, immobilized, alienated, alive, alone, furious, ambivalent, whole, happy, threatened, angry, annoyed, dirty, drugged, shaky, drained, antagonistic, punished, sad, anxious, indecisive, resentful, scared, healed, pessimistic, shy, bitter, apathetic, apprehensive, impotent, joyful, pressured, ashamed, empty, degraded, disappointed, insecure, like a loser, assertive, defeated, rejected, hostile, dominated, attacked, comforted, smothered, fearful, hated, attractive, awed, forgotten, out of control, put down, stressed, discontented, awkward, enraged, pained, envious, unloved, irrational, exasperated, stupid, manipulated, beaten-up, confused, dreadful, shocked, exploited, helpless, violent, isolated, pissed off, jealous, unhappy, lost, frightened, desperate, uptight, intimidated, peaceful, explosive, blamed, worn out, optimistic, exposed, ticked off, weary, supported, challenged, heavy,
distressed, powerless, hurt, controlled, paranoid, sick, terrified, inferior, vindictive, sorrowful, ignored, cared for, needy, uncertain, disgusted, unable, withdrawn, devastated, guilty, fatigued, dismayed, powerful, crushed, cheated, cut off, used, disturbed, secretive, concerned, overwhelmed, unprepared, strong, unbalanced, hopeless, worthless, persecuted, useless, shamed, mad, burned up, inadequate, intense, traumatized, judged, lonely, misunderstood, vulnerable, outraged, ugly, vengeful, upset, weak, tranquil, unfulfilled,
You can write other feelings here:
I feel so sad all the time. Will it ever stop? . . . For Parents The more you and your daughter begin to understand the emotions that are making both of you feel so sad, the closer you will get to feeling like life is worth living again. It’s important for you to help your daughter think about the feelings she is having and which ones she feels most often. Which feelings are the strongest and most troubling? Parents should also work through this exercise on their own and identify the feelings you are having regarding what has happened. Comparing your own feelings to your daughter’s feelings may be a very revealing experience that can build a positive parent-child relationship. Do you feel sad all the time about this? Do you feel that the sadness will never stop? You probably do, and you may feel that way even longer than your daughter does. Remember, you need to find your own support system so that you can help yourself, your daughter, and even other family members.
IX.
Is my life worth living anymore?
After you circled some of the feelings in the last chapter, did you think any of these thoughts? that no one can possibly know how awful I feel that no one understands how depressed I am that the future will be just as horrible as the present That no one really cares
Do you ever feel that life just isn’t worth living anymore? If you have felt that way, or if you feel that way right now, you need to understand a few very important things: that you are not the only person that feels this badly that even though it seems you will always feel this way, you can feel better that you have a right to feel exactly how you feel. Your feelings are real.
Is your life worth living? You bet it is! One very important lesson to learn is that if you feel bad enough to want to hurt yourself, find someone you trust to talk to. Know that it’s OK to feel that way. But that does not mean you have to act on your thoughts of harming yourself. It simply means that for this moment, your despair is very real and it hurts. When life hurts so badly that you don’t want to go on living, consider these thoughts: It may seem that you will never be free from this horrible feeling of despair, but with help, these feelings can and will end. Every time you resist the urge to hurt yourself, you have defeated whoever or whatever drove you to feel like you do. Your life is valuable. No matter how badly you have been hurt, no matter how hurt you may feel at this moment, you can heal.
Finish the following sentences: The next time I feel that life is not worth living, I plan to
One thing I can do today to make my life better is
Is my life worth living anymore? . . . For Parents Work through this final section seriously – along and then with your daughter. If you feel that your daughter is suicidal or if you are concerned about other behaviors such as cutting, anorexia, or any other harmful behaviors, do not hesitate to seek help. Try not to over react, but do act definitively if you feel there is danger that your daughter will harm herself. Do not think that suicidal ideation or even a suicide attempt is the end of the world and that she will never recover. Healing is possible, very possible. And the fact that you have worked through this booklet with your daughter is proof that a better day will come for both of you. Try to believe in that hope with all your strength, even if your daughter does not feel hope at all. Both of you will make this journey. Get the help you need all along the way, and be assured that there are many supportive persons who care. Never hesitate to call a Safe Places advocate. Let us help you find other support persons such as persons in your faith community, other supportive family members friends, neighbors, school counselors, etc. Live IS worth living. Hang on to that and continue on the journey.
Choosing to Heal Healing is a choice that you have to make for yourself. It is a very important decision that says that either you are or aren’t going to be a victim any longer. It is admitting the fact that someone hurt you, robbing you of things that you had a right to, such as your self-respect, self-esteem, and self-worth. To be a survivor is the healthiest option for a victim of violence or abuse. Sure, you could turn to drugs, alcohol, prostitution, suicide, or running away, but wouldn’t that show the abuser that he/she won? There are four things to remember about the healing process. 1. Healing can’t start to happen if the abuse is still going on. 2. Healing takes time. It is about reminding yourself over and over that it wasn’t your fault. Sometimes you forget and have to relearn what you are working on. That is okay, because it is a process that doesn’t come overnight. 3. Healing happens on your own time. You do it at your own pace and in your own way. Everyone is different. 4. You are the only one who can make the choice. No one else can. You have to do it for yourself. You may be thinking: “counseling is not for me.” Many people your age feel that way. Some survivors think that the best thing to do is to forget about the abuse and get on with their lives. Many want to try to skip the pain involved with healing, and just go on. But not dealing with the pain does not get rid of it. It just puts it on hold for days, months, or even years. Advocacy or counseling does help! It means dealing with your feelings and the impact that violence or abuse has made on your life. It gets things out in the open so you can share your feelings with yourself and/or others. It can get questions answered that you thought were unanswerable. Safe Places staff can help you get through any part of your journey with support, compassion, counseling, advocacy, and information. We offer free individual and group counseling. If you are a survivor of acquaintance rape, stranger rape, or incest, you will find a safe place here at Safe Places. Emotional support, counseling, and support groups are confidential and free of charge. For more information, call us at 501-801-2700 or at 501-374-SAFE (7233).
Together . . . A Journey through Depression for Teen Girls
Kathy Manis Findley Executive Director Safe Places 1609 Broadway Little Rock Arkansas 72206 ďƒ“ 2011 by Kathy Manis Findley