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May You Live in Interesting Times

Gloriosa by Jitney58 is licensed through CC-BY-2.0

There is conflicting information about the origins of this expression, but it is generally agreed to be a curse. We are watching history be made as each day goes by, and frankly, I wish I lived during a more boring chapter of future history books. At the same time, though, it is through the difficult times that we grow.

As a psychologist, I’m used to walking with people through the difficult times. I usually can’t offer a quick or simple fix, but I can be there with tools, hope, and connection.

My goal in creating this site is to offer resources to a wide audience during these trying times. I want to reach those who share my drive to help children and provide them with the tools to do this effectively: teachers, social workers, counselors, and fellow psychologists. If there are specific resources that you would like to see, please let me know, and if I have the appropriate skills and knowledge, I will do my best to make it happen.

Thank you for joining me during these interesting times. Follow my site to stay up-to-date with resources.

Let’s Talk About Burnout

I wrote this post for mental health professionals, but it’s something a lot of people can relate to right now.

Pictured: A master of self-care

The demand for mental health has spiked in the pandemic, and while it is fantastic that people are reaching out, therapists are scrambling to meet the demand. We are living in the same world as our clients, while being that source of support and healing.

To be honest, I am exhausted. Many of my go-to self-care activities aren’t available right now because I live in an area where numbers are rising, and since my husband works as a nurse, we are being extra careful. I decided this week to really explore what burnout looks like for me so that I can be mindful and take care of myself. I owe it to my clients to be at my best, I owe it to my loved ones to have something left to give them at the end of my work day, and I owe it to myself to be well.

I am sharing my burnout levels as a template so that others can think about what their warning signs are. I doubt it’s possible to be Level 0 in 2020, but I left it on anyway to be aspirational.

Burnout Level 0
Everything is good! I feel great and have plenty of energy! The tasks I need to accomplish are getting done. I am doing things I enjoy in my spare time, and I feel good about how I am doing at work. I might be experiencing stress, but it’s typical, daily life things that I can manage easily.

Burnout Level 1
I am experiencing more stress and anxiety. I might not have a lot of extra energy for my hobbies, but I am trying to make time for them. My overall self-care, like making good food choices and keeping up with hygiene, are minimally impacted, and my functioning at work is good. I might not even notice that I’m hitting early burnout.

Burnout Level 2
I have no time or energy for hobbies, socialization, or things I find fun. When I force myself to do these things, I have trouble enjoying them. I am stress eating and not choosing healthy food, I am much more tired than usual, and I might be having trouble sleeping. I might be drinking more alcohol than average. Work is still good, but non-urgent tasks get put off more and more.

Burnout Level 3
My hygiene is taking a hit: I might be showering less and forgetting to brush my teeth. I am either missing meals all together or snacking on “junk” food. I am very tired but take a long time to fall asleep. I am irritable with my loved ones. My focus at work takes a hit; in addition to putting off deadlines, I notice I’m having trouble focusing in meetings but am keeping up in sessions and can push through with enough coffee. I’m also probably drinking too much coffee. I start having physical symptoms, like headaches, stomachaches, and sore throat.

Burnout Level 4
I feel physically sick, very anxious, and have few positive emotions. Things that would be mildly inconvenient normally give me feelings of rage. My sleep schedule is a mess, and although I can push through to the weekend, my work performance is not up to standards. I have no energy to interact with loved ones, socialize, or do activities that I enjoy.

Burnout Level 5
I am not functioning at all and need an immediate leave of absence from work.

I cannot think of a time when I have hit Level 5, fortunately, and I would like to keep it that way. Lately, I think I have entered Level 3. It could be worse, but I have plans in place to ensure I don’t hit Level 4. What are you doing to take care of you right now?

Telehealth and Kids, Volume 12: Emotional Support Animals

As always, more telehealth resources are available here!

Hands down, my favorite part of telehealth is meeting everyone’s pets. A close second is my clients meeting my pets.

A while back, I shared a story about my cat, Vera, and how she was affected by trauma. I’ve shared this story with kids at my practice for years as an allegory to some of their own experiences, and if my boss was not severely allergic to cats, I would train her as a therapy cat and bring her to work every day. Let her earn her keep a little bit.

Pictured: a freeloader

Research has shown that pets help people manage stress, especially those living with mental illness. Animals bond to their humans and respond to our emotions. Even pets with no special training often try to comfort us when we become upset.

Talking about pets has always been a great icebreaker with kids, but when a pet joins a session, even more options for interventions open up! Clients can explore how petting the animal makes them feel. They can look at their pet’s body language to practice social skills. With well-trained dogs, I’ve even had parents play Simon Says so the dog can model good listening for the child. Possibilities are endless!

Bringing pets into sessions has led to some awesome therapeutic work that would never have been possible in my “real” office.

Armani wants attention too!

PESI Presents: A Step-by-Step Guide to Successful Virtual Sessions with Children, Adolescents and Families

Friends, I have some very exciting news: on Monday, December 21 and Tuesday the 22, I will be presenting a certification training for telemental health with children and adolescents! The training will be live on those dates, but PESI will be recording the seminars and making them available for purchase to be completed at your leisure.

The brochure for my training

This training is something I have been working on for months. Before March, when a young child was referred for telemental health services, best practice was to refer them for in-person sessions. Of course, that has not been a safe option for quite a while now. I have had to scramble, adapt, and learn quickly, and now I get to share what I learned with other professionals!

My hope, by making telemental health accessible to a younger demographic, is to make mental health services available to kids living in rural or under-served areas even after we have found ways to make in-person services available again.

If you provide therapy services to kids, check this out!

Repressing Versus Compartmentalizing

As a therapist, I spend a lot of time telling people that it’s okay to have feelings, and it’s healthy to express those feelings. You can think of “bottling up” feelings like making a purchase on a credit card: you still have to pay later, and the longer you wait, the more interest accumulates. When we see someone have a huge outburst in response to a minor frustration, this is all the feelings from before coming out all at once.

You will pay for it later! (Photo by Pixabay on Pexels.com)

This does not mean that we need to let out every emotion all the time as soon as we feel it, though! To use a personal example, sometimes in a therapy session, a client might say something that gives me an emotional reaction. It would absolutely not be appropriate for me to burst into tears in the middle of someone’s therapy, so I compartmentalize that feeling to deal with when I am not working.

Compartmentalizing is like buying groceries with a credit card but then paying it off before it accrues interest. The difference between compartmentalizing and repressing is that you go back and deal with that emotion in a healthy way before it has a chance to fester or build up.

Be mindful of how you compartmentalize feelings, especially during times of high stress. It’s tempting to bottle things up – I will feel better now if I insist that everything is fine, but in the long run, I will pay for it with interest later.

Telehealth and Kids, Volume 11: Roblox

Every time I think I have run out of topics for this series, something else comes to me!

Don’t mind me, I’m just living my best life with Zoom backgrounds and filters!

A big part of therapy with kids is sharing in the child’s interests. Yes, we want to work on making good choices, modifying behavior, and developing appropriate coping and communication skills, but none of that can happen unless I’m able to connect with the child. And the fastest way to connect with anyone is to share in their interests.

When I was doing primarily in-person sessions, many of my clients would talk to me about a game, Roblox. I have never played this game myself, but thanks to my clients, I know a lot about it. A big part of the appeal for many players is that the game allows you to create your own character and home, and you can customize these things as much as you want. There are default options to choose from, but you can be as specific as you would like and can create a world to your exact specifications.

Can you tell where I’m going with this?

I’ve done many guided visualization exercises over the years that involve creating a space that is calm or happy for my clients. Roblox lets us do the same thing in a more literal sense. Since customizing the world can be time-consuming, I typically have the child show me a world that they already created.

As the child shows me the living space they set up, I ask questions like:

  1. What was most important to you when you created this space?
  2. How do you feel when your character spends time here?
  3. Which items are your favorites, and why?
  4. What would you do if you were in this space for real?
  5. What does it smell like here?
  6. Was there anything you chose not to include?

Similarly, I ask the child to introduce me to their character, whose appearance they can customize completely if they choose.

  1. Tell me about your character.
  2. In what ways is the character like you?
  3. In what ways is the character different from you?
  4. In what ways do you wish you were more like your character?
  5. As you created your character, what was it important to you to include?
  6. Was there anything you chose not to include?

I should note, it’s helpful to let a parent know you are using this intervention as well as the rationale behind it. Otherwise, you will get phone calls and emails asking why the child was playing video games in their session. You could do a similar intervention with games like Minecraft, but the point is to help the child create a space that is just for them and help them be mindful of what they like about the space. Talking about their character can also help with building self-esteem and setting goals.

What unconventional interventions have you used with telehealth?

Antistress

The home screen on the Antistress app

I’d like to share one of my favorite therapy apps: Antistress. I actually first heard about this app from a client who had found it helpful. The app basically has several sensory items and activities that can help with boredom, fidgeting, anxiety, and self-regulation. There is a free version and a paid version, with the paid version taking a one-time fee to unlock more choices, but you can also temporarily unlock the paid version by watching an add. (Usually I try to only recommend apps that are free to download.)

They update regularly with new options, and there is a way to submit suggestions to the developers. Although some of the options have the feel of a flash game, the activities are focused on mindfulness and are appropriate for kids of all ages. I’ve shared screenshots of some of my favorite choices. Which is your favorite?

Who doesn’t love a virtual fidget spinner?
This stress ball screams when you throw it around the screen.
Virtual glass for when you want to smash something
Prompting for belly breaths
And, of course, virtual bubble wrap!

Color Your Emotions

I created this activity to help kids express a feeling that they might not have words for. The worksheet below shows an outline of a body and asks kids to color in where they are experiencing a feeling using a color that reflects the feeling, but another way to do this activity is to give the child a blank piece of paper and have them draw what the emotion feels like to them.

When we experience strong emotions, the part of our brain that controls language goes offline. It can be helpful to learn techniques to put that part of our brain back in charge, but sometimes kids need to be able to express a feeling without the pressure of having to put words to the feeling. Using this technique, adults can discover what children are feeling and offer appropriate support even if the child is not in a place to put words to the feeling.

If the child likes the idea of using colors to express feelings, you can have them assign colors to feelings when they are calm so that, in the moment, you know what each color means to them.

Color Your Emotions Worksheet

Drawing out the feeling will help the child process it and communicate it in a way that is appropriate and understandable. Once the child feels calm, you can go back to the worksheet and talk them through the best way to handle that feeling.

For more tips on helping kids communicate their feelings, check out I Don’t Want To Be Bad on Amazon!

Telehealth and Kids, Volume 10: Virtual Backgrounds

The intervention I want to talk about today isn’t a specific game, so I am writing in a different format than I usually do in this series. For more telehealth interventions with kids, check out my resources page. Also, details about the client interaction that I describe below have been changed for privacy, but the spirit of the story is in tact.

The Enterprise is one of the many, many places I’ve held sessions in the past six months.

Since March, I have gotten much more comfortable holding online sessions with kids, but in the beginning one of my biggest struggles was holding their attention long enough to have a productive session. In my office, kids can run around, and I can just follow them. If a child disengages or shuts down, I can get down on the floor and join them at their level. But when I’m on camera, I can’t move or even control what I am looking at.

Early on in my work from home life, I asked a child if we could talk about the difficulty they were having engaging with me on Zoom. I asked what might help them focus, and they said (this is paraphrased), “I’m sorry, Dr. Amy, but before our meeting I was watching Godzilla, and that’s just more interesting than you are.”

They were absolutely right; I’m not as interesting as Godzilla.

So I asked them to wait a moment, went on Google Images, found a picture of Godzilla, and made it my virtual background. It was magic! Suddenly our meeting was much more interesting.

If a child is struggling to pay attention, I’ll ask them where they would rather be and find an image that matches that, or I will find a background of their favorite television show or a special interest they have. Some kids have used the virtual background for imaginative play and will tell me that I need to be in jail, or my house is on fire, and I find a background that fits that. I’ve done sessions on the moon, at the bottom of the ocean, in a cave, and at Disneyland. This is definitely one of my favorite Zoom tools for telehealth with kids.

What tips or tricks have helped you keep kids engaged in Zoom sessions?

Praise for I Don’t Want To Be Bad

(It’s October 3rd!)

I am so excited and pleased to share that I Don’t Want To Be Bad currently has a five-star rating on Amazon! I wanted to thank everyone who has shared, purchased, or reviewed. This is a lifelong dream come true for me and has given me the confidence to pursue other projects.

I Don’t Want To Be Bad is available in paperback and ebook format on Amazon!

Here’s what readers are saying about I Don’t Want To Be Bad:

This workbook is a great resource for communicating with kids and preteens about their emotions and thoughts. Every page offers an array of activities for parents/guardians and children alike, from journal entries and coloring pages to ice breakers, activities and conversation topics. …  Dr. Marschall brings her expertise to the forefront here and the material is very approachable and easy to comprehend.

Amanda (Verified Purchase)

More praise for the book:

I Don’t Want To Be Bad is a very practical, hands-on book detailing concepts that parents, educators, and mental health professionals should find interesting and useful. The book follows a distinct pattern: short explanation of concepts -> how the current exercise helps -> the exercise itself, occasionally followed by relevant notes. The examples are sound, practical, and plentiful. They range in difficulty (from the child’s perspective) so that each concept builds upon the last. The exercises given are intended for multiple use until mastery is achieved, and not to be rushed through. This means that this book and its contents will remain relevant over time as the child grows.

Senseandrew (Verified Purchase)

Feedback from a mental health professional:

This book is well written and practical. It provides clear language to help parents better understand the brain and the possible reasons for their childs behavior. I find it useful as a clinician, and clearly written, so I can give it to clients. The activities give parents practical solutions that help build their skills towards a healthier family.

Jeflesner

Thank you all for your support! For those who left such kind reviews, I hope my next project is as beneficial to you as this one has been!

Press Pause on Impulsivity

Impulse control is one of the last abilities our brains develop, so children and teenagers really struggle with this. Sometimes this gets labeled as disobedience, but kids are literally not capable of controlling their impulses the way that adults are.

This activity helps kids work on improving impulse control by visualizing a remote control and trying to “pause” and think before making choices. Adults can help them by cuing the child to press pause as the impulsive behavior is starting.

Photo by Ian Panelo on Pexels.com
Remote control worksheet

Image text:

STOP!
Imagine that you're watching yourself on a screen right now. You are holding a remote control in your hand, and you see yourself about to make a choice. Look at the remote, and press "pause." This causes you to freeze on the screen!
Now that you're paused, you can fast forward in your mind and see what might happen next. What are you about to do? What might happen if you make that choice? Are you happy with that choice and its consequences? If not, rewind and think about what different choice could have an effect that you are happy with.
Maybe you didn't hit "pause" until after you had made a choice. That's okay! You can still rewind and see what was happening before, and you can think about what you could do next time. You can also rewind further and see what might have lead up to that choice to help you notice what things might make you want to behave a certain way so that you can change how you react or avoid those things in the future.
Adults might help you remember to press pause. This is because they want to help you notice when you might need to pause, and they want to help you make good choices. But you don't have to wait for an adult to remind you! You can press pause any time you want to remember to think before doing something.