Why Your Kid’s Lack of Motivation Might Be Depression (and what to do about it)

close up photography of a man
Photo by graham wizardo on Pexels.com


Often times when working with students in schools teachers and parents will confide in me that their student is unmotivated. “I just can’t get him out of his room.” “He’s not motivated to do his homework.” “We have to beg him to walk the dog, and he LOVES that dog!” “She does nothing in class! She doesn’t even get to school half the time!”

And along with this lack of motivation there seems to be an um…errr..uuhh…attitude problem. “He’s so angry.” “She’s so sensitive these days.” “He is so short fused with his siblings!” “You can’t say anything to him about it!”

“Have you considered that your child may be depressed?”

“No, she/he’s not sad. She/he doesn’t cry. She has fun; hangs out with her friends on the weekend.”

While crying, sadness, meloncholy and moping may be common place for some teens who are struggling with depression, many times these are simply not symptoms. For a teenager with a host of emotions, and quite frankly, a reputation to uphold, what you will see as depression is primarily a lack of motivation and irritability. Combine that with copious amounts of time spent alone in their room and you have a potentially depressed teen.

And it’s not too uncommon. Even those with everything they could want can be depressed. Happiness is not linked to socioeconomic status…at least, not how you may think. As it turns out American teenagers from upper-middle class families report higher rates of depression (and anxiety and substance abuse as well). So next time you think, ‘why is he/she so depressed, he/she has everything!’ remember that a youngsters fear of failure or not living up to societies expectations coupled with other societal pressures can be a hot bed for under expressed, under appreciated emotions. And just as you would give serious consideration to a friend who seems touchy and no longer engages in the activities you used to enjoy together, you should give consideration to your teen as well. Is this normal? Let’s look closer to find out. Consult a mental health professional who can help you discern the expected from the concerning. I’ll be here to help.


The Paradox of Self Harm in a World of Quick Fixes


rubik.cube.02Today I’d like to talk about some serious paradoxes of modern society. Could this explain in part why we are so ill? And why is self-harm occurring at such alarming rates?

  • Society tells us to love our bodies but then offers lipo and  tummy tucks to fix those problem areas.
  • Society tells us to seek materialism, buy more things, but then condemns us for not finding happiness in it.
  • Society tells us we’re beautiful but then bombards us with very unnatural makeup products.
  • Society tells us to grow old gracefully but then pushes a multi-billion dollar anti-aging campaign on us.
  • Society tells us effort is the most important thing  but then drapes young adults with cords at graduation and has a ceremony to honor outcome.
  • Society tells us to love ourselves and take time for self-care but then pushes little white or blue pills at us to remedy our sadness, or loneliness or brokenness.
  • Society wants us to be connected to our families, our neighbors, our friends but then values Facebook and Instagram likes more than phone calls and hugs.

{{Society tells us we are not good enough……and we listen.}}

It seems absurd to the majority of the population that harming oneself would ever feel better than not harming oneself. In fact, self-harm behaviors contradict what appears to be reasonable, logical and acceptable ways of self care, even in a world of quick fixes. But I’ve worked with enough self-harmers to tell you definitively, self-harmers are seeing all of those societal expectations and more. And they are condemning themselves for not measuring up.

This condemning takes the form of self-loathing, guilt, anxiety, anger, and being overwhelmed and its so unbearable to be stuck in this emotional storm that they find a way to shelter themselves. Self-preservation though self-mutilation of the body’s soft tissue. The act offers a temporary but effective quick fix. The emotional pain goes away, instantly, for the moment. Quick fix. Society likes that, no doubt, except this one is taboo, shameful, and “bad”.

So what do we do? How do we change? First understand quick fix and society’s paradoxes. Then work towards understanding why self-harm happens, and why it happens again.

Peace be with you my friends.

The Mind-Body Connection

When I sat down to write a piece for my blog today, I started to look to the notes on my phone. I routinely save topics on there that I might like to write about later. But before I even got to those stored notes, the mind-body connection popped into my head, and I knew what I wanted to write about. And this is why: In the past 7 months, nothing has been more transforming, mentally, emotionally and physically, than my making my health a priority for the first time in my life.

It goes back to May 2015, and a cluster of spots on my annual mammogram. Funny, because I was considering skipping my annual mammogram that year. I had gotten busy! I had become legal guardian to two teens in April and life was FULL. So as it were, I put it off, usually going on my birthday in April, this time going in May after my boyfriend pestered me a little bit and said I should probably not skip it. Okaaaayyy, fine. I’ll make an appointment. I had no breast cancer history in my family and no previous issues and I considered it an exercise in wasting time, but something I would do to show him, and myself, I was responsible. I was 44 years old.

In June 2015, after another mammogram, an MRI and a biopsy, I was given the diagnosis of Stage 0, non-invasive, DCIS cancer. Otherwise known as Ductal Carcinoma In Situ. Otherwise known as “the best type of cancer you can have”. Geeeeee, thanks doc, I feel so much better now.

I was shocked. Devastated. Scared shitless. Let me again emphasize how scared I was. I had no idea about cancer or types of breast cancer. I didn’t know anyone with cancer and no one in my family had cancer. The doctor, the medical oncologist, did her best to explain it to me, while I sat, internally dumbfounded, externally calm, cool and collected. She explained my treatment options. She explained the success rates. She looked from my boyfriend to me and back again. She was waiting for an answer. How did I want to proceed? She wanted to get me on the surgery schedule as soon as possible. I left the office, with a promise to call her and tell her my decision as soon as I could.

Finally, when alone (which is hard to do with two kids at home!), I broke down, sobbed, in fact. I sobbed in my bed, I sobbed in my car, I sobbed on the phone with my mom. I researched. I researched some more. I researched again. I stayed up late at night reading everything I could about DCIS. What was this? Why had I gotten it? Why had I gotten it at such a young age? How could I have gotten it with no family history? What were my treatment options? What were the success rates? How do they know? Are there different outcomes for those who get it so young? Why did this happen? I’m a very practice, science-based, rational decision-maker. So after a lot of thought, I finally decided on a lumpectomy with the 6 1/2 weeks of radiation they recommended. I couldn’t see lobbing off my whole breast for cancer contained in my milk ducts. Seemed radical. Totally respect those who make that decision. It’s your body and you have to live with it. As it turns out, I had to have a lumpectomy and two re-incisions…which means they had to go in two more times to take more tissue that they believed contained cancer. Maybe I should have had the mastectomy…

Anyway, after three surgeries I was ready for radiation to start in several weeks. I was told some patience get tired from it. My first thought: I can’t be tired!!! I have to work!!! I have kids!!! I can’t take time off work!!! I have things I need to do!!! The tiredness is more from the grind of having to go to the hospital every day, Monday through Friday,  than from treatments themselves. I had been told this early on (plus, I had done all my research about it), but I was super paranoid I would get too tired to live my life. Taking a leave of absence was not an option. So,  I had decided I was going to start exercising to be ready for the possible fatigue. I started walking outside with my neighbor after re-incision #1. I planned on averting fatigue, if at all possible, and I knew exercise could make me more invigorated and energetic. I had avoided exercise for a long time. Why? Because I was busy. Because I was a single parent, working, and doing it all. Because I had other priorities. Because I was overworked and stressed. Because my kids took priority and that made me a good mom. Because I liked carbs and sugar and those things drained my energy. Because…

By the time radiation began in September, I had already lost weight. I was happy about that, but it’s not what drove me. I wasn’t weighing myself. There was, however, always a nagging thought in the back of my mind that did drive me: did I fuel cancer with eating unhealthy, not exercising and being overweight? Could I have prevented this? Was it partially my fault I got cancer? I kept walking. I walked with my neighbor. I walked without my neighbor. I walked in the beautiful colors of the fall. I walked in the plummeting temperatures of late autumn in Michigan. I walked until the trees had no leaves. I took in every sight, every smell, every touch of the air. I walked. I thought. I reasoned. I felt sorry for myself. I talked. I walked with my cancer. And that fall, I grieved my way though my cancer diagnosis, step by step.

Radiation was well on its way. I was working full time. I was taking care of kids. I was walking. I was radiating. I started eating better. The weather turned cold. I joined the local community center. I walked on the treadmill. I radiated. I began incorporating some weight lifting into my routine. It felt good. My friend’s attendance fell off. I kept going. I radiated. I tracked my progress. I tracked my food intake. I lost weight. I liked it. I radiated. I went to the gym. The kids didn’t die from missing me. I was doing it. I was taking care of myself, my whole self.

At week 5, things got hard. By week 5 1/2 I almost quit radiation. I was in pain. A lot of pain. The radiation was burning my skin. My skin was peeling and weeping. It hurt to wear a bra. It hurt not to wear a bra. It hurt to move my arm. It hurt to overhead press a weight because it stretched my skin. I kept lifting. Luckily, the skin was least painful in the evening and I was able to ignore it more and keep lifting. I kept walking. I walked faster. I incorporated jogging intervals into my walk. I felt good. I knew I was doing something good for my body. My body responded and so did my mind!

Fast forward several months. I have joined a different gym with more space, more equipment and more hours. I go there 5 days a week. I lift, I cardio, I track my nutrition. And this is what I’ve learned: there is absolutely a mind-body connection.  It reminds me of the quote attributed to Abraham Lincoln when he was asked about his religion. He said, “When I do good, I feel good. When I do bad, I feel bad. And that’s my religion.” This is exactly how I feel about what I am doing. When I workout, I feel good. When I don’t workout, I feel bad. And that has a direct impact on my mental health.

Mentally, working out routinely, and I mean specifically lifting weights, puts me into a head space like no other. While lifting I am focused. I am breathing. I am putting my mind on a singular goal. Lift the weight up, put the weight down. Breath. Lift it up, put it down. Breath. There is a name for this in psychology. It’s called mindfulness. There are several similar definitions, however Psychology Today says mindfulness is a state of active, open attention on the present. Bingo! And mindfulness is attributed to decreased rumination, stress reduction, boosting working memory, more cognitive flexibility and less emotional reactivity. I can tell you it does that for me, and more, so much more.

Emotionally, I feel stronger and more even keeled. I just don’t think I have the capacity to be both emotional and exerting physical energy at the same time. Every day, I’m one workout away from emotionally washing away the ups and downs of my day.  As the physical tide comes in, any upset or worried feelings wash away. And I can rely on it. I’m the type of person who likes predictability. Most of us are creatures of habit. But if that habit predictably creates a clean emotional slate that carries you to the next day, it’s the best kind of habit to have. It does it for me in a way that chocolate never did.

Physically, I cannot tell you what lifting weights has done for me. I am strong. I am no longer winded. I want to take long hikes; I take long hikes. I want to climb big staircases; I climb big stairs. I move my body. I challenge my body. What else can you do body? I bet you can do THIS! I can make you look the way I want you to look now. I bet I can make my waist narrower and my booty bigger. Yep, I can. I bet I can sculpt my shoulders. Yep, I can. I challenge myself to reinvent myself, any way I want. Physical limitations? Not on your life! And to think, I had put them on myself before, voluntarily, out of sheer ignorance and negligence. Whaat?

I am reaching the 10 month mark post-diagnosis. I’m feelings good. I was one of the lucky ones. I’m lucky I got cancer. I’m lucky I got they type of cancer I did. Am I sad I got cancer? You betcha. Am I afraid it might return? Yes I am. These feelings are normal. Working out isn’t putting me in la-la land. I’m still a realist at heart and I know my chances of getting cancer again are there. I understand working out isn’t going to solve everything. But it has given me so much I never knew existed. It has given me, ME. And that all happened because cancer happened. A cancer diagnosis fueled the mind-body connection I needed to experience the whole person I am. For that, I am grateful to cancer.

walking path

(Pictured above: A favorite walking spot. Stony Creek Metropark, Shelby Township, MI)

I’m Not Crazy: The Social Stigma of Therapy

Business patient talking about his private problems at phychological session

Throughout the years, and because of my profession, I’ve often had the chance in a non-clinical setting to lend an ear to people from all walks of life who are struggling with something. It may be something as big as childhood molestation or as small as being easily frustrated by a spouse’s habits. Sometimes it’s anxiety or depression or anger. All things big and small share a common element. These things occupy valuable real estate in the person’s mind and draws uncomfortable emotions to the surface, while detracting from a life filled with joy and peace.

After listening intently I ultimately suggest therapy as an option to deal with said thing. “Oh no, I’m not crazy!”

It’s a much more common response than you might think and I’m saddened there is still a social stigma attached to mental health help. I ask why they think going to therapy means they’re crazy. Sometimes I get blown off. But, sometimes, I get a chance to dispel the myths surrounding therapy and mental health.

Here are my thoughts on who goes to see a therapist and why, from a therapists perspective.

Most people who go to therapy go to help themselves cope with intense and uncomfortable feelings they don’t like having.  PERIOD.

Many people go to help themselves cope with normal, every day stress and some go to improve relationships. Often people go for moderate problems and it is not true that people who go are “really messed up”. Most people go for only a short time before they begin to feel better (8 to 12 sessions). There’s no rule that says one has to go for a long time or dig into their past. And for that matter, it can be exactly what the person wants it to be. A good therapist will work on what the client wants to work on by helping the person navigate the thoughts, feelings and beliefs that keep them “stuck”.

People who go to therapy know there is a difference between talking to a friend and talking to a therapist. A therapist can help them reach their goal. Most people do not need to go on medication to start feeling better, but some do decide to go on medication while in therapy. Neither being in therapy, nor taking medication, makes you crazy. In my opinion it makes one proactive, courageous, and demonstrates self-care.

Therapy is a tool in your coping tool box. Sometimes you need to pull out the right tool for the right task. If you’re unhappy or anxious or want to change something that is taking up space in your zen zone, consider therapy. There is no shame in taking steps to improve one’s mental health. It’s one of the best things a person can do for themselves. Know what you need and how to get it in a healthy way. There’s nothing better than that.

For information on getting effective therapy see my blog post entitled

Good Therapy: Are You Getting It?

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What’s Your Client’s ACE Score?


The topic of childhood trauma has been in the news a lot in the past 15 years. From the Sandy Hook shooting to Hurricane Katrina to the Wold Trade Center terrorist attack, it seems more and more children are experiencing tragedy. On a smaller scale, every day children across the United States experience domestic violence, drug abuse in the home, a family member’s mental illness, divorce and a number of other significant life events. All of these experiences are adverse and are potentially and likely harmful to the development of the child. In fact, if you experienced toxic stress in childhood, you likely are more prone to health consequences, both physical and emotional.

toxic stress

As our understanding of the effects of Adverse Childhood Experiences (ACEs) has come into light, so have advances in Trauma-Informed Practices in the mental health field. But how can one quantify Adverse Childhood Experiences and their effect on one’s quality of life and their life span? This article seeks to inform the reader about one tool that can be used to assess a client’s childhood adversity, the ACE score.

In 1997 the largest study to date on the effects of childhood trauma was conducted as a collaboration between the Centers for Disease Control and Prevention and Kaiser Permanente’s Health Appraisal Clinic in San Diego. More than 17,000 insurance members provided detailed information about their experiences with abuse, neglect and family dysfunction before the age of 18. Participants also underwent a comprehensive physical examination. A link to these questionnaires can be found here http://www.cdc.gov/violenceprevention/acestudy/questionnaires.html

The results were astounding. Certain childhood experiences showed a strong correlation to some of the leading causes of illness, death and social problems. Listed below are the correlates.

  • Alcoholism and alcohol abuse
  • Chronic obstructive pulmonary disease (COPD)
  • Depression
  • Fetal death
  • Health-related quality of life
  • Illicit drug use
  • Ischemic heart disease (IHD)
  • Liver disease
  • Risk for intimate partner violence
  • Multiple sexual partners
  • Sexually transmitted diseases (STDs)
  • Smoking
  • Suicide attempts
  • Unintended pregnancies
  • Early initiation of smoking
  • Early initiation of sexual activity
  • Adolescent pregnancy

(Data taken from http://www.cdc.gov/violenceprevention/acestudy/findings.html)

Looking at the data from ACEs alone only gives us half a picture. Therapists understand that trauma impacts everyone differently and that what is traumatic for one person may not be traumatic for another. So how do we measure the impact of trauma? We need to also look at a clients resilience. Although there is not yet a standardized measure for resilience, the one found here Resilience Questionnaire  is a good start to furthering your understanding. Resilience encompasses certain protective factors, including external factors such as positive relationships and internal factors such as mental attributions.

Armed with these new data points, how can you use your client’s ACE score and resilience score to develop a more effective and comprehensive treatment plan? Can you help your client develop an understanding of how these childhood traumas impact their functioning today? How can you foster resilience in your client?  Using a client’s ACE score and resilience factors can help you provide high quality treatment to a wide client base.

If you enjoyed this article, please subscribe and leave a comment.

More detailed information about ACEs can be found here http://www.acesconnection.com/home and here http://acestoohigh.com/



Cutting: A Bonafide Addiction?


Every time I speak to a crowd about self-injury, and specifically cutting, I am asked to comment on whether or not I think cutting is an addition. If we look at the online Merriam-Webster dictionary defining of addiction, it states: a strong and harmful need to regularly have something (such as a drug) or do something (such as gamble). Addiction involves both strong psychological and physiological components.

Many young people report to me that once the started self-injuring, they couldn’t stop, or rather, didn’t want to stop. The psychological relief they felt when they cut themselves was a strong reinforcer, causing them to turn to the behavior the next time they were in intense emotional pain. The sight of the blood seems to act as a change agent as it  triggers an emotional change that otherwise couldn’t be achieved by their own will. It serves as a bright red stop sign to the emotional pain. Future cutting episodes are described as planned preoccupations. The how, where and when become as much a part of the behavior as the actual act of cutting. If you ask these young people, cutting IS an addiction. They become as preoccupied with it as an alcoholic is thinking about his/her next drink.

So are there physiological effects that gives cutting similar properties to drug or alcohol addiction? In the limited studies on self-injury, scientists have two major theories. One is that the body released endorphins, such as dopamine and serotonin, which minimize pain and provide a sense of well-being. The act of cutting produces the same “feel good hormones” as a drink or a shot of heroin does. Another hypothesis is that people who self-injure have an opioid (endorphin) deficiency and when a person cuts it increases their natural opioid levels allowing them to feel okay again. In this theory, cutting would bring the person back to a type of homeostasis. Either theory leaves us with the understanding that the act of cutting helps the cutter’s body to regulate it’s chemistry. A powerful force.

Both psychological and physiological factors play a role in addiction. So many of those who self-injure report feeling like self-injury is an addiction for them and that is effective in providing relief. In absence of another coping skill that is equally or more effective, those who engage in cutting are often reluctant to give it up. Considering what we know about addiction to substances and other behaviors, it seems that cutting can be a bonafide addiction.

If you or someone else is struggling with addiction, there is help.