The blog

Suicide attempts, self-injury, threatening violence, running away, drug abuse, promiscuous sex, refusing to go to school, violent outbursts . . . help!!

Sometimes we see teens acting in ways that seemingly make no sense. What in the world is the reason for these behaviors? How do we protect kids from themselves, families from the risk, and ourselves from liability? This is a tall order and often results in providers becoming understandably anxious and flummoxed. What are we supposed to do? Follow this 5-step plan to make sound and effective decisions with the teens you work with.

• Focus on the relationship. Teens need their connections with us and rely on us to stay close when they are most vulnerable. Paradoxically, they need us most when they tell us they need us least. Without the connection, we are shut out, unable to accurately assess and help, and teens are alone, relying solely on their peer group for guidance and support. Stay connected. Even when it’s hard.
• Take a breath. Literally. When human beings are presented with a surprising and novel situation the brain suspends breath for a moment and focuses on the cue. This allows for a quick (often inaccurate) assessment of the situation as either threatening or rewarding and orients behavior accordingly. There is a risk that if we don’t slow down our response, we may respond to a perceived threat with immediate aggression (punishment, exerting control) when a more effective response is to take the time to assess the situation accurately first. Take a breath and allow your emotions to settle a bit.
• Figure out the function of the behavior. Everything teens do makes sense in the context in which the behaviors occur. Consider that for a moment … behavior is always understandable when we become aware of the bigger picture. Suicide attempts may be efforts to escape intense pain in the absence of psychological skills for managing it effectively. Self-harm may be a way to signal to the larger peer group that teens are struggling, which results in empathy and support as well as distraction from psychological pain. Violent behavior may be an attempt to right a wrong, preserve self-worth, or get one’s needs met if other skills have not been developed. Drug abuse or sexual promiscuity may be an attempt to access some pleasure in the context of pain or distress. Avoiding school may be due to anxiety about facing the consequences of not doing work or social challenges. There’s always a reason! Just because a behavior solves one problem temporarily and frequently creates many others in the long term doesn’t negate its effectiveness in the moment. Figuring this out requires collaboration, trial and error, and patience.
• Help teens solve their problems more effectively. Once we understand WHY teens are doing what they are doing, then we can shift our focus to helping them solve the problem that results in the scary behavior in a more effective manner. This may result in a referral to a mental health professional to build psychological skills, a more precise set of goals on an IEP to address learning or social challenges in school, more focused and strategic responses to behaviors within the family, or admission to a supervised setting to increase safety until skills develop or the crisis passes. While there is sometimes a place for punishment, without skill-building and problem solving, teens are doomed to repeat these behaviors. They need new skills, effective support, and understanding adults to guide them out of the woods of scary behaviors and into the world of a value-driven life worth living.
• Build hope. Teens need adults to believe in them. We all need cheerleaders to keep our spirits up when the going gets rough. Incredible growth often occurs at times of distress and challenge. Maintain an encouraging stance and make an effort to be the adult who “gets it” and makes a real difference.

~Britt Rathbone