Teen Talk

Written by Amoreena Berg, LMFT, Site Director for Adolescent Counseling Services.

Starting simple is the best way to be successful with teaching mindfulness to kids. For example, an adult who begins learning meditation may start off with 15 minutes of meditation a day, for a child it would be better to start off with 5 minutes. They also write that whomever teaches the child should be comfortable with teaching mindfulness exercises and the person should also have some experience practicing mindfulness.

Three areas of mindfulness activities are suggested for use with kids. These areas are: mindfulness of the environment, mindfulness of the body, and mindfulness meditation. The first area activities deal with directing a child’s attention toward the things in their environment. The exercises are designed to help the child become aware of the things they are aware of and the things they are not aware of. Take…

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Another school shooting tragedy occurred a few months ago, this time near Portland, Oregon. Two people, one being the gunman, were killed and one teacher was wounded. This school shooting came only weeks after Elliot Rodger’s rampage near the University of California at Santa Barbara (UCSB) which left six people dead as well as himself. That incident, meanwhile, came just six weeks after another student stabbed 21 people at his Pittsburgh-area school. And, of course, the memories of the Newtown massacre continue to collectively haunt our country.
The more school-based violent attacks occur, the more our country collectively wrings its hands and shifts the conversation towards the familiar and contentious debate over gun control, and talking heads flood the airwaves opining about the dangers the persistently mentally ill pose to others. Political debates and fear-mongering over the specter of mental illness do not help us answer one basic question: Whose responsibility is it to help those who might commit such horrific acts, before they happen?
Parents, of course, would seem to shoulder most of the burden but even well-meaning and deeply committed parents are not always able to single-handedly combat the challenges severe mental illness may pose to their child. What about teachers? Should screening their students for potential killers be part of their job description? After all, confronting and taking down school shooters apparently is. What about potential attackers’ fellow peers? It’s certainly not anybody’s responsibility to befriend anyone else, but at the same time peer support and positive peer relationships are extremely important for developing healthy social skills and self-esteem, especially for adolescents. One need only to read the deranged, sad and disturbingly angry manifesto left by Elliot Rodgers and ask: Would you have been his friend? Who would have? Perhaps the UCSB counseling center could have helped Elliot Rodgers begin to work through his troubles….but they can only help when someone seeks out services. Or should it be the responsibility of schools to proactively screen for students that may pose a threat? If these tragedies can collectively teach us one thing, it is that predicting violence is extraordinarily difficult.
Looking beyond questions of prevention, little attention seems to be paid to how best to care for those affected by these tragedies. The students of course need vigorous social, community, and psychological support. Post Traumatic Stress Disorder (PTSD), anxiety, depression and grief are all common responses to witnessing a violent event like a school shooting. However the fellow students are not the only ones needing such support. Teachers are affected in all of the same ways, but their mental health needs in the aftermath of such tragedies are frequently overlooked. Finally the surrounding community itself will likely feel the emotional and mental aftershocks of such horrific events for months or years to come. The shock, stress, anxiety and fear which these events can incite in community members who were otherwise not directly affected can be formidable, and frequently unrecognized.
While the nation debates the merits of gun control, arming teachers, and spreading damaging misperceptions about the vast majority of those diagnosed with a severe mental illness, it remains more important than ever to pay closer attention to how our country prioritizes mental health and the consequences of not taking it seriously enough. It’s far beyond the scope of this blog to weigh in on the topic of gun control, but it doesn’t take a Ph.D. to recognize that the only side effect of increasing our nation’s prioritization and funding of mental health issues would be a healthier, and better cared for, population.

Psychology Benefits Society

Baby waving at camera with parents in the background

By Michele Knox, PhD and Kimberly Burkhart, PhD

Did you know that nationwide, nearly 1 in 3 U.S. students say they have been bullied at school? Does it make you wonder what we’re doing wrong? What are we missing?

Maybe we’re missing parents. Research has shown that youth violence prevention and intervention are most effective when parents are involved. Further, interventions that have the goal of preventing violent behavior are best implemented in early childhood, before major problems occur.

This makes sense because early childhood is a time when developmental milestones such as the development of secure attachments, emotion regulation, and development of peer relationships and interpersonal skills occur. Violence prevention happens when kids have the capacity to understand and regulate their own feelings and possess a repertoire of appropriate non-violent responses. Kids learn these things from parents.

Adults and Children Together: Raising Safe Kids (ACT-RSK) is a group parenting…

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Just like Batman often relies on the assistance of his trusty sidekick Robin, I have a sidekick too!  Unlike Robin though my sidekick is furry, walks on four legs and has a habit of giving affectionate licks.  I’m talking about Yang Chu my standard poodle of course!  Yang is a therapy dog, which means he is specially trained to help my clients and their families.  Yang’s natural friendliness, gentleness, and of course cuteness, seems to elicit smiles from just about everyone who interacts with him!


In the clinic I have noticed that children often find it much easier to open up when Yang is around, and when a child is upset or scared nothing is more comforting than a warm, fuzzy, happy dog to pet!  Yang loves to play too, so sometimes clients might practice their social skills by interacting with him.  Therapy animals can help in lots of ways and in a variety of settings.  Oftentimes therapy animals are brought to hospitals to visit seriously ill children and their families and warm their spirits.  Other times therapy animals are used in residential or long-term care facilities to help ward off depression and feelings of social isolation.  Therapy animals can even help older adults suffering from diseases such as Alzheimer’s to improve their mood and functioning.

There is a wealth of research demonstrating the effectiveness in therapy animals, such as dogs, at improving the lives of clients.  Let’s take Autism Spectrum Disorder (ASD) as an example.  ASD is characterized by impaired social and emotional reciprocity, which refers to difficulties in communicating, having back-and-forth conversations or interactions and understanding non-verbal cues, as well as fixated and narrow interests and repetitive behaviors.  The use of therapy dogs in working with children diagnosed with ASD has been shown to result in improved prosocial behaviors, increased sensitivity and focus, and many other positive effects.  In fact, one study even suggested that ASD symptoms might be detected earlier than normal by observing how a child interacts with a therapy dog. 

Whether a child is struggling with depression, anxiety, ASD, or any many other problems, many of them find interacting with a therapy dog to be helpful and therapeutic.  Clearly the future is bright for loving and lovable four-legged friends like Yang!  As Batman knows, it’s great to have a helpful sidekick you can trust.


Be well, 

Dr. Stephanie AND Yang Chu Mihalas

Bullying has been increasingly recognized as a serious problem for children and adolescents over the past several decades.  While once mistakenly written off as a normal, even necessary, part of growing up, psychological research has documented the serious and damaging effects that severe or chronic bullying can have on a youth’s emotional, mental and physical well-being.  Chronically bullied children can become depressed, exhibit school refusal behaviors, begin bullying other peers themselves, and even become suicidal or develop other severe psychological problems.  A little teasing now and then may be extremely common and relatively innocuous for most school-aged children, but for a significant percentage of them – as many as a third according to numerous studies – bullying can become severe and chronic enough to begin causing serious harm. 

A recent large study surveyed 4,300 children in fifth, seventh and 10th grades about bullying and their mental well-being.  This research reinforced what many prior studies have reported; that bullying is extremely common and is frequently associated with reduced mental and emotional well-being and lower self-esteem.  However an additional layer was added to our understanding of the toll bullying can take on youth.  The study found that even once chronic bullying stopped, the negative effects on children’s’ mental and physical well-being lingered.  The more chronic and longer-lasting the bullying, the worse the damaging effects, even if the bullying had stopped.  As one of the researches involved in the study noted, “the effects of bullying compound over time, and it’s important to catch it early.”

But what can be done to help?  One important avenue to combat bullying which the article noted is the importance of bystanders stepping in when they notice bullying occur.  The reluctance of uninvolved persons to jump in and help someone in need is such a well-known phenomenon that it has its own name: the bystander effect.  Educating youth about bullying and empowering them to take a stand can help snuff out the social conditions which allow bullying to thrive.  Bullying can be seen as a systemic problem, in that it takes a number of factors working in concert to allow bullying to flourish: the youth involved themselves, the bystanders who sit by and do nothing, school administrators who fail to implement or enforce anti-bullying policies, and teachers who do not intervene or advocate on behalf of bullied students.  All facets of this system must change to effectively reduce bullying.

One potential area of support which this recent article did not mention is the importance of supportive teachers who form caring relationships with their students.  Research my students and I conducted has demonstrated that caring teacher-student relationships can help alleviate some of the negative effects of bullying.  Teachers can become tremendous and crucial allies in the fight against chronic school bullying.

What can parents do to help?  The most beneficial thing you can do for your child is to be a good listener.  Supportive and caring parent-child relationships are often cited as the single biggest protective factor against the damaging effects of severe bullying.  Likewise, aggressive or negative parental communication has been linked to increased bullying behaviors in their children.  Another way parents can help battle bullying is by enlisting the support and assistance of their child’s teachers.  Oftentimes teachers may be unaware of the existence or extent of a bullying problem, but once alerted can pay closer attention and intervene when necessary.  For a child being victimized by severe bullying, knowing they have trusted allies and advocates both at school and at home can make all the difference in the world.

Be well,

Dr. Stephanie

It is common knowledge that the food you eat can affect your mood.  After all, that is why the concept of “comfort food” exists!  Going through a rough breakup? Plowing into that pint of Ben & Jerry’s might make you feel better.  Had a rough day at the school?  Maybe a little visit from the dark chocolate fairy can help.  What many people may not realize is that our food choices can actually impact our mood too—that is, what we eat first, can change our mood later. Research soon to be published in the Journal of Consumer Psychology has demonstrated that positive moods can lead to healthier eating choices, whereas negative moods can lead to unhealthier (i.e., “comfort”) food choices. 

Part of this connection has to do with what time frame people keep in mind when in particular moods.  For example, being in a positive mood (such as feeling happy or grateful) has demonstrated more future-oriented and long-term thinking.  This in turn compels people to make mindful choices around what to eat. Participants in the study were more likely to select foods which would provide greater benefit down the line, due to being healthier and more nutritious.  On the other hand a negative mood (such as feeling anxious or sad) encouraged a preoccupation with shorter-term thinking and participants therefore sought out more indulgent foods, such as those high in fat and sugar, which might boost their mood in the short term.

It pays to keep in mind the circular relationship between mood and food.  While eating indulgent foods (such as that pint of Ben & Jerry’s!) may elevate one’s mood temporarily, they are more likely to have negative mood repercussions later due to the sugar crash, feelings of regret, or general lack of energy.  This could cause one’s mood to take another nosedive, which could once again lead to cravings for unhealthy foods.  On the other hand, while eating healthy food may not have the same level of immediate sensory satisfaction, it is more likely to lead to increased energy and feelings of well-being later, which can help sustain a positive mood state.

This connection between one’s state of mind and the foods they choose to eat has an important upshot: By doing something to influence your mood, you can also influence your eating habits and health!  Something as simple as spending a few minutes before each meal thinking about something that makes you happy, or engaging in a brief gratitude meditation, can have a large impact on how healthy you eat.  In fact, the researchers found that thinking about what makes you happy can lead to up to 77% healthier eating choices!

So the next time you’re trying to decide what to eat, or find yourself tempted by that last donut in the office kitchen, sit down and close your eyes, take a few deep breaths, find that happy place inside yourself and bask in that for a few minutes.  Afterwards you might be surprised how much easier it is to resist temptation!

I think I am going to take a bite of some quinoa and cranberry salad. YUMMO,

Dr. Stephanie

Most children will, at some point, wish to avoid going to school.  Almost every parent could regale one with stories of phantom stomach aches, faked fevers, or doe-eyed pleas for a “mental health day.”  To a large extent, this kind of occasional and mild school avoidance can be seen as normal and relatively innocuous.  However for as many as 28-35% of youths (Mihalas, 2014), at some point in their lives this kind of behavior may escalate into what psychologists term School Refusal Behavior (SRB).  With SRB, it’s not that a child won’t go to school; it is that for all intents and purposes they can’t.  Symptoms such as panic attacks, vomiting, excessive tantrums, and severe parental separation anxiety surrounding school attendance can signify problematic SRB which should motivate a consultation with a qualified mental health professional.  If SRB seems to be developing and becoming more severe, it is crucial that parents avoid continuing to try forcing the child to go to school, as that can often exacerbate the underlying issues.

A key point to remember is that SRB can almost always be traced to a root cause.  SRB may be due to severe bullying, difficulty adjusting to a new environment, emotional issues related to academic difficulties, problems separating from one or both parents, or any number of other causes.  Regardless of the root issue, the important thing is that it is identified and dealt with.  Parents can encourage their children to open up and talk about their problems by being compassionate, empathetic, non-judgmental, and by asking questions.  Keep in mind however that younger children may have difficulty articulating the causes behind their distress, and older children or adolescents may be reticent to divulge this information.  In these situations a qualified child psychologist can be invaluable.

A psychologist can provide a safe space where children or adolescents can share their thoughts, feelings and fears outside of the normal family environment.  This can be particularly helpful if the relationship between one or both parents and the child is difficult or conflictual, but even in cases of good parent-child relationships some children may be embarrassed or ashamed to speak to parents about such painful issues.  Once the root cause(s) of the SRB have been identified, the psychologist can work with the child and parents to devise an appropriate treatment strategy.  One common approach is cognitive-behavioral therapy (CBT), which helps children identify how their thoughts, feelings, and actions all influence each other, and how to interrupt problematic cycles.  Parent training can also be an important component to treatment, as parents may need coaching on how best to support their child at home by changing behaviors or routines that are maintaining or exacerbating the problem.

In cases where the root cause of SRB appears more mysterious, or the child is too young to assist in this process, a child psychologist may be able to conduct a functional-based assessment (FBA).  In an FBA, the psychologist observes the child and parent(s) during the normal morning school routine multiple times and attempts to assess the underlying purpose of a child’s SRB.  While conducting a FBA in these situations could be considered best practice, the higher cost of such a procedure and the possible lack of appropriately trained local practitioners may render a FBA unrealistic (Mihalas, 2014).  Additionally a proper FBA should ideally include the assistance of school personnel, such as allowing the psychologist access to school grounds for observation.

This raises another crucial issue surrounding SRB, which is the importance of cooperation from school personnel, whenever possible.  SRB can lead to children missing weeks or even months of class.  Therefore, school administrators and teachers who are willing to work with parents to keep kids on track academically from home are imperative.  Likewise, trusted friends from school can be enlisted as informal liaisons, keeping a child up-to-date on classroom activities and acting as a buddy during the re-integration process.  In addition, it can be extremely helpful in some situations if schools are willing to accommodate a child’s different needs in order to combat SRB, such as being dropped off at a different place from other children, attending certain classes but not others temporarily, or allowing a child to have quiet time alone instead of needing to leave school completely.  Unfortunately some schools are unwilling to work with families dealing with SRB and this can present a hindrance to treatment (Mihalas, 2014).

The bottom line is that while an occasional desire to avoid school is normal, any number of issues may drive a child to begin refusing to attend school altogether.  Parents are advised not to ignore this behavior if it becomes severe, nor are continuing to attempt to force school attendance likely to alleviate the underlying problems and, instead, may further inflame them.  A child psychologist can help determine the core issues influencing the SRB and devise a treatment plan.  School assistance can be invaluable in this process.

Feel free to contact me. I am happy to help.

Dr. Stephanie 


Mihalas, S.T. (2014). School refusal behavior. In L. Grossman & S. Walfish (Eds.), Translating Psychological Research Into Practice (pp. 85-88). New York, NY: Springer Publishing Company, LLC.


Mindfulness and Children

Mindfulness has become one of the hottest words in the mental health field, and within popular culture as well.  Interest and participation in mindfulness-based activities such as meditation, yoga, tai chi and Qi-gong are skyrocketing.  Within the therapy room, a similar surge in popularity is being seen as more and more clinicians begin adopting mindfulness-based approaches in their work, either by using manualized mindfulness-based treatment interventions such as Mindfulness-Based Stress Reduction (MBSR) and Mindfulness-Based Cognitive Therapy (MBCT), or by incorporating mindfulness practices such as various forms of meditation or yoga in an integrative fashion.

Regardless of the particular mindfulness-based method or technique used, the core teachings are similar.  Mindfulness-techniques aim to improve one’s ability to stay present in the moment, to reduce distractions from past or future-oriented thoughts or fears, and to increase one’s awareness of their bodily sensations as well as their thoughts and feelings.  Crucially, mindfulness advocates taking a non-judgmental stance to this awareness.  In other words, the more one learns to pay attention to their thoughts, feelings, and body states, the more they also learn to avoid judging any particular thought or feeling as good or bad.  This can be particularly helpful for those suffering from depression or anxiety, in which the internal monologue of thoughts can frequently exacerbate a person’s distress.

Mindfulness-based methods, despite being around for thousands of years in various forms across the world, have begun infiltrating the practice of psychology only in the last few decades following the groundbreaking work of Dr. Jon Kabat-Zinn at the University of Massachusetts Medical Center in the late 1970’s.  The numerous positive effects of mindfulness-based methods for adult populations have since been increasingly well documented, and include increased subjective well-being, reduced emotional reactivity, reduced levels of physiological stress, and improved behavioral regulation.

Adults are not the only ones who can benefit from mindfulness-based techniques.  Children and adolescents have also been found to react positively to a mindful approach as well.  While research on mindfulness and children is relatively nascent, results thus far appear promising.  For example, studies with adolescents have found that mindfulness-based methods can improve cardiovascular functioning, academic performance, and internalizing and externalizing symptoms of anxiety.  In addition, it has been suggested that the tenants of mindfulness may prove especially helpful in improving children’s memory, attention, focus and self-control.

Utilizing a mindfulness-based approach with children requires the clinician to modify or adapt mindfulness techniques or exercises to be developmentally appropriate for the client’s age.  For example, while adults may be able to sustain their attention on meditative practice for thirty minutes, most children and adolescents would find it difficult, at least at first, to control their focus to such a degree.  Instead, shorter meditation intervals can be used, such as beginning with three minutes and gradually increasing the time as children gain comfort and mastery.


In a previously-published article, this author (SM) suggested several mindfulness-based techniques suitable to use with children and adolescents (Mihalas & Witherspoon, 2013).  These recommendations are summarized below:

  • Attempting to focus on internal thoughts or sensations (such as breathing) may be too esoteric a task for children to start mindfulness training with.  One possible alternative is mindful drawing.  In this exercise a child is asked to draw anything they like.  During this time they are instructed to pay special attention to the lines, shapes, and colors which constitute their drawing.  After 10 to 15 minutes, the child is asked to draw the same thing again.  Afterwards they compare the differences in details between the two drawings.  Clinicians can help the child process what it is like to pay particular attention to the small details, which normally we miss due to being on “automatic auto-pilot.”
  • One way to help children or adolescents learn to become more mindful and aware of their surrounding environment is by encouraging their imagination.  Hooker and Fodor (2008) recommend telling children to imagine that their eyes are like looking through the viewfinder of a camera.  What does their lens capture in the world around them?  Similarly, children can be encouraged to imagine they are newspaper reporters, documenting their everyday experiences.  Through these techniques new awareness can be brought onto the minutia of our surroundings, such that previously hidden beauty becomes much more noticeable, and the child gains experience in focusing their awareness on the present moment.
  • Finally, mindful texting can be particularly helpful for teens.  One of the goals of mindfulness is to increase the space in between a stimulus (such as a person snapping at us, or a negative thought) and our reaction (e.g., snapping back or becoming angry at ourselves). Texting provides a simple and concrete example in which to practice this skill.  Teens are encouraged to “check in” with themselves when each text is received: Do they feel a particular urge to respond right away to texts from a specific person?  What kinds of emotions, thoughts, and feelings does a particular text illicit in them, and why?  What are their different options for responding?  Teens are encouraged to view their texts as responses instead of reactions.  Skills learned in this method can then easily be generalized to in-person social interactions.

One of the great attributes of mindfulness-based methods is that they can be seen as adjunctive to other interventions or styles of treatment.  The core mindfulness virtues of self-awareness, compassion, non-judgment and patience can be seen as beneficial skills to develop regardless of one’s theoretical orientation or temperament.  While mindfulness-based techniques may not be a catch-all method to cure any presenting issue for any population, they do appear to be powerful and increasingly validated methods to enhance one’s quality of life.

Be mindful,

Dr. Stephanie


Police and Mental Illness 

The recent acquittal of two Fullerton, California police officers charged in the beating death of Kelly Thomas, a homeless man diagnosed with mental illness, has re-ignited the ongoing debate over how police officers interact with people suffering from severe and persistent mental illness.  Voices are calling for enhanced and improved training for police officers in working with psychiatric illness, and indeed the need for this training has likely never been so great.

Since the emptying of the vast majority of American mental institutions in the 1960’s and 1970’s, especially here in California, more and more severely mentally ill people have been ending up homeless, filling up prisons, and finding themselves face to face with police officers.  In fact, law enforcement officers are frequently the first-responders for issues involving severe mental illness.  Despite this, mental illness-related training for law enforcement officers often amounts to just six to eight hours during academy, sometimes less.  Training varies widely between agencies, departments, and regions.

Fortunately the last few years have seen a growing recognition of the importance of expanding this training.  In the late 1980’s Crisis Intervention Team (CIT) training was created to address this need.  CIT is a 40-hour course which teaches law enforcement officers about mental illness and trains them to interact with persons diagnosed with mental illness in ways that facilitate de-escalation.  CIT has been found to effectively improve law enforcement officers’ self-efficacy and attitude towards the mentally ill, as well as improving outcomes of calls involving mental illness, and reducing costs associated with mental illness, such as helping people get placed in appropriate health facilities instead of simply in jail.  Law enforcement departments around the country have begun implementing CIT for some of their officers, including Los Angeles county and many others within California.

While CIT is demonstrably effective, it does not represent a total solution.  CIT pulls officers off their job for a week, which many departments can ill afford, and even then only some officers will receive the training.  In Fullerton, where the Kelly Thomas incident occurred, the acting police chief has stated that all police officers receive “homelessness and mental illness training and crisis intervention training,” though he did not specify how many hours this included nor what this training actually involved.  Regardless, events such as Kelly Thomas’ death highlight the fact that the current methods of training appear to be inadequate.

Ignorance about psychological problems, and stereotypes that people with a mental illness are frequently violent, pervade both the general public and law enforcement.  While some people suffering from mental illness can certainly become violent, this can sometimes be a result of police actions which unintentionally escalate the situation.  Strategies as simple as lowering one’s voice, maintaining personal space, and taking a minute to assess the emotional state of a person may mean the difference between a peaceful resolution and tragedy. 

Along with the importance of expanding law enforcement training in working with psychiatrically-involved populations is the importance of shifting our attitudes as a culture and a society towards mental illness and those who struggle with it.  Whether homeless or not, many people suffering from psychological disturbances or disorders are indeed suffering.  This does not necessarily excuse any inappropriate or harmful actions they may take, but it should be sufficient cause to take an empathetic stance towards these people.  Empathy, or the ability to understand another person’s perspective, is an enormously important capacity to develop for everyone, but especially those in front-line professions that interact with diverse groups of people, such as law enforcement.  Empathy enhances compassion, facilitates communication, promotes mutual understanding, and can enable cooperation.

Without knowing all of the facts of the case it would be irresponsible to speculate about the motives or actions of any of the parties involved in the Kelly Thomas incident.  Regardless of the one’s opinion about the verdict, one possible take-away from this sad affair is that enhancing our level of empathy as a culture, and correspondingly the level of empathy law enforcement officers are trained to view mentally ill people with, the likelier that tragedies such as this could be avoided.