September is National Suicide Prevention Month. In 2022, the CDC found that almost 50,000 Americans died by suicide. Among 10 to 14 year olds, suicide is the second leading cause of death, and among those who are 15 to 24, it is the third leading cause. According to the Jason Foundation, more young adults die by suicide than cancer, heart disease, AIDS, pneumonia, and influenza combined.

Let that sink in for a moment. Our children and early adolescents are struggling, oftentimes silently.

While in many ways we have made strides in the field of mental health towards normalizing depression and suicidal thoughts, we still have a long way to go. Children who have thoughts or urges to end their lives oftentimes fear the reactions of trusted adults. Will they send me to the hospital? Will they think I’m just trying to get attention? Adolescents might share more readily with their peers, but their friends often don’t know what to do with this information either. Their friends might also be struggling and have the same questions of what might happen if they tell an adult.

The reality is that as a society we are still uncomfortable talking about suicide. We speak in euphemisms or hushed tones when we need to be speaking loudly and frequently. It is not an exaggeration to say that we have an epidemic of suicide among our adolescents.

All the research says that talking about suicide does not increase rates of suicide. So talk about suicide with kids in age appropriate ways. Be direct in your approach, especially if you have noticed any of the warning signs of suicide, which in youth include withdrawing from friends, increased depression, sleeping less or more often, and extreme mood swings. Ask them directly if they are having thoughts of killing themselves.

Another important thing to do with adolescents, whether you are a parent, an aunt or uncle, or any other adult around children, is to model vulnerability. Be honest about your own mental health struggles and that you get anxious or depressed too. This will create an environment in which adolescents feel more comfortable sharing their own thoughts and feelings.

Connection and communication are two of our most powerful tools against suicide. In her novel Delirium, Lauren Oliver reflects on the hidden quality of suicide in our culture: “Suicide. A sideways word, a word that people whisper and mutter and cough: a word that must be squeezed out behind cupped palms or murmured behind closed doors. It was only in my dreams that I hear the word shouted, screamed.” In this passage, Oliver highlights the disconnect between the interior world of someone who is struggling with suicidal thoughts and the world around her that remains silent. We must not be silent anymore.

If you or someone you care about is experiencing thoughts of suicide, there are numerous resources available to help you navigate this crisis. You can call the National Suicide Prevention Hotline, which is 1-800-273-TALK (8255). You can also just dial 988. If you are in the St. Louis area, you can call Behavioral Health Response 24 hours a day at 314-469-6644.

Numerous resources in St. Louis exist specifically for teenagers who are experiencing suicidal thoughts. The St. Louis County Children’s Service Fund operates a Youth Connection Helpline. This is a 24/7 helpline to help teenagers and their caregivers navigate a suicide crisis. You can call 314-819-8802 or text BHEARD (31648) to be connected to a trained mental health professional. KUTO (Kids Under Twenty One) is a local organization that has a crisis intervention hotline run by teenagers. It operates weekdays from 4 pm to 10 pm and on weekends from 4 pm to midnight. Teens can call 314-644-5886 to receive confidential support from other teens.
​
Let’s work together to destigmatize suicide. Let’s talk about it without fear.

Every year it comes sooner than the last, but it comes all the same. The end of summer vacation, and for many, the beginning of the school year. Parents may be excited and even relieved for their children to return to school, but this time of year can also be fraught with stress. Figuring out schedules and navigating transitions can be tricky, and children may be nervous about making new friends, meeting new teachers, and finding their place in new classrooms or even entire buildings. Many children may be reluctant to return to school due to negative experiences with peers or difficult classes. 

It is important to draw on our capacity for empathy when children express fear or reluctance to return to school, whether we are in their lives as caregivers, teachers, or other professionals or family members. Sadly, many of us may have had painful experiences associated with school and did not feel like we had anyone in our corner to support us when times were tough. For myself, I enjoyed the learning aspect of school, but dealt with severe bullying throughout grade school that left me crying when I came home nearly every day. I wish that our tiny school had been equipped with a counselor, or that my parents were aware of or had received any sort of guidance on how to support me emotionally. My childhood experiences became the groundwork for my future career as a therapist, because I wanted to turn what I went through into something positive. I wanted to make a difference for children who may be bullied, feel stressed, or struggle to find a sense of belonging. 

Now that several years have passed, I look back on myself as a child and think “She really could have used a hug” or “All she wanted was someone to listen.” As adults, we hold a responsibility to provide children with the love and support they need in order to explore the world and find their own values and dreams. A significant step on this journey is to foster children’s interest in education – whether they love to create art, solve math problems, write stories, or conduct science experiments. Here are some suggestions that may prove useful as we navigate the back-to-school rush. 

1. Start – and stick with - a routine. This is much easier said than done, but children (and adults!) of all ages respond positively to consistent, manageable routines. A routine creates familiarity and helps children learn what to expect while practicing self-discipline. Learn your child’s school schedule and factor in breaks, meals, family time, and relaxation outside of classes, sports, and clubs. Set clear, reasonable expectations regarding screen time. Try to stick to a relaxed version of your routine on weekends and days off as well, so that Monday isn’t so daunting when it rolls around again. 
2. Familiarize yourself and your child with their school environment. If possible, attend any open-house or orientation that your child’s school may offer. Get to know your child’s teachers and see the school from a student’s perspective. If your child is unable to attend themselves, ask them if there is anything they would like to know that you might be able to learn on their behalf and relay back to them. Having first-hand knowledge of your child’s school can help you connect better when they tell you about their day. 
3. Encourage your child to share their feelings - and listen to them. Some children may be more upfront about their worries than others; others may be waiting for an opportunity to share with you, but never feel as though it’s the right time. Before the first day, make time for your child to share with you any fears or worries they have about the upcoming school year – whether it’s something big or seemingly small, it is important to validate your child’s feelings (never dismiss them) and let them know you are there for them and appreciate their willingness to share. Ensure your child has the space to speak about their experiences without interrupting them. Encourage your child to be open with their feelings and know that you are someone they can trust. If your child has a counselor or therapist, encourage them to be honest with those trusted professionals as well. The more that we know, the more we can help. 
4. Celebrate the joys and praise positive behaviors. School doesn’t always have to be a terrible, horrible, no-good, very bad thing. Celebrate when your child gets a sticker for the day, or makes a new friend, or scores a goal. Share in their excitement about having pizza for lunch or being able to overcome their nervousness and ask the teacher for help when they need it. Trophies and certificates aren’t everything – sometimes our greatest, most meaningful rewards can be a hug or an “I’m so proud of you” from a loved one. This isn’t to say that you should throw a party every time something remotely good happens but try to focus more on the positives than the negatives, especially if your child struggles with behavioral and emotional difficulties in school. 
5. Don't be afraid to reach out for support. Fortunately, many schools nowadays are equipped with incredible faculty and staff who genuinely care for children of all ages and want to see them succeed. Establish a good rapport with your child’s teachers at the beginning of the school year and ask that they check in with you regarding any significant concerns or accomplishments. When appropriate, provide updates on your child as they pertain to school – are they coming back from a rough weekend? Has there been a recent loss in the family? Has your child started any new medication? Check in with your school counselor or social worker about community resources including therapy, support groups, and activities to utilize at home to help your child thrive emotionally, mentally, and physically. Parents and caregivers need to take care of themselves too – and it’s a good thing to reach out for help when you feel like you or your child need it. 

Of course, all children are different and have varying strengths, values, and struggles. What may be easy for one family may not be as feasible for another. We cannot protect our children from everything and should never expect to shield them from every single negative experience, but we can do our best to provide loving, nurturing care and support to encourage them to participate in school and find appropriate solutions to any issues they may have. When your child comes to you for help or reassurance, remember just how much you mean to them. You don’t have to have all of the answers – I’d be shocked if anyone did – but remember to reach out for help when you need it, lend an ear to your child’s worries and accomplishments alike, give your child the opportunities they need to grow, and be an active part of your child’s educational experience. 

 April is the cruelest month. Or at least that’s what T. S. Eliot said in the opening line of his poem The Waste Land.
​
For many of us, Eliot’s thought defies expectations of what April should be. April is the advent of spring and of the earth’s annual rebirth. The trees are blooming. The squirrels are scurrying around. The birds are chirping, and the sun is shining far more. After months of awaiting spring, we are ready to feel better. This is especially the case for those who suffer from the winter blues, also known as Seasonal Affective Disorder (SAD).

For many, it is certainly true that spring improves their mental health. They are able to get outside more and move their bodies, and the Vitamin D and increased daylight hours rejuvenates them. But for others, they wonder why their depression doesn’t improve. They might see all their friends or families posting on social media about their happiness and outdoor events and feel isolated. Because, unlike others, they aren’t better. The relief they expected with the change of the season didn’t come.

For any of you who are feeling this, I want to reassure you that it’s okay not to be okay, even if it seems like everyone around you is waking up after a long winter.

In fact, research has shown that April is a tough month for people’s mental health and consistently has been for at least a century. More individuals, particularly in the Northern Hemisphere, complete suicide in the months of April and May than at any other time of year. Lots of researchers have speculated on the possible reasons why. One theory is that spring allergies lead to physical inflammation, irritability, and increased impulsivity, all of which can increase suicide risk.

Another theory is that we feel like we should be feeling better and when we don’t, we lose hope. This is the feeling of paradox Elliot was trying to capture in his poem. He writes, “April is the cruelest month, breeding lilacs out of the dead land, mixing memory and desire, stirring dull roots with spring rain.” In other words, the rebirth of spring makes us want to feel better. We desire more and instinctively raise the bar on who we can be and how we can feel. Eliot writes, “Winter kept us warm, covering earth in forgetful snow.” Many of us hunker down in winter and adjust our expectations. Then spring arrives and we hope for more. And hope can be a scary thing sometimes.

Ultimately, researchers don’t know for certain exactly why suicide rates spike so high in April. What we do know is that talking about our mental health and realizing we are not alone in our sadness or pain can be the bridge we need towards feeling better. No matter what is going on inside your head or outside your window, realize that just as the seasons change, so too can our thoughts and feelings. In April, we might not bloom just when the daffodils do, and we might not feel like singing as loudly as the birds outside are chirping. Yet we can feel better in the future.
And, in the meantime, it’s okay not to be okay.

Seeking out help when you are struggling is not a sign of weakness; it’s a sign of strength. Some ways to seek help if you are struggling this spring are to reach out to a mental health professional and make an appointment. If you are already seeing a therapist, let them know that you are having a hard time so that they can provide you with additional resources and create a safety plan for those tough moments. Additionally, there are numerous hotlines where you can seek immediate support. These include the National Suicide Prevention Hotline, which is 1-800-273-
TALK (8255). You can also just dial 988. If you are in the St. Louis area, you can call Behavioral Health Response 24 hours a day at 314-469-6644. No one should suffer alone.

Every February, countless individuals flock to their local jeweler, florist, or Walgreens to pick up that special gift for that special someone in their life. Friends, parents, siblings, partners…regardless of the special someone, Valentine’s Day is a reminder to show them how much we care. And though the chocolate is delicious, and the new flowers brighten the room just right, there are more significant ways to show our love for others...and ourselves.
    
Love Each Other

Famous songwriter/musician, James Woods, tells us to, “Shower the people we love with love,” and while we all strive to meet his call to action, there are times when the shower may barely be a sprinkle, and the magic of love has been replaced with something more reliable and consistent, albeit mundane. Below are some helpful reminders of how to stoke the fires of love without a trip to Tiffany’s.
​

1. Be Curious – Whether you have been together for 3 months or 30 years, there is plenty to learn about the inner workings of your partner. Each of us holds a unique understanding of the world around us, and in order for us to understand and accept our partner, we must understand and accept the meaning they make of the world. Don’t rely on old assumptions. Allow your partner to be the expert on themselves and invite their perspective whenever possible. When in doubt, ask.
2.  Be Grateful – Express gratitude whenever possible to your partner. Often, we make the assumption that our partner knows exactly how much we appreciate them. Unless your partner has developed mind-reading abilities, assume they don’t know how you feel. Let them know, daily, why you are appreciative of them. No act is too small to express gratitude.
3.  Be Receptive – Your number one priority as a partner is to ensure that you are open to the wants and needs of your own partner. This does not mean you have to agree with your partner on everything. Disagreement, when expressed respectfully, is very healthy in a relationship. Receptivity is about dropping your own defenses and insecurities long enough to let your partner know that their needs are important and should be listened to with respect.
4.  Be Adventurous – Finally, what is a romantic partnership without a little (or a lot of) fun? Not every romantic partnership is rooted in adventurous behaviors like skydiving, mountain climbing, or bungee jumping. If that’s not you, no problem! Adventures come in all sizes and experiences. Try something new with your partner. Go to a restaurant you’ve been wanting to try. Take that cooking class you’ve been putting off. Start a new book together. Adventure is what you make it, but above all, it should be fun, and it should be done together.

Love Yourself

For some of us it is easy, even a delight, to spread love freely and abundantly, but we find the pitcher empty when it comes time to fill our own cup. Here is some loving advice on how to be more loving to yourself.

1. Be Kind - First and foremost, kindness is an essential quality to all interactions with ourselves. We are too quick to criticize or punish ourselves for perceived mistakes. In the name of self-improvement, we can bury ourselves in “projects, diets, routines, and regimens” which serve only as reminders of failure, rather than acknowledgement of growth. Remind yourself, regularly, of what you do well. Take time every day to remind yourself of what you have achieved, small and large.
2. Be Forgiving – Forgiveness can be seen as an act of kindness, but it is an essential practice in self-love. We are often quick to forgive those who wrong us but hesitant to offer ourselves the same grace. Life is full of trial and error. The significance of failure is the experience one gains in the process. What meaning do we choose to make of our shortcomings, and do we choose to recognize the courage in trying but falling short? What would you say to a friend or loved one who made a mistake? Try this approach for yourself.
3. Be Mindful – In other words, “Be Here Now.” Mindfulness is fully diving into the present moment without judgment. Far too often, we find ourselves lost in the regrets of the past and the worries of the future. In the process, we miss out on life where it truly exists – in the present moment. Mindfulness can be done any time, anywhere, in nearly any activity. It only requires that you ground yourself to the moment and not allow your mind to latch on to thoughts and emotions outside of the moment. Easier said than done! Try taking a walk outside without music, podcasts, or videos. Simply use your senses to hear the sounds around you, to feel the wind on your face or the sun on your neck. When a thought enters the mind, simply notice it an come back to the physical sensations you are experiencing.
4. Be Intentional – Whether it is love for ourselves or others, love is intentional, and it is work. Many assume that if we truly love someone (ourselves included), it should be easy. A more realistic assessment is that if we truly love someone, we are willing to work for it. While love may require effort, it can be highly rewarding. Be intentional with your love Make love a practice, not simply an emotion. Take time every day to share your love for self and others. Whether it be expressing gratitude to yourself or recognizing a moment of growth, make the time to express love. The job can wait. The text can wait. The loved one can wait. You are worth the time and the effort. Remind yourself of that.

Are you the same person you were a year ago?

Every January, as we switch out the calendar for a different year, some of us may make resolutions or tell ourselves “I’m going to be better this year.” Whether we’re trying to kick a bad habit, start a healthy one, or achieve a certain goal, many of us take January 1st as an opportunity for change.

Unfortunately, we can never predict how our year will go. There are so many variables at play that it’s impossible to control for all of them. School, work, relationships, hobbies, finances, health, travel – none of it is set in stone. Anything can happen to make us think “Well, so much for that.” We forget, we give up, we get overwhelmed, we move on. Sometimes, when we switch out the calendar for the new year, we think Oh yeah. I told myself I was going to do that this year. Sometimes we feel guilt for the resolutions we abandoned and changes we never made. Sometimes we end up in a totally different place than we were one year prior, and our resolutions seem irrelevant. Sometimes we do follow through with those resolutions and we feel accomplished, ready to move on to the next thing. Or maybe we feel burned out.

A few weeks into 2024, where are you in regard to your resolutions? Have you made any progress? Have you changed your goals? Have you (like me) avoided making resolutions because you hate feeling disappointed when they don’t work out? No matter where you are in your personal journey, you are not alone. Our world today is more connected than ever, and we have the ability to find communities full of other people who understand and empathize with our struggles, or who have similar goals to us and help hold us accountable, or who share in our passion for certain hobbies or interests. These people exist both online and offline – they’re our friends, family, coworkers, teachers, and neighbors. You may have more in common with someone than you think – even with your therapist! Everyone has goals they are trying to reach, no matter how seemingly small or major. Many of us benefit from the connection we feel with other people who support and motivate us.
​
Naturally, as a human, there are times where I have trouble following through with goals or resolutions, I try to set for myself. Whether I get distracted, my priorities change, or I lose motivation, I sometimes struggle to maintain focus on myself and my needs. Especially for those of us who are caregivers (in any sense of the word), we may have trouble taking time for ourselves to focus on things like our own health, dreams, or personal growth. I encourage you to regularly set aside time to reflect on what changes you may want to make for yourself. It is absolutely never too late to start. Just because January 1st has passed doesn’t mean you’ve missed your chance to initiate changes – and just because you have a setback (or several) along the way doesn’t mean that all hope is lost. I encourage you to build relationships with your friends and family, find a sense of belonging and community, tend to your mental health, and practice self-care year-round. Acknowledge the progress you have made, even if it seems insignificant to you. Take every opportunity to be patient with yourself and the world around you as you become more of the person you aspire to be. It’s a journey that lasts your entire life, and it’s not one that you have to take alone.

As the days grow shorter, the New Year approaches, and we find ourselves in the middle of the holidays many of us are experiencing the emotional toll of what is and what isn’t. The reality of global crisis, personal and collective losses, loneliness, challenging family dynamics, and everyday stressors have a way of intensifying this time of year against the backdrop of Hallmark movies, Instagram posts, unrelenting marketing campaigns, and the family we once had or wish we had. There is often a stark contrast between the ideals and our actual experience. For many of us the holiday season acts as a spotlight on what and who is missing… our grief. Often, we are also experiencing a lull in energy, if not because of, at least amidst growing demands and pressures related to the holidays.

I am not a positive spin kind of person so you’re not going to get that here. Nor do I think we are meant for the void, at least not long term. What I hope for you this season is to use the reality of what is in ways that serve you, connect to what’s important to you, remember your belonging, and embrace being fully human.

It is possible to use the holiday spotlight as a tool. We can use it to identify what is hurting and thus turn towards the place calling out for our attention and care. We can engage this place and the corresponding emotions with compassion. I know this can be hard for many of us to practice with ourselves, so it might be helpful to imagine what you would do for a beloved pet or a friend.

Keep in mind we can create our own spotlight with our attention and focus. What we focus on will grow. It is okay to redirect the light in ways that serve us and provide comfort.

We can reexamine the “should”s. We can investigate the traditions we participate in and what expectations we hold ourselves to. We can become curious about our values and what is actually important to us. We might create new traditions, practices, or even holidays that align with our values and that we find life giving.

We can connect to our belonging. Loneliness, rejection, the loss of or never experiencing being sheltered by our people is the greatest grief the holiday season highlights. Connecting to belonging and forming new relationships will not make grief or losses experienced any less. What it does do is allow us to experience connection and love in the now. Search out people who are willing to invest in relationship and practice healthy relational skills. (Notice I didn’t say chase or make any attempt to change anyone). People are messy, it takes hard work by all involved, and time to build intimacy. Remember too that there is the natural world, animals, the spiritual, and the interconnectedness of all living beings that we can draw upon.

We can practice connecting to being fully human. We contain multitudes and yet so often our thinking locks us into either/or and very restricted versions of understanding. We can embody our wholeness and use the practice of both/and. We can feel pain, joy, grief, gratitude, anger, hope, emptiness, love… knowing it all of it belongs. Each experience, each feeling contains the opportunity to connect us to wholeness and compassion more fully.

As the holidays cast a spotlight onto all the cracks and we feel the cold drafts, may we engage with compassion and allow its warmth to hold us, all that is, and all that isn’t.

Why Couples Counseling?

Often, the most difficult step in therapy is taking the action to begin. Therapy is joyous, fulfilling, scary, exhausting, life-changing, and one hundred other things to countless others. Sitting in a room with a relative stranger, discussing the most vulnerable aspects of your life, can feel like a daunting challenge. But is it worth it?
​
Much of the feedback I get as a therapist to individuals, couples, and families is, “Why didn’t I come in sooner?” This feels especially poignant when it comes to couples. There is a unique level of distress that occurs in each of us when we find ourselves in relationships that “just do not work.” There are few people in the world that can elicit the emotional highs of love and the miserable lows of rejection than our romantic partners or spouses. To steal a quote found on motivational posters across therapy offices, worldwide, “If you want something you have never had, you must do something you have never done.” The goal of couples counseling, like any counseling, is to elicit change in the most positive sense. It is finding something new by doing something new, and most importantly, we are not doing it alone.

How is Couples Counseling Different?

Couples counseling is unique in that it is relational, in nature. Many individuals come to therapy wanting to discuss the difficult relationships in their lives. Of course, they do because they recognize the powerful impact these relationships have on their emotional wellbeing. However, imagine coming to therapy, receiving positive feedback regarding your relational conflict, learning the tricks and tips to effective communication, taking these newfound strategies to your partner, only to find yourself falling back into the same old argument in same old ways. Very frustrating. Now imagine a scenario where you and your partner are learning these strategies together, inviting each other into new ways of communication that allows each other to be heard and seen. Inevitably, like in life, conversation will sour, feelings will be hurt, defenses will rise. But now you have an ally to turn to. Your couple’s counselor is your guide. That is, until you learn the map yourselves. Then your path is your own, but you are no longer walking it alone.
​
Like anything in life that requires openness, trust, and vulnerability, it is scary. The conclusion is unknown. There are no guarantees except this: If you are feeling hopeless in your relationship, change is necessary. Therapy = Change.