Questions for the PCA Psychologist

 
 
Questions for the PCA Psychologists
 
As you may already know, Framingham Pediatrics andPsychological Care Associates have teamed up to provide our patients with INTEGRATED BEHAVIORAL HEALTH.  Drs, Megan Cassidy and Megan Brault provide consultation, evaluation, education, brief care and referral guidance to the patients followed in our office.  Going forward, the staff at PCA thought it would be interesting to have an intermittent posting of some of the relevant questions that they receive.  We hope that you find these questions interesting and helpful.

i.

Myths About Starting College

1. Everyone is SO thrilled & excited about starting college, right?  Wrong. 

This is just one of the many myths about the transition to college that warrant discussion. 

Here are some more myths:

2. Everyone adjusts easily to college. 

3. Most kids don’t get homesick.

5. Everyone parties at college so I have to too or I’ll feel like an outcast.

4. Friends abound almost immediately at college.

6. I’ve got to pick a Major asap or my future career is in jeopardy

 

Let’s tackle these one at a time…

Everyone is SO thrilled & excited about starting college.   Sure, there usually IS excitement, but just as intense & common are feelings of nervousness, anxiety, or sadness. Maybe you’re well aware of such feelings, or maybe you’re noticing physical signs like unease, your heart racing, nausea, dizziness, trouble sleeping, or headaches. These are possible signs of distress & anxiety, but are quite typical when facing a big life change. You may feel ashamed having such feelings or worries. Actually, most kids heading off to college don’t share these reactions with each other since it’s hard to admit even to oneself, let alone to someone else. Sharing these concerns with someone you trust is often a huge relief, even if it doesn’t change the reality. Other things that help include reminding yourself of all the ways you’ve coped well with past challenges, new situations, & stressors, & hopefully what you gained or how you grew as a result. With all the worry you are feeling now, you may fail to notice the ways that you are resilient, so take stock. Notice what helps you feel stronger under stress, & keep these in mind to use now & when you’re at college. 

Everyone adjusts easily to college.   Again, what you see on the surface is not always what is true. Most kids struggle with the adjustment & just don’t want to feel embarrassed talking about it. Of course, the more outgoing you are by nature, the less stressed you may feel when faced with the prospect of having to make new friends, manage unknown roommates, & navigate a bigger, new setting. But even outgoing kids may feel scared or sad as they leave home & old friends & familiar turf. It’s just a fact that every single kid you will meet is feeling some element of this, to one degree or another. This dovetails into the next, related Myth…

Most kids don’t get homesick.  How homesick you feel in the beginning is in no way an indication of how much you’ll end up liking college & forming friendships. Homesickness is normal, no matter how old you are. Expect it; especially at night when you’re drifting off to sleep, walking to class in the morning, or during downtime. That’s why so many kids throw themselves into a lot of activity: it helps to distract yourself from feeling homesick or anxious, & that’s a really good coping tool that also helps you make connections with other people & more readily find your niche. Rather than frequently calling home, try also confiding in someone at college; this will help you form stronger connections where you are.

Everyone parties at college so I have to too or I’ll feel like an outcast.   Sometimes in a flurry of activity to distract from feeling nervous, homesick or sad, kids throw themselves into activities that aren’t so adaptive—like partying too much. At many colleges, you’ll find it’s the freshman who tend to do this much more than the older students, & that’s one reason why. The other reason of course is that it can feel liberating at first to do what you want without concern about parents’ supervising you & restricting your drinking & late-night hours. Just know that many freshman have no real desire to party a lot & are hoping that there are other kids like them. To find such kids, go to activities on weekends that don’t revolve around partying. When you’re at a party, look for the kids who are consuming moderately or not at all; they truly exist. And let’s face it, the frat parties often attract those activities, so even which party you choose to go to affects how much you’ll feel like you fit in.

Friends abound almost immediately at college.  That’s absolutely false. Many kids take a full year or two to find some good friends. You may find acquaintances early on that you meet up with here & there, but we all know the difference between feeling like you have a close friend vs passing time with others. Connecting on a deeper level with people is wonderful, precious, & by its very nature special—so it can’t happen so easily. Some people just make it look easy because they’re outgoing. The world is filled with extroverts & introverts, & both types still take time finding their special circle of friends; the introverts just take a lot longer. If you’re an introvert, don’t beat yourself up: it’s not an indication of your worth, your success in life, your eventual capacity for close friendship. It just takes you longer to find your kind. Push yourself to get out of your room; use organized activities to structure your social time so you have something to share & talk about with other kids; give yourself permission to feel lonely for a while; & remind yourself that you can handle this. 

I’ve got to pick a Major asap or my future career is in jeopardy.  Unless you’re going to a specialty school (of Engineering, Art, etc), it’s just a fact that kids often have no clue what career path or major they’re going to end up with, & many change mid-stream. So relax. Now that you successfully got in to college, you have nothing to prove about this. But, do seek out a college advisor sooner rather than later, & tell them your situation. Ask them to help you keep an eye on the bigger academic picture & key decision-points along the way.

 

Though the Myths exist & college adjustment isn’t always a piece of cake for most kids, do reach out for help if your moods, anxiety, sadness, or actions worry you. Every college has a counseling center. Tell your parents, ideally, or your doctor. Let some adults help you sooner rather than later. 

And, as always feel free to consult by phone or in person with our Primary Care Psychologists. 


ii.

Q: “If my child is resisting day camp & the summer activities we’ve proposed, do I force her to go?!”

 

A:  First, Define the Problem: 1. Lack of interest? or 2. Avoidance? 

 

If #1:  It can help to reflect first on what you as a parent are trying to accomplish by arranging structured summertime activities for your child: Supervised Childcare? Expanded Socialization &/or new friends? Development of Skills like art, sports, etc.? or Broadening her World View & experience?  Labeling your goals will help you steer your child, while the specific path towards the goal can be their choice via collaborative problem-solving.  Sometimes we forget that what one child loves (or we loved) to do in the summer (day camp, for example) may not be what this child loves. Take the time to discuss your child’s preferences.  And remember, it’s good to have a balance of structured & unstructured time. There’s plenty of research showing that unstructured, non-media, playtime is vital to children’s development psychologically, cognitively & physically.

 

If #2:  If your child is avoiding or resisting a camp, setting, activity or plan that your efforts in #1 came up with, you’ve got to do a little detective work and a little psychologist work. 

First find out WHY she’s avoiding, resisting or unhappy about the chosen activity. Does it have to do with the activity, setting or context, people, routines, requirements or something else?   If there is an identifiable problem, you can figure out how to solve it.  Assuming there are no noxious or feared elements and your child is just plain nervous, then you have an opportunity to help her manage her nervousness and in so doing teach her skills that will build resilience. So, steel yourself to be compassionately firm.  Aim to challenge your child just enough. Remember that a little bit of anxiety is good when you’re facing a challenge.  Take a long term view of helping your child take on more & more challenging activities to expand her competencies. Don’t forget that mastering challenges takes time and can require activities with longer calendar durations (a 3-week activity, vs a few days). Allow time at the end of each day for your child to relax, refuel, soothe, & process the day, with you and others, and deliberately support her doing so. Your job is to reinforce her sense of resilience by helping her label emotions; highlighting her good problem-solving & coping moments; brainstorming additional ways to handle stressful moments; normalizing bumps along the way; & pointing out overall positive progress. This may not be an all-rosy summer experience, but the goal is for your child to learn that she is capable of doing new or challenging things, & to feel proud.  

Call Any Time for a Consultation with our Primary Care Psychologists
 


iii.
Q: “
My teenage son came home drunk for the 1st time & I’m really not sure what to do?!”

A: Unnerving but certainly not unusual. There are thankfully some clear Do’s & Don’ts to follow.

DON’T: 1.Freak out, lose control & put your child down; 2. come down too punitively; 3.set unrealistically high expectations for winning back your trust; or on the flip side… ignore the issue, be too lax, or fail to monitor things.

DO:

1.  Model Maturity & Stay Calm in order to have a constructive discussion. This will probably require you to delay until you are calmer, which is a great skill for your child to learn too. Reassure & remind yourself that you have the strength & love for your child to face this age-appropriate challenge, even if your child may not yet have such skills.

2. Aim to Explore, Assess, & Communicate Collaborative Problem-solving. Though this event must be taken seriously & requires consequences, consequences alone will not help your child. Real help for your child comes through improving their self-awareness, decision-making, & planning skills—all skills that an adolescent brain has not yet fully developed! If your child has a real problem, they will need this collaborative atmosphere to tell you.  It will likely entail multiple conversations. Ask him about where, what, when, with whom, how often; but also towards what end & what was behind their choice; about social norms & pressures. If the conversation is going well, expect to hear his mixed feelings about substance use. Listen for & reinforce talking about decision-points & whether other solutions could have been used to accomplish what he wanted. This is the very real upside to the crisis: as a parent you have been handed a pivotal moment to guide, mentor & promote your son’s developing sense of self, his needs & concerns, his decision-making, & his trust in your relationship. 

3. Set Reasonable Limits, strong enough to be a deterrent yet not so harsh & unfair as to backfire. Ask your son for input: what does he think is fair? Most teens are quite able to take some perspective when the collaborative tone has been set.

4. Monitor things, Focus on Progress, & Expect Uneven Progress.  Maturing means increasingly listening to your gut, wrestling with mistakes, making fewer faulty decisions, & gaining confidence in your true self. Your son will need time to do this work of maturity, with your help. So focus on the progress, have compassion, all the while providing reasonable limits when needed.

 


iv.
Q: “ My child is plenty old enough to be sleeping in her own bed, & used to, but ever since she watched a scary movie she insists on sleeping in our parental bed. We were understanding at first, but now we can’t get her out, or if we do, she only crawls back in our bed in the middle of the night! ”

A:  Such a common, stubborn problem. This will only improve with 1st-- your conviction to implement the advice, & 2nd-- the acceptance that you will not sleep well for a week.  As with tackling all fears, children need a tricky balance of your TLC, a clear message that you have faith in their resiliency, & skills.  Being “brave” is something every child wants. That said, don’t push her out without a safety net.  And, be sure to have buy-in & agreed-upon small rewards for progressively braver steps in the plan. Depending on the age of your child, you may start by having her sleep on a mattress on your floor. Every single time she crawls into your bed, place her back on the mattress with your firm reassurances. Next step is expecting her to be in her own bed, but the key is to use predictable, regular check-ins at small intervals which will ease her anxiety. Assure her you will continue check-ins even after she falls asleep. Keep your promise.  Agree on longer & longer intervals between check-ins. If your child comes into your bed, immediately escort her back & continue the check-ins.  Key=reward the progressively longer intervals & braver efforts… not just the end result!


v.

Q: “My high school senior will be hearing from colleges soon. I fear how she’ll handle rejections & comparisons with her classmates. What can I do if/when this happens?”

A:  Don’t you wish you could shield your child from all disappointments? Senior year is a whopper of a test of self-esteem & resilience, but ironically our teens are not nearly as equipped for these challenges as they will be when they’re even a little older. It helps if you demonstrate faith in your daughter’s potential for resilience, even if hers’ is not robust yet. Resilience is also something you will need to model & reinforce in your child. The tricky balance to strike is to share in your daughter’s pain & disappointment but communicate that it will pass, & do NOT share in her belief that the rejection makes her unworthy, less-than, or doomed to mediocrity or failure. Periodically make note, but not persistently, of those who had similar college disappointments or took an indirect route to eventual personal success. Share your own esteem rattling experiences, your wandering paths, & the varied definitions of success. Help your daughter be compassionate with herself just as she would be for a respected friend.  Encourage engagement in things that she values & which bring her pride, & distract her from this overly charged moment.  Intentionally create relaxing moments & family bonding time, showing her that love & pride are not defined by single accomplishments.    Feel free to call for a Consultation with our Psychologist.  



vi.

Q: “ It’s MCAS time & my son is having stomach aches, headaches, & other ailments. I suspect this may be stress, but what should I do?”

A:  First, talk to your pediatrician so that medical causes are ruled out.  Your doctor will also ask questions to ensure that your son is hydrated, sleeping enough, eating normally-- the basic functions that can also cause ailments you describe, but which can go awry during test prep times. Once a medical diagnosis is ruled out, then it’s fairly safe to assume that these symptoms are stress related. Did you know that requests for mental health services peak during MCAS prep times? So your child’s reactions to the pressure, anxiety, fear of failure, & fear of not comparing well to peers are