Working with Teenagers and Their Parents During an Illness

Presented by:

Corinne Barnickel. MS, CCLS

Ali Houshmand, MA, LPC-Intern, LMFTA

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Sponsored by

Thank you to AECOM for their Generous support of Wonders & Worries

Community Education Program

Founded August 8, 2001 by Meredith Cooper & Melissa Hicks

Child Life Specialists and Licensed Counselors

Helping children cope when a parent faces a serious or

life-threatening illness.

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WONDERS & WORRIESA family’s illness. A child’s journey.

Wonders & Worries free, therapeutic programs help children by:• Giving an age-appropriate understanding of the illness, its

treatments and side effects• Facilitating expressions of feelings related to changes in the family• Identifying individual coping skills to help ease feelings of sadness,

anger and fear

Helping children cope when a parent faces a

serious or life- threatening illness.

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Nearly 20 % of 1.4 million adults diagnosed with cancer this year will have a child age 18 or younger.

THE NEED

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In Central TX this year, more than 1300 parents will be diagnosed with cancer

Cancer is the 2nd leading cause of death in the U. S• 1 in 4 Americans die of cancer

(American Cancer Society, 2010)

W&W also reaches beyond cancer to support families impacted by

other serious illnesses.

Inside the Teenage BrainCharacter Traits

Moody Stubborn Rebellious Irresponsible Dramatic Irritable Risk Taker Lazy Competitive

Negative Seeking new experiences Impulsive Struggling with independence Fitting in means everything Inability to plan Difficulty recognizing basic

facial expressions• Brain area to process this

information is different from the adult brain

Inside the Teenage BrainThe Brain Rewiring

Female Teenage Brain Reactivity to relationship stress heightened. More

intense responses to stress Verbal areas of the brain are larger (2-3x times

more words per day). They want verbal intimacy! Matures 2-3 years earlier than male brain Maintaining relationships at all cost is a goal.

Have a negative alert reaction to relationship conflict and rejection

Main goal during puberty is to become sexually desirable

Twice as likely to suffer from depression by the age of 15

Inside the Teenage BrainThe Brain Rewiring

Male Teenage Brain Brain growth happens from back to front. Frontal lobe

is one of the last areas to develop Male frontal lobe develops later than female “B.S.” syndrome in teens (bright yet so stupid) –

limbic system vs. frontal lobe Occipital lobe (processes visual information) is the

last to finalize its growth Brain below the belt! Hormonal changes in the brain activate the aggressive,

territorial and competitive side of the male brain Testosterone changes the sleep cycle – go to bed later

and sleep later

Inside the Teenage BrainFemale Hormones

Oxytocin – a neurohormone that triggers, and is triggered by, intimacy (the bonding hormone)

Dopamine – a neurochemical that stimulates motivation and pleasure circuits. Regulates movement and emotional responses

Estrogen & Progesterone – a group of steroid hormones that primarily regulate the growth, development, and function of the female reproductive system.

Cortisol- The “stress hormone”

Inside the Teenage BrainFemale Hormones: The Result

Estrogen/Progesterone surges cause weekly changes in sensitivity to stress. Lack of those hormones during a female’s cycle causes the brain to be irritated (FREAK OUT behavior)

Estrogen at puberty increases dopamine and oxytocin production. Social bonding! The constant chatting and text messaging is helping cope with stressful situations

When a relationship is threatened, oxytocin & dopamine levels drop causing the feelings of anxiety and fear of being rejected.

Inside the Teenage BrainMale Hormones

Testosterone - the King of male hormones. Dominant hormone in the teenage brain development

Vasopressin - hormone working hand in hand with testosterone. Helping males establish boundaries and protect loved ones.

Androstenedione - hormone helping males attract a partner

Inside the Teenage BrainMale Hormones: The Result

Testosterone is the driver behind the scene. It causes teens to be aggressive, territorial, and activates the “below the belt” brain

Vasopressin in conjunction with testosterone helps males develop the protective side, and with time regulates their need to protect their family. It also plays a role in their development of seeking a mate – monogamy.

Androstenedione: Activated by testosterone, it will be released as a pheromone to attract a partner.

Inside the Teenage BrainImpact on Family Illness Dynamic

School work is disrupted High levels of anxiety Illness takes center stage Social Life interrupted Fitting in with Peers Feelings of unfairness and

meaning of life

Inside the Teenage BrainThe Zebra Story

Founders of The Christi Center, Don and Susan Cox, felt like zebras in a herd of horses after the sudden death of their daughter Christi.• In their adult minds no one else saw their stripes – they felt

different, out of place, but no one else saw or could relate

Staff member Erin Spalding shared the zebra story with a group of teens who had all experienced a loss• They said that Don and Susan had it wrong. They felt like zebras

and like no could relate BUT EVERYONE CAN SEE our stripes (and that made it even more difficult for them)

Thanks to The Christi Center - www.fortheloveofchristi.org

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Relating to TeenagersRapport Building

Mirroring and Matching: Tone of voice, body language, response to teen’s verbal and nonverbal cues. Be genuine.

Trust Building: Discuss confidentiality. Two- way Communication: Teen helps determine

number of sessions and care plan.

Relating to TeenagersTips For Professionals

Communicating with Teens: Be informed – research (diagnosis, treatments, prognosis)

Gauge their understanding and feelings Use scientific language with explanations Be honest - realism based on fact as currently available Silence is okay Provide options to keep hands (and sometimes eyes) busy

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Relating to TeenagersTips For Professionals

Explain you are an advocate for them as needed Encourage questions and expression of concerns Listen rather than tell Use open-ended questions

• What are you wondering about with your mom’s surgery? • NOT: Do you have any questions about your mom’s surgery?

Validate emotions

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Relating to TeenagersPrompts to Encourage Conversation I hear you saying… Tell me more about that How did you respond to that? Other teens have felt… Other teens have wondered…

Advocate for Teen: Three-Way Communication

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Relating to TeenagersTips for Parents

Be mindful of your nonverbal cues – teen may sense asking questions will make parent uncomfortable causing hesitation

Be aware that teens are sensitive to emotional moods and non-verbal communications of adults - adult mood can impact/alter teen’s mood and affect them physiologically

Be honest about the illness situation but reframing can be helpful - recognize that some changes can be positive

Be in tune with your teens unique coping skills

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Relating to TeenagersTips for Parents

Be available - teens usually choose to talk at their convenience. Take advantage of the opportunity!

Consider teen’s emotional and mental state when information needs to be shared and adjust timing when possible

Be aware of how family routines may change and the impact on the teen

Listen rather than tell

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Relating to TeenagersDon’t…

Use judgmental statements Ignore emotions Use slang unless offered first Use personal examples – don’t focus

on your teen years or yourself

Activities to Engage TeenagersRapport is Key

Establishing a connection/relationship with the teen is key to having him/her “buy into” the support and receiving therapeutic value from it

It’s really not about the tools- it’s all about the RELATIONSHIP

Activities to Engage TeenagersImportant Components

1. Age-appropriateness and appeal

2. Introduction to and presentation of the activity• Provide options to give the teen control• Be positive (believe in the activity)

3. Flexibility and modification• Personalize and adjust the activity based on teen’s response• Don’t be afraid to get messy or to be active

Activities to Engage Teenagers Illness Education

Therapeutic Goals: Inform – provide information about medical

terminology, equipment, and procedures Validate – understand, acknowledge and

normalize the teenager’s experience Answer - address questions and concerns Clarify – clear up misconceptions

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Activities to Engage TeenagersIllness Education

Technology to Educate and Engage: App Options Simply sayin’ – good for younger children The Human Body (paid version)- very interactive

(different systems) – good for tweens/young teens Visible Body (medical version) – good for teens 3D Brain (free or paid version) Brain Tutor Cancer.net (resource for parents)

Monitor internet usage. Acknowledge that a lot is available online. Encourage teen to share what they come across online then clarify/individualize to the illness situation in their family.

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Activities to Engage TeenagersIllness Education

Hands-On Activities to Educate and Engage: Question & Worry Jar Medical Mystery Box

• Include medical items and pictures to talk about and/or use in expressive art

Texas Oncology Portacath book Blood Soup

• Use hot tamales, beans, rice and Karo syrup to discuss components of blood and impact of chemotherapy

Tree Life Cycle drawing• Use a “tree cookie” (a cross section of a tree, can be

found at Michael’s/Hobby Lobby) and have teen plot out life events with the tree rings (can represent years)

Activities to Engage TeenagersFeelings

Therapeutic Goals: Expression - provide opportunities to identify

and express emotions through various genres Normalization – decrease feelings of isolation

and separateness through normalizing emotions Reflection – facilitate acceptance of self and

insight through the process of reflecting feelings

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Activities to Engage TeenagersFeelings

Feelings face mask (inner-outer feelings) Collages Feelings Jenga• add question cards to the standard game

Photography• Emotions polaroids

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Activities to Engage TeenagersFeelings

Journaling• Chill & Spill Journal – from Art with Heart

• (map of my head; map of my heart)

• Ink About It Journal – from Art with Heart• Graffiti Wall (“What I want you to know”)

Music• Lyric activities• Lyric rocks• Playlists• “Sing Me A Story” – www.singmeastory.org

• Music therapy/drumming circles

Activities to Engage TeenagersStress and Coping

Therapeutic Goals: Define stress and coping – describe with

teen friendly language Identify stressors – facilitate identification

of stressors and individual coping styles Build coping skills – provide tools to

develop and practice positive coping strategies

Empower – enable teen to implement strategies that work for him/her

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Activities to Engage TeenagersStress and Coping

Targets (traditional and modified) Coping kits Aromatherapy kits Scream boxes Pumpkin smashing Clay sculpting Stress Bingo Pet Therapy

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Activities to Engage TeenagersStress and Coping

Physical activities• Yoga• Sports • Dance, Karate

Apps• Mellodive (game)

– shuts down limbic part of brain

• Silk– Drawing with fingers on tablet, helps with

self-regulation

Activities to Engage TeenagersSocials

Therapeutic Goals: Establish rapport and strengthen relationships

with others Develop trusting relationships with peers and

increase trust in self Normalize the teen’s experience

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Activities to Engage TeenagersSocials

Theme parties Bowling Rock walls Mini golf Team building locations • Peaceable Kingdom

Therapeutic horses Scavenger hunts Cooking

Helping children & teenagers (ages 2 – 18 years) cope when a parent faces a serious or life-threatening illness.

All Wonders & Worries services are offered:• Free of charge • In English and Spanish

W&W SERVICES

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Individual Sessions – for children ages 2-18

Group Sessions – helping children ages 5+ meet other children coping with similar experiences

W&W PROGRAMS

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Child/Parent Relationship Training Classes – teaching parents how to reconnect with their children during the illness or following a loss

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Family Fun Activities – allowing families to enjoy being together in a fun, relaxing environment

Bereavement Support Sessions – helping families prepare for the end of life, gain the skills necessary to cope with loss, and create legacies (for clients connected with W&W prior to the loss)

W&W PROGRAMS

Wonders & WorriesHow to Refer

On-line referral form www.wondersandworries.org

Select the following links/options:• “What We Do”• “Refer a family”• “Request support for a family you know”

• “Through this website” Fax in the referral form to 512-329-5767 Call or Email Wonders & Worries

• 512-329-5757 x202• kim@wondersandworries.org

Make sure to have permission!