IamA Overnight Crisis Counselor for Teens; AMA!

What are the problems that the teens usually encounter? How do you help them?

Most common problem I've seen is lack of effective communication between teens and their parents/guardians. The teens have the egocentric behaviors and are reluctant to follow their guardians' rule structure. More detailed example: We've worked a lot with lower socioeconomic-level families and a common recurring theme I've heard involves usually a single-parent household; the caregiver is working several jobs to keep their household afloat and the lights on. Their child gets sucked into the teenage drama of school and social influences and acts out against the guardian in various ways (defiant behaviors in the home, lack of care for school/grades, drug experimentation, etc). The caregivers would feel deeply devastated as they claim to be working long hours in order to support their children in order to provide a better childhood than what they experienced. If that makes sense? In those type of situations there's a lot of 'reality checks' and mindfulness exercises I like to guide the family through. Teens don't like to try and see things through other people's eyes, especially their parents'. It's shocking to find out that some of these teens only communicate with their parents when there is conflict. They don't know how to talk to one another in a caring, emphatic manner and just introducing that to some families begins to yield immediate positive gains in the healing of their relationship. Not always, of course, but it happens when both parties actually want to make permanent changes more often than not.

I'm a high school teacher in a low SE school and I see this behavior frequently. It is almost impossible to get in touch with parents and most of them don't speak English so having an effective conference is not impossible, but quite difficult. What can I say to a student, as a role model, when they are exhibiting these behaviors?

We have counselors on campus, to be fair, but I'd like some advice on what can I say on a daily basis when I see a kid acting out.

In the moment in a situation you've described, I would probably appeal to doing everything in your power to convey you think it's a bad idea for them to continue any given behavior without using the literal words. Avoid the definite "negatives": "don't" "shouldn't" "can't" "never"; all those won't help.

Pose a statement like, "Is there any way doing that is going to benefit you in the long run?" "Isn't it worth the time to figure out a better way to handle this?" "I have a suggestion for you on how to handle this without harming your parents if you're open to hearing me out."

Appeal to the fact he or she is ready to combat their frustration and anger they're feeling in that moment. Shine light on the fact if they do something irrational and impulsive now, sure, it could make them feel better, but the residual consequences might create the next dispute.

Thank you so much for the reply!

It's definitely knee-jerk to just say "you can't do that" when you're trying to redirect behavior. I'm guilty of it and many of my colleagues are as well. We don't realize how much of an effect being negative can have on a child. They take everything personal.

From a teacher that works alongside counselors dealing with similar issues, thank you so much for what you do. I can't even begin to relate the magnitude of your positive influence on your kiddos.

(thumbs up symbol)

Another reason to take this approach, at least from my own personal experiences growing up with a single parent, is you can't treat them like kids anymore and just tell them what to do. Depending on age the kids are probably taking more adult roles in their home lives to get things done. They are already fighting to get noticed when they go to the store to buy food because when a kid wanders in, people ignore them more and are far less helpful because, you know, he's just a kid.

That would infuriate me to no end. The people who interacted with me as an adult were good and I would be much more calm when dealing with them. I am doing adult chores and expect some respect.

So making suggestions or wording things properly is very important, let them see you are treating them as an equal and not a kid and they will respond in a more reasonable manner.

Reminds me of a Frank Zappa quote: "The first thing you have to do if you want to raise nice kids, is you have to talk to them like they are people instead of talking to them like they're property."

Hello! What would you say to a guy who has the exact opposite problem?

I've always been shy and "nice". I've never done anything crazy, anything illegal or anything cool. Instead of having a horrible relationship with my parents, I've had a good relationship with them. I've grown up to be a 19 year old man in a complete bubble. I literally feel like a child. I haven't done even the normal "teenage stuff". Never been in a fight, never had a girlfriend, never tried drugs etc etc.

I want to do these things. Sure, being emphatic and intelligent is good, but not when you are an energetic, fun loving teenager.

I mean heck, intellectually I understand that I am an adult. I could apply for a job, get a driver's license, mock about in public drunk and whatever have you. But I'm scared to do these things because of how I view myself. Instead of everyone else being side characters in my life, I am a side character in everyone else's life. In my mind, at this age, I should feel like I'm the king of the world, hitting on the ladies, stirring up trouble, doing slightly illegal shady things (without hurting anyone). I'm just nothing...

A month or so ago I got really scared that my life will always be boring. Been to a psychotherapist 3 times now, and while it has made me feel a little better, it also has made me realize how completely pathetic I am at the moment. When I complain that I've wasted my carefree teenage years doing nothing, she says that I should look at the future, and how everything will get better now that I'm finally talking to someone.

It sounds good, but I just don't understand how a complete pussy like me can ever become confident when I currently basically fear everything and feel inferior to everyone. What if I will forever be this shy mess of a boy?

Have you worked with people like me? People who, instead of being aggressive/mistreated/depressed, think super lowly of themselves even though they've had a great upbringing? Is it common for teens to feel like they are more childish than their peers to the extent of it hindering all aspects of life?

Sorry for the long ramble. I'm basically asking you to do your job free here so....yeah.

Just needed to get it out.

You are doing an incredibly important job. During the last couple of years I've realized how fucked up mentally people can get. Keep at it! :)

Again, referring back to my disclaimer at the top, these are just my opinions: I'm getting the sense that you've yet to get out and establish your own identity as an individual with unique likes/dislikes/wants/preferences/etc...As in, you're content with being the side kick but you really want to be the super hero for a change and you're realizing that a little later than you think you should have.

You ever hear of the saying, do one thing each day that scares you? Try that out. Don't play play chicken with a freight train or anything, but get out and get yourself uncomfortable. Get a (new) hobby and immerse yourself in the culture. Find a calling and never let it get to the voicemail box, ya dig? For me that was playing music. I've never done anything crazy, no arrests/charges, never went to a high school or college party, I've never smoked anything or drank alcohol...by choice. I'm boring as hell from the outside looking in to some people. They find out I sing and play guitar in a punk rock band and say "What?" That's when I'm my happiest and the most selfish...and I want it to always be that way.

Get out and live a little and don't let other define for you what is and isn't cool and most socially acceptable. Naw mean?

Thanks for the reply!

I've heard the saying and of course it does make sense. It's the rational thing to do. The problem is that even starting a hobby is practically impossible for me because I feel inferior to everyone. I've been in the background for so long that I need people to look up at me and say "that guy is cool/funny/strong/handsome."

I have such an insane obsession of being independent and respected by others. I assume that whenever someone looks at me, they see an insecure kid. The crazy thing is that even if it was true, why does it matter to me so much!? Skinnier/fatter/younger people than me are totally fine with who they are, whereas I hate who I am at the moment.

I can't even find the words to describe how I'm feeling. I've rewritten this comment like 10 times already. I just...I'm so irrationally afraid of everything.

Is it even possible to become a self confident, proud man after growing up in boredom, safety and insecurity?

It's possible. You're deep into your own head and hanging on to some assumptions that drive your overt behaviors and end up ultimately reaffirming your initial thoughts...to make it confusing. It'll take some rough first steps I imagine, but that's what changes involves for most people. You're going to need to learn to walk all over again, but now with a different perspective and vision. I'm limited in what I can recommend through Reddit, but I think your biggest opponent at the moment is in your mind. Don't worry about what others think; a simple concept but appears daunting as you try and employ a new mentality.

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If you were a parent I was working with and you didn't understand why you have to participate in the first place (a common opinion): "I hear you, LanceFree, and you've clearly presented some of your concerns with your child, but I am thinking about how we can move forward from here knowing that what you've been doing recently doesn't seem to be working too well."

It helps set the stage, in a way. If you come back stating, "Well if ____ would just listen to what I say and not question me all the time, things would be much better between us." That's just dropped a huge hint about where we're likely to go next. The keyword was 'listen' and I'm gathering your perspective immediately in that you don't feel as if ____ listens to you, at least not to a degree that's satisfactory or ____'s actions suggest otherwise.

I don't debate topics or rule/consequence/reward structures with parents. If they say that in their house Susie has to do the same three chores every night until her grades improve, that's what it is. I may offer an alternative response or plan, but I wouldn't try to persuade them otherwise if I personally disagree with them.

Listening and mirroring seems like a great start, but do you also find that to make a lasting difference, you need a way to challenge deeply held beliefs, e.g., about what it means to be a parent/child/person? Do you think it possible to do this? Thanks for doing this interesting AMA.

Challenging deeply-held beliefs is something more suitable for longer-term family therapy. Crisis counseling, short term counseling...all that stuff is usually never a good time to go for the deeply seeded aspects. You need enough time to address the concerns and rushing that process is almost a sure fire way to ruffle one too many parent feathers. So yeah, it's possible but the right time frame is important.

I'm certain that is the most common issue, but I hope you don't take the teen's fault for granted. I was likely guilty of all those behaviors as a teenager, but my parents were also extremely unstable, and good at hiding it. Learning empathy as you mention was a huge help, but learning when to remove myself from a situation and completely disregard them was important too.

Of course. I'm speaking in general terms with most of my responses unless prompted to otherwise. I see what you're saying.

Does it count as "Experimentation" if you only tried one, that about half of all Americans have tried?

Matter of perspective, I suppose.

Please, paragraphs!

Sorry! I'm drowsy....and it shows.

What was your background coming into this? Experience and education?

I started working with the agency as a supervised graduate-level mental health counseling student about three years ago. I did a lot of shadowing at first and eventually worked up to facilitating one-on-one counseling sessions with teens in the residential program, and so forth. After the completion of a semester-long period of what was essentially volunteering I was offered a full-time position. While employed I continued working on my Master's and just graduated earlier this year. Up until I started volunteering with this agency I had very little experience in the field. Since employed, I've held various roles and have done most anything required by staff ranging from unclogging resident toilets to conducting telephonic sexual trauma crisis counseling. It's never the same day twice, and that can be a great or extremely frustrating feature.

On that note, what was a very good day, and conversely, what was an extremely frustrating day?

I really can't recall a very good day other than I consider any day I don't have to break up a fight, call cops, and/or deal with hostile parents a pretty good day. When we have a group of residents that really want to work on their issues, that's when I'm glad to be in this position and feel as if I can help provide meaningful support for teens we work with. Frustrating days seem to stem more from administrative/day-to-day procedural conflicts that aren't always directly related to the teens. I've worked with teens that conduct themselves in a more mature manner than the adults I've deal alongside, and that's alarming at times, to be honest.

Thanks for what you are doing. I ran a similar program for 8 years and I know exactly what you are dealing with. In fact, I hired a number of overnight counselors during my time there. The good ones were hard to find and impossible to replace.

What percentage of the kids you work with are in foster care?

The good ones like to sleep!

Joking aside; it fluctuates pretty randomly. It's the children transitioning into or out of foster that I've worked with the most. I feel for them, too. That can't be easy and we try to help them as much as we can knowing they have plenty of questions we can't answer. I had a early-teen ask me once, "Why does nobody want me?" That was rough. Not sure what I said but probably something along the lines of, "They (the placement agnecy) wants to make sure you get into a family that supports and understand you, and that's not always easy to find the first time." Never an easy conversation.

What are some interesting stories you have?

First story I usually share with folks involves the time I was pretty confident a parent was going to physically assault me. I believe this individual was under the influence of alcohol, but nevertheless, I didn't have the answers this parent wanted to hear and this individual stood up directly in front of my desk and grabbed the front lip of the desk top. They then gave me a bonfide death stare as I sat in my chair and slowly rolled it back to give a little more distance between me and this particular individual. I had to verbally deescalate the situation even though I was shaking with adrenaline as my fight-or-flight response kicked in.

this individual stood up directly in front of my desk and grabbed the front lip of the desk top.

I honestly thought this came next:

(╯°□°）╯︵ ┻━┻

I was waiting for it in the moment. Had me shook for the next week or two.

What made the parent so upset to begin with?

Slight disagreement, really.

Come on man, don't leave us hanging like that!

I'm just respecting privacy. It's really not that interesting in retrospect. Without the desk getting gripped up I probably wouldn't remember the encounter still today.

I had to verbally deescalate

What exactly do you say in situations like this? I'm working as a newbie Social Worker, and will be on call during wee hours of the morning. I'm worried most about those under the influence. =/

Pretty much, main goal is to bring all parties involved into the present. "Here's what's going on right now..." "This is what I don't want this situation to turn into..." "Let's make better choices right now so we can figure this out..." All that jazz. Sometimes getting somebody to slow their breathing helps; bonus points for deeper breathing! We breathe short and fast when we're about to fly off the handle, so gaining that biological leverage doesn't hurt!

I had a friend commit suicide a few years back, how many cases of teen depression do you typically deal with? Have you ever dealt with a case that truly effected you personally?

I'm sorry to hear about your friend. I have dealt with depression/suicide ideation myself in the past and I have definitely seen depression with the teens I've worked with. In the past three years I've probably been directly associated with several dozen teens that display depressive symptoms or have been formally diagnosed with a depression-oriented disorder. The most personal case I worked one involved a teen male that lost his mother to a drug overdose when he was in his early teens. I lost my father unexpectedly when I was 13 (thus the aforementioned depressive thoughts) and felt as if I was dealing with somebody that had very similar thinking patterns as I did when I was trying to sort through things while coping with tragedy. Talking with him brought back memories of my experience and I had to tread carefully as it's not always appropriate for counselors to self-disclose personal issues, in fact, it's almost never appropriate. I went home some nights relating what he shared to my experiences and it kept me up a little later than usual a few times.

I always imagined that these kinds of jobs would have high burnout from the emotional investment. Do you have a way to turn off so to speak when you get home? Or is it not much of an issue?

The burnout exists for sure. This setting isn't too high stress compared to other, related jobs (CPS case workers, I'm looking at you), but it can take a toll on folks. I try to leave everything at the door when I leave here and head home. It doesn't always work. I turn to music and sports when I need to let go of frustration and those work well. It's definitely an issue; and those who can handle it well do this for the rest of their lives and have a meaningful career. Those who can't end up finding out pretty quickly.

I left CPS after working there a whooping 3.5 years as a foster care worker. All I can say is...fuck CPS.

Nature of the beast, I guess?

Can you give me some advice regarding how to handle a situation that occurred on Christmas Eve with my teenage daughter and her male friend?

On Christmas Eve my daughter was texting one of her friends when he made the statement "I might not be here in the morning" and "I took a bunch of sleeping pills". My daughter appropriately freaked out and told her mother (my wife) who in turn informed me. At the same time she was telling her mother she also texted the friend letting him know she had informed us and that we were calling the police to send to his house. He responded by telling my daughter that he had thrown up the pills and didn't want the police called and started blowing up her phone to convince us not to call the police. Since I had only been to his house once I was unsure where to send the police when I called them so I hesitated and didn't call them immediately (a HUGE mistake on my part). Unfortunately this gave him time to convince my daughter to not call the police and that he would be OK. So while I was figuring out how to handle the situation my daughter started freaking out about me calling the police and telling me "it will kill him" and other high drama teenage things. Being that we were at a family gathering at my parents house and my just wanting the situation to end I caved and told her we'd deal with it later as long as she was convinced he was not in any immediate danger. She continued to monitor him via chat and phone calls for the next 30 minutes until the clock ran out on her texting time allowance (it goes off at 9:00 P.M. every night) at which time she seemed fairly convinced that he'd be OK. She has since communicated with him and says he seems to be OK and is doing fine.

So here are my questions:

1. What should I do now? I don't know whether he actually took any pills and I am actually fairly doubtful that he did. Either way it's not a healthy situation for my daughter or her friend. If he actually took some pills then he may do it again and maybe next time something more serious will happen. If he didn't take any pills then the implications are that he's looking for attention from my kid and/or trying to manipulate her. Either way I don't like it and I especially don't like the effect it's having on my daughter.

2. Do I call his parents whom I've never met or had any contact with and inform them of their son's actions?

3. Do I ban my incredibly strong willed daughter from having any further contact with him which will more than likely force their friendship underground and her hiding things from us?

Obviously I'm confused and concerned about how to handle this and am pretty much grasping at straws by asking questions on Reddit, but any advice you can give would be welcomed and well received. Even if it's just you telling me to call someone else because this type of thing isn't your bailiwick.

Thank you for you time in reading this.

I'll give you my feedback. KEEP IN MIND THESE ARE MY OPINIONS.

1) If I were you, I would approach his parents/guardians and get them up to speed with everything. I view suicide ideation/intent/attempts as a serious issue every single time and will react accordingly. Whomever is legally responsible for the minor should be aware of the event. They can make the decision to seek further care/treatment based upon various factors. Overall, I think a mental health professional needs to evaluate this child. From there, an informed decision can be made.

2) See above; Yes, I think if he decided to inform your daughter about his ideation/possible attempts, his parents should know. Again, my opinion.

3) Should you ban her from further contact? I would venture the assumption that if he told her those things about his potential suicide attempt, he likely trusts her very much. He probably views her as a positive social support and I think anybody contemplating suicide NEEDS positive support. If I were you I would empower your daughter to help support him as well as open up the topic within your family to discuss how serious of an event this is/was regardless of if he actually consumed the pills or not. Communication in families (in or not actively in conflict) is huge!;regardless of the topic. Suicide is one of those tough ones, no doubt about it. However, it's literally a matter of life or death and mental health professionals (should) take the subject seriously in every way.

Was there a case/patient where you thought "I'm in way over my head here"? Were you able to help?

It's happened a few times. I used to work exclusively with the parents/guardians to facilitate family counseling sessions. Some parents held the mentality that they do not need "the help" and are not willing to budge on their parenting style, beliefs, etc. They firmly believe that their child is the only party responsible for making any changes and will reassert this belief numerous times within session. In situations like this I would attempt to show the parents how the family can be viewed as a system (Google 'Family Systems Theory' if you'd like) and a complete evaluation of the family structure (GENOGRAMS ALL DAY!) can yield useful insight on how to proceed with addressing certain issues.

I also recall a teen I worked with that had several diagnoses and medications that were managed by a psychiatrist for the past few years. The teen did not like the effects the mood stabilization medication produced and refused to take them at home. This individual dealt with Bipolor Disorder symptoms and was cycling dramatically while in the facility. With several teens in the facility it was hard to devote the individualized attention needed to help this particular individual get through their manic and depressive episodes. In another more personalized setting I would have felt more comfortable, but this setting isn't great at helping in those types of situations; something I realized very quickly.

Thanks for writing this, I've found it to be pretty eye-opening along with finding some very useful advice for dealing with children/teens/emotionally underdeveloped coworkers and other people sharing the human condition.

I learned about genograms recently from a friend, they sound incredibly useful. They used them to examine their family of origin dynamic and prepare for counselling as clergy. I've been meaning to look into them further to examine my own.

Genograms help organize things in a manner that conveys a lot of meaning with little effort. I know some clinicians that swear by them and now I'm starting to embrace them more and more.

How often does fear play a role in someones reluctance to seek help? It seems that many people afflicted with mental illnesses are terrified of seeking help, can you offer some insight as to why this might be?

I agree that fear plays a role, for sure, but the degree to which it influences someones willingness to seek help depends on such a multitude of factors. I wish it was more concrete and specific so it could be tackled more effectively, but alas, 'tis not the case it seems. With teens I would venture an educated guess that fear of being judged is what can prevent them from accepting help. I've had adolescents tell me that they don't like to talk about their experiences and feelings as they don't want to be judged. I think that makes perfect sense and I can agree with that sentiment Monday through Sunday. However, I try to point out to them that counseling/therapy isn't a time for one to feel judged. Therapists need to withhold expressing judgement toward their clients; that's something we're taught in school (feel free to wiki 'countertransference') and it makes sense as we're socially-groomed to try and avoid facing ridicule by others we care for/love/trust and that might mean holding back on admitting certain feelings about certain topics. Usually in this setting we'll see teens begin to open up to a certain staff member (that they trust more than others for whatever reason) about 4-7 days after they begin the residential placement. Once they start to get past the initial fear and start revealing what's really at the root of their current concerns, that's when this program is most effective, I think. Overall, the fear stems from the unknown and seems to gravitate toward the idea of "Will he/she/they think any less of me if I tell them what I'm really thinking/feeling?"

What are some things you think parents/teachers can look for or do to mitigate common crises before they get escalated to a service like yours?

That's a good damn question. Unfortunate part is that I'd offer the least direct response possible: it depends. Kids/teens/adults all respond to stressful situations in different ways. I love to confront issues head-on and get something solved ASAP. Other folks need time and distance to get their mind ready to figure stuff out. If a parent/teacher knows what works best for any given child, I'd hope they would embrace that approach and try to support them even if it goes against their own personal style. That, in essence, is what counseling can be boiled down to. Just being more aware helps too as nonverbal behaviors can reveal things that some teens wouldn't dare reveal verbally without significant cause. A simple, "Hey, John, you don't seem to be acting yourself lately. Is there something bothering you?" might help get a meaningful conversation started. BUT, of course, there's going to be times when that will make a teen want to try and shut down more since now they feel like they're being judged unfairly even if your suspicion is right. It's a tricky dance, for sure.

How do you house transgender youth? Does everyone get their own room or are they shared?

Whenever there is a concern about issues relating to sexuality, for any reason, we try to prevent the likelihood of incidents occurring by various means. Most residents do get their own room until the population rises about a certain level. At this present time all residents have their own room, but that may change by this time tomorrow and staff are expected to pair residents using their professional judgement. In the event that we are working with a teen that has a history of sexual abuse, they are likely to not have a roommate. We also have cameras set up in the hallways/common areas for staff to monitor residents' whereabouts. Furthermore, when conducting intake assessments, we have to compare the potentially-incoming resident to the population we are currently serving to try and predict potentially hazardous mismatches. It's always a case-by-case basis and some staff are better at making an informed decision than others, but we haven't had any major issues recently that I'm aware of.

Why don't the sexually abused ones get a roommate?

It varies case to case. Safety is top priority. If somebody has a history of sexual abuse and I'm completing the assessment interview, I ask if they are comfortable with a roommate or not and if they don't want one, we do what we can to provide that environment for them.

Did you encounter any lgbt teens?

It hasn't been very frequent, but I'd venture a safe estimate of about 10% of the teens the agency works with present concerns associated with their sexual/gender identity. It's something that the mental health field needs to be better prepared for, in my opinion, and especially with teens as they begin to try and shape their personal and social identities. It's difficult at times since I've had parents/guardians explain that they do not tolerate the idea that their child may be anything other than purely heterosexual. "It's impossible, we didn't raise a gay child." Statements like that tear at me since I don't hold the power or authority to instruct an adult on how or what to believe regarding their children. In situations like that I've focused on providing the teen various coping skills to help reduce anxiety and build personal confidence. Our residential program is very short-term, but we offer information on other area agencies and resources that focus on helping teens and young adults with LGBTQ concerns.

Do you think it'd be possible to explain how things are to parents, even simple things like "People have different sexualities, they are born that way."

Or would they, instead of listening to a mental health "authority", think that you are wrong and maybe even stop contacting you?

Chances are, by the time they've made it to me, they've formed their opinion and made up their mind. I'm not in the business of persuading parents into believing my reasoning as to what causes sexuality to develop any given way.

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I understand your frustration. At the end of the day, parents are going to parent. Some will do things I fully support, and others may do things I can't even fathom. Above all else, we try to support the family as a whole and introduce the idea that if they're using our services it's safe to assume that things aren't working to well doing what they have been doing recently. Why not try something new? That's something I pose to families often.

I am a middle school teacher and I have several students who come and talk to me about the issues that they deal with. Many of the students have difficulties with their parents and seem to not get the emotional support they need from either parent. What advice should I offer the student and how would I go about approaching the situation with the parent without stepping on anybody's toes?

I think you're last line is the most difficult part. Some parents don't want ANYBODY telling them how to raise their child(ren). While I think it's a good idea to figure out a way to address the issue out of concern for the child, the fear I would have is bringing it up directly to a parent and having it backfire in my face and the child's.

Follow me for a moment: Child abuse and neglect (or suspicions of) are required to be reported by teachers and counselors. Your school may have a specific protocol on how to report such instances. Now it depends on the situation, and there's fine hairs to split as you may, but emotional neglect is very real and seems to fall in line with what your describing. Consulting an on-site administrator or school counselor with your concerns may not be a bad place to start.

Do you think that this rule should be changed or kept in place?

As a teenager, I am afraid to involve my teachers with anything personal for this very reason.

Kept in place. No child/teenager deserves to be abused or neglected in my personal opinion. If you don't want to tell a teacher, I'd urge you to find somebody else. A teacher, as part of their profession, is mandated to report allegations of suspected abuse. It's not down to a personal decision at that point.

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No worries! Teamwork makes the dream work! So I hear.

Can you give me a quick walkthrough of a teen's case as they move through your hands? How does a case come in, how do you work with them (And for how long? What sort of schedule do you/does a patient keep?), and how does a patient leave?

^{Is 'patient' the right word?}

Super quick walkthrough: We get a call from a parent/guardian asking for help, if they meet criteria we schedule an assessment interview, if they are appropriate and want to work with us they can get admitted immediately. Teens get individual counseling multiple times per week (they live here with us so they can't really not show up, but they can refuse sessions). Parents are urged to come in a few times a week as well; the more the better, I think. Placement length varies, but it's generally pretty short (less than a month). Schedules don't exist, other than when an employee is supposed to be in the facility. Meet when you can, ensure safety all the time, and keep in mind that everybody's here for a reason, staff included. I use the term "resident" as the patient label has that medical-vibe and we're definitely not a medical facility.

What state are you in? Ive never come across a residential facility in my state(RI) like this.

Most of the kids I come across aren't allowed contact with their parents.

I'd prefer not to reveal the specifics for privacy purposes, but I'm located in the Mid-Atlantic region. This agency is pretty unique, and I think that's what makes for a great learning experience and I'm glad I've been able to stick around for a few years.

How much do workers discuss the patients amongst each other? My brother went to a crisis center twice... later my parents were horrified to find out through the grapevine that one of the counselers was talking about the situation to people they know. It was one of those small world kinds of things but it left me with the impression that when folks in some professions tell work stories, it can really suck. It was the equivalent of a pharmacist going "oh! I know where I know your new girlfriend from! Her dad is the one who comes in for Viagra and anal lubricant! We all laugh about him..."

If you're speaking of post-discharge, we don't talk about them unless they call back and want to come back or need more referrals. I'll talk to their main individual counselor and ask how the previous placement went if I don't have adequate first-hand knowledge. I don't joke or otherwise speak negatively about former residents and I hope my coworkers don't either. Client privacy is huge and a major ethical feature that we need to be aware of. Your story isn't uncommon, unfortunately.

Did you have a traumatic adolescence yourself? Do you see a link between your choice of this line of work and your own story?

Thanks, good job, and good grammar!

I unexpectedly lost my father when I was 13. Tore me up. Tore my family up. I miss the hell out of the guy and would give everything I own to hug him one more time. I went into depression, suicidal thoughts, went to therapy, battled insomnia...all the above. Came out the other end of adolescence with a better perspective on how tomorrow's never guaranteed and we all play an active role in making the quality of our own lives as best as we can. I admit I don't have all the answers and I slip up from time to time, but I also know that I can help others that are ready to receive it. That's why I'm here, that's why I chose this field, and hopefully that's what will keep me in the field for many years.

I have been dealing with some problems of my own, depression, suicide, etc. I am 18 and I currently have no money of my own. My parents dont have a lot of money either. I have talked to a therapist and she actually recommended a inpatient place, but I dont think I could pay for it. I was wondering if you knew what my options may be? Im moving back in with my dad, and probably pausing college for a semester, but I still sometimes feel like I would be better off dead. I already tried once. Not sure where to go from here. Thanks for your time :) ??? Is that enough punctuation automod XD ???

Well, bad news first. You're 18. You're legally an adult now and if you live in a place like I do it's a good idea to get accustomed to the fact that there are limited services for you that you don't have to pay arms and legs for. However, it's not a bad idea to get in contact with your region's human or social services department to assess options.

If you're dealing with a history of suicidal thoughts, some current, take a step back and focus on what's important right now. List the top three things you want to work on/change/improve right now and see what lands there. Take a break from college if you need to in order to refocus. Likewise, if you have health insurance on your own or through your parent(s), give them a call and see if they cover services though local agencies be it group counseling, individual, or otherwise.

Do you have any healthy hobbies you enjoy? Do those things. Don't have one? Find one. The first steps toward making some positive, long-term changes always seem impossible or damn near. I'll leave you with a bit of perspective that I'll share with the teens I work with: People don't do things that change their lives because they're comfortable. When you're comfortable, you don't risk it because what's the point? If you're feeling down, and even question your own life, I'd assume you're not comfortable in your own skin. Use that to motivate yourself to do what it takes to make some positive changes in your life. Use some of my suggestions or keep looking elsewhere for something that sticks.

Final thought/tip: Start daily journaling today; track what you do each day to improve your life. Something great happens? Write that shit down. Something bad happens? Write that shit down. Work on finding trends in what you like happening as well as trends in what you don't like happening. Find the way to best cut off those bad things and maximize your chances of running into good outcomes using your own experiences as the foundation. You got this!

is there some place you can find clarity if your not sure what kind of mental illness a person have (but you are pretty sure they have one)?

A strength of our program is that we have to recommend families to follow-up with multiple referral sources when they discharge from our residential program, regardless of length of stay and how many times I got told to go fuck myself (it happens; they're frustrated, I get it). A proper psychological assessment can help shed light on various conditions that can best be treated with long-term therapy and/or proper medications to help regulate disruptive symptoms. When families actually take the time and effort to follow-up on the referrals I feel as if we made a significant impact even if the teens did not display substantial progress while in the program. If hanging out with us for a few weeks was the first step toward making some positive changes in the long-run, I feel accomplished.

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That nightmare again?

I would like to do this for a living. Can you tell me what type of schooling is involved?

Depends on your area and/or the specific types of agencies you want to work for. A safe bet is either with counseling or social work. If you want to do more of the case management and link up families with resources, social work is what you're looking for. Are you all about theories of behaviors and implementing interventions to augment negative behaviors? Counseling should be your focus. Do you want to make money? Computer science.

What about the types of jobs we can look for before we get our degrees? I see many places requiring either your MSW or your counselling/therapist masters before you can get into direct client interactions, but there have to be lower level jobs at crisis centers and shelters that don't require six years of college...

Do you want to make money? Computer science.

I started a CS degree 15 years ago. I honestly wish it were easier to do both. Counselling and crisis intervention is emotionally and mentally taxing as a full time profession, but I also have no wish to sit at a be-cubicled desk 40 hours a week. My dream would be to do social work part time, and fill out the rest of my time with programming, QA, maybe game theory or something along those lines, as a sort of built in self-care.

I'll occasionally search on Indeed.com and other posting search sites to see what's available using "mental health" as a search term. In-home counseling jobs for example can be occupied by people with a year of providing direct care to children/adults with mental health diagnoses. That's were having experience in a shelter-type environment can lead to new jobs for those not looking to do graduate level academic work.

Have you had any counseling experiences that really touched you positively? Understanding it's a difficult job, why did you choose to do this, and what keeps you going day to day?

The experiences in sessions that end up touching me the most occur when I feel as if I can personally relate to the teen/family I'm working with. I've heard things from teens that I used to say and believe when I was their age and it can bring up both positive and negative feelings. I chose to do this because I think I'm good at what I do and that it's not a job for just anybody. Some people SUCK at listening and trying to see things from other people's perspectives. I think when I'm in the room with somebody that wants to make some changes and just need some support and guidance, I believe I'm able to help them achieve that. I won't lie to you or myself and make it seem like it's the only thing I want to earn a living, but I've gone this far and have learned a lot about myself and my profession just in the past few years. To know that I might be able to impact a teen or parent in a way that enables them to live a better life is what gets me out of bed in the morning.

Do you think you could have more of an impact doing something different? Was a troubled teen and want to help others get past it also. I plan on setting up a non profit for opiate use. Never touched the stuff my demons were elsewhere, but i still want to help.

I think if I was able to choose the population I could work with for the rest of my career I would work with combat veterans experiencing post-traumatic stress symptoms. I don't know if I would provide more of an impact, so to speak, but I have been interested in that population for many years and have done several projects for school on the topic. I am not myself a war veteran, but I just fundamentally have an issue with the fact that these men and women come home with a war still inside their head and cannot readily find adequate help and support. I'm not going to climb on my soapbox at the moment, but I do know that I would love to get a chance to work with these folks sooner than later.

I was a resident at a long term facility for troubled youth back in 1999 to 2001. It was a Straight, Inc. spin-off program. What are your opinions on these types of long term programs?

I can't offer too much of an opinion as I don't have personal experience on either end of the spectrum when it comes to long-term facilities. I think those types of services are needed for some folks that simply do not respond well to other programs. Furthermore, I believe that no program works for anybody unwilling to receive the help. So if it takes longer for somebody to see how they could be doing things differently in order to improve their own life, then that's what it takes. I may change my opinion should I ever work for a facility like that, but for now, that's what I got.

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Greetings!

1) I don't get to diagnose in my current role, but I do have training using the DSM-IV-TR and I have to start using the DSM-5 soon since the field will be running with that soon. ANYWAYS, I try not to look at the people I work with as being a (insert diagnosis). Nobody is anything but human and they may be displaying various symptoms that tend to follow a specific pattern as others. In a long-term setting the diagnosis plays a role unlike what I do where I'm working now. By that I mean in a long-term setting, especially with third party reimbursement through insurance, the diagnosis grants that person so many sessions that they will pay for. Some diagnoses earn longer duration of treatment...but I think that's slowly changing? In my setting, I'm looking at what behaviors are associated with any diagnoses they may have so that I can address them as they occur and plan an intervention strategy as needed. People make mistakes, and people make diagnoses, so it's going to happen and my professional opinion may differ from others. Roll with it and focus on providing a high quality of care for the individual is how I stay focused.

2)Worst case? Nothing sticks out in particular, but any time I have both a parent and a teen unwilling to try doing anything different, I know I'm in for rough waters. They don't want to hear what each other has to say and the minute I say something they don't agree with, I find out quickly.

My advice is for you to stay positive as best as you can. The world is full of people that will try and tear you down, and teenage years can be filled with that reality. Keep yourself motivated and set goals you can achieve in the short-term and long-term, and stay focused.

Where there ever any teens or family's that you just couldent handle?

Yes! I'm going to copy/paste a response from a previous post: It's happened a few times. I used to work exclusively with the parents/guardians to facilitate family counseling sessions. Some parents held the mentality that they do not need "the help" and are not willing to budge on their parenting style, beliefs, etc. They firmly believe that their child is the only party responsible for making any changes and will reassert this belief numerous times within session. In situations like this I would attempt to show the parents how the family can be viewed as a system (Google 'Family Systems Theory' if you'd like) and a complete evaluation of the family structure (GENOGRAMS ALL DAY!) can yield useful insight on how to proceed with addressing certain issues. I also recall a teen I worked with that had several diagnoses and medications that were managed by a psychiatrist for the past few years. The teen did not like the effects the mood stabilization medication produced and refused to take them at home. This individual dealt with Bipolor Disorder symptoms and was cycling dramatically while in the facility. With several teens in the facility it was hard to devote the individualized attention needed to help this particular individual get through their manic and depressive episodes. In another more personalized setting I would have felt more comfortable, but this setting isn't great at helping in those types of situations; something I realized very quickly.

How often do patients/parents withhold/lie about important information? Is is a serious problem?

Technically we don't know how much they lie. We catch lies on occasion, and it can delay progress with counseling, but for the most part we just roll with what information we have and stay focused on the goal of getting the family reunited and better equipped to deal with the stressors that led to them seeking out services.

How do you deal with teens who have physically/verbally abusive parents? My parents are assholes :P

I report allegations of abuse. If you're in a home environment where you are routinely subject to abuse in any way, I would advise you to contact your local authorities if you feel that your well-being (physical/emotional) is in danger. I can't tell if you're joking or not with the last character you added, but I do take claims like this seriously and hope you have the ability to reach out for help if you need it. Abuse has no excuse.

How do you prevent burnout? Do you ever get to follow up or find out how these kids turned out? What's the most rewarding thing?

I love teenagers and sometimes wish I had taken a career path like yours.

Burnout happens and prevention isn't always easy. I prevent it by playing/listening to music and staying physically active through going to the gym or playing sports. We follow-up with families after the teens discharge from the residential program. Short-term results varied widely and I don't think accurately reveal if what we did made an impact or not. I think any work done with teenagers isn't revealed until they're in their mid to late 20's. I secretly hope somebody I worked with will remember that time tee5150ii told them something that still resonates with them and help shaped the person they are trying to become. I may never know it, but I like to be positive that something I say will stick. Most rewarding this is when I can tell the teen and/or family "gets it" and starts to consider doing things differently. Every journey begins with a first step, so if I 'see' that step happen in the session(s), that's awesome.

Hi! Thanks for the AMA. Sometimes when I read my eyes go ahead of my brain and I make words into what they aren't. I saw your post and I thought it said IAmA Overnight Circus Counselor. Crisis counselor makes a lot more sense.
Here's my question:
What's the most common reason for teens to call when they do? Their "cheif complaint", if you will.

I'd be a circus counselor. No hesitation. Some folks have called me a clown so no issues with fitting in.

Most common issues are fundamental effective communication breakdowns that manifest into drastic behaviors. In other words, parent/guardian gets mad about something, enforces harsh consequence (in part to assert dominance), teen reacts negatively (e.g., runs away, verbally lashes out, criminal activity, etc.), and now parent doesn't know what to do to intervene. The basic flaw that I see in these chains of events is that somebody (parent or child or both) isn't willing to talk out their concerns...and sometimes the root of the issue isn't even associated with the overt behaviors. Household defiance or family discord are the terms I use for assessment purposes.

Are there ever times when a teen calls in and you think "Seriously? You think this is a crisis?? Like for example, their parents wouldn't buy them Justin Bieber tickets, or their parents got them a new Toyota, not a BMW? Or something else ridiculous..

How do you let these kids know that their problems are not real problems?

I've personally never fielded a call like that. I have heard things that I wouldn't consider to be "real" problems in the sense that my expectations do no match with that of a given parent. For example, a parent once stated that they were upset about their child's grades. I'm thinking maybe some failing grades here or there, nothing too crazy or out of the ordinary for a teenager going through a rough patch. But, I found out, the child had two B's on the last report card as opposed to all A's. Granted, this wasn't the primary reason they were contacting the agency, but I had to make sure the parent wasn't joking. They weren't.

What is the best way to work with (naturally emotional) teenagers? For instance, when you give them news - you can't go out tonight because your grades weren't good enough - and they fly off the handle. Is there a best way to talk them down?

Is there a best way? Tranquilizer darts.

Joking aside; not giving in as a parent/rule enforcer is huge. Some kids think that if they let enough shit hit the fan their parent will cave so they don't have to put up with it anymore. Don't give in. Also, be consistent. The same consequence should be administered for the same behaviors...in a sense that if Mary doesn't clean her room, she can't go out on the weekend every time the room isn't clean...not some times. I see the temper tantrums ramp up when they get away with the violation once. It's like, "Well shit, mom didn't get pissed that one time I didn't clean my room" even though it was a year ago and there's been 20 other times sense...doesn't matter. Teens aren't always logical, and a little consistency in consequence dispersion can go a long way.

What is your degree?

I have a B.S. in Psychology and recently obtained my M.S.Ed. with a concentration in Mental Health Counseling. I'm also a National Certified Counselor (NCC) and that was obtained through a credentialing exam that I voluntarily took during my final semester of graduate studies for shits and giggles.

How long is your overnight shift for? Are you sleeping, waking up for calls, or are you awake the whole time?

Pretty much from midnight until 8am. Can't sleep; something could come up at any moment and I'm expected to respond accordingly. I don't do caffeine (G.I. tract can't take it) so I rely on walking around, cleaning, preparing basic food to stay occupied, checking emails, Reddit, Halo for PC, TV's always on...pretty much anything. It's cold out so if I start dozing off I'll walk outside and let the cold give me a boost.

On a typical night, how often does something come up for you to deal with? Are you typically called pretty frequently, or do you have long stretches that you have to fill with other activities to stay awake?

Typical is a dozen phone calls per night. Only had one no call night. Biggest battle is staying awake and hoping I'm not using the toilet when the phone rings. Rushed paperwork is always messy, ya know?

Does your weight affect your job in any way?

Yes. I'm overweight. It affects everything.

I think /u/PANCAKETWAT14 may have misread "Overnight" as "Overweight".

That makes much more sense now that you mention it.

Have you seen "Short Term 12"? If so what did you think of the film and its portrayal of a contemporary group home for troubled teens?

I've never heard of it. I think I need to look into it ASAP. Thanks for the heads up!

When should parents worry that their child's behaviour/issues require outside intervention, as opposed to being normal teenage brain development stuff?

I ask as the mom of a 15-y.o. girl and as someone who has mental health issues herself. Thanks!

I like to differentiate between outside intervention versus outside support. To me, intervention means that you're slamming on the brakes and hoping to get all-encompassing help right away. Support, to me, is a gradual process utilizing outside professionals likely housed within an agency or otherwise centralized support entity.

If the behaviors your noting are severe and causing significant issues within your lives/relationship, that's when an intervention is definitely warranted in my opinion. If you're beginning to see behaviors that don't immediately concern you, but you are noting an increase in frequency or severity, I would begin to assess for support services in your area.

By all means, just being there for your daughter can help. Listening goes a long way. Although teenagers are notorious for not usually seeking out feedback from their parents when they have an issues (like I was), knowing that you have a strong support close by is refreshing for some teens. While you may be told you don't "get it" from time to time, I'd urge you to don't let that phase you and let her know your there when she needs you and can respect boundaries when each of you need a moment to cool off and collect your thoughts if the conflict is existing between the both of you.

You say communication with parents is the largest complaint. Do many of these issues stem from religious beliefs?

I wouldn't say that many or most of the communication issues I've observed stem from religious beliefs. It does surface from time to time, but our program is not based upon any religious belief system and I think families that have that strong religious component would be more likely to seek out services from within their church. That being said, we've had families approach us stating that they exhausted services provided by their church and were referred to us as a result.

I teach one-percent suburban kids. What issues do you see most often among privileged kids? I feel that while there is an abundance of material wealth in these kids' lives, they can have the same problems as kids in lower-socioeconomic situations - parents working long hours, messy divorce, etc.

I don't care how much money any family has, you can't buy quality time with each other. It's as if some families have a business-like relationship; only talking to one another to get something or submit a request for somebody to do something. Then, when something big happens and emotions get involved, nobody knows how to approach one another. Things get convoluted quick and everybody gets offended and makes the situation worse. Not always, but these things don't care about your SES status and never will.

Did you start working in your field before or after you started gradschool?

Working in the field after I started graduate school. Some can get their feet wet with undergraduate-level education, but it really just depends on what you want to do. I'm really into the clinical/therapy aspect and you've got to get the grad noise done if you want to make that happen as a long-term career and support a family. These jobs don't pay very well, so the more letters behind your name the more opportunities can open. Plus, time and experience can speak louder than degrees with some agencies.

Why did I read it as "Overweight Crisis Counselor"?

Freud has some ideas.

[Serious question] What's an "overnight crisis" and how does one counsel for it?

Simple. Is the sun down and shit's going down? OVERNIGHT CRISIS!

Kidding. I think the wording isn't clear in how I presented my title. I'm a crisis counselor that is currently working an overnight shift in a 24 hour facility that works exclusively with teens and their families experiencing a crisis situation. I can talk it out with them over the phone, they can come in (unannounced walk-ins even), or they can schedule a time to come in when the sun's up to talk with others to assess their situation.

So you work with vampires?

Yes. Scary stuff.

Thanks for what you do. I could have really used someone like you about 16 years ago.

This job seems like it could be pretty stressful. Is there a support system in place for the counselors?

Our support system is each other, to be honest. We don't provide therapy to each other by any means, but we all live it and can relate to one another on a level that allows us to vent to each other when appropriate. Everybody has their own ways to cope, at the end of the day.

As somebody who is interested in helping kids in this capacity where would you suggest I start? Is this something you have to have a degree for? Even as a volunteer position of watching kids? I'm not quite sure how to word it.

Second question, although it seems a lot of the frustration comes from the parents I was wondering what were some of the frustrations that came from the teens themselves. Thanks!

edit: totally just noticed the 5150 in your name, nice touch!

Start by looking in your area at agencies that work primarily or exclusively with families and their children. If you have a department of human/social services, give them a call or email and ask if you can volunteer somewhere as most places like where I work love for people to get involved.

The teens present problems that I have to look at differently than the adults/parents for various reasons. I'm a sucker for biological influences and it's well known that teens SUCK as making decisions due to their brain still forming (frontal cortex and all that jazz). So when a teen says they stole their mom's car to go to the party to see a peer that promised to have sex with them if they show up, that's almost expected, so to speak. They mess up, they sometimes choose not to admit they messed up, but it's out on the table nevertheless and provides somewhere to start when counseling kicks in. It's when parents claim that they've got this parenting thing down pat and have three other children that are "perfect" but Johnny wants to raise hell because he didn't get the new Jordan's that came out (no joke), they think he's destined for a future of incarceration. It's hard to counsel parents that don't want to hear what I have to say; they just want me to nod and agree. If that makes sense...

And speaking of 5150; although I know it's relation to the legal code, my usage relates to a model of guitar amplifier that I have used for many years and adore. Fun fact!

First off, thank you for doing what you do.

Second, what kinds of credentials does it take to do what you do? And, more specifically, what does your job demand of you?

Credentials pend on the agency/role and who's paying for the services being administered. Assume a 4-year degree is minimally required to get your foot in the door. Then, pending how much further you go and how many letters you can get behind your name, that dictates what's behind that door one you open it, so to speak.

My current job demands are basically to keep everybody safe first and foremost. Everything past that boils down to counseling, paperwork, housekeeping duties, and showing up on time. It has it's ups and downs but I wouldn't still be here if I didn't want to be.

Thank you for what you do. Historically, do you think the state of mental health with teens is getting worse, better, or about the same? If worse or better, what do you think the contributing factors are?

I wouldn't offer any type of guess about if it's getting better or worse. I'll say that mental health concerns largely unique with teen populations is going to always exist. Teenagers are balls of emotion that tend to make decisions based on right here, right now mentalities. That can create issues, at least in our society and legal system. Parents will always play the most significant factor in helping their children survive their teenage years, in my opinion. More informed and willing parents, the better the future outlook will be, perhaps? That's my thoughts.

What's the link between you and psychiatrists? Do you have any at your facility, or do you call'em as necessary?

Short answer is they go to medical school and for much more time than I've been in school. They get the training required to manage and prescribe medications. I can't and don't desire to reach that level at any point in my career. There are none at the facility I currently work in. We network with them and coordinate care for folks that do see one regularly, but not any direct contact outside of those situations.

What is the one call, if any that makes your stomach drop if any?

Not too much surprises me anymore, to be honest. But I've always been a little weary whenever we're dealing with a family that has an active investigation being conduced by social services (CPS, etc). Much more paperwork involved and the family can tend to hide details because they feel like anything they say goes directly to the person investigating the claims.

Have you ever met someone in your line of work that was so messed up that you didn't think you could be of any help? If so how do you handle that situation?

We've had folks that required more intensive care inquire about our services before. It's somewhat common. Our phone screening process allows for us to get those types of situations handled by directing them to agencies more equipped to handle more serious issues. Anything medical related is directed to the hospital/ER and self-harm or homicidal thoughts or ideation is usually directed to facilities specializing in acute psychiatric stabilization and screening.

That being said, yes, we've had folks that ended up being too much for us to handle and realize it after they have spent some time in the facility. We try to intervene as best as possible, but we know our limits and refer accordingly when needed.

What are the demographics of your clientele?

Are the "urban youth" overrepresented?

Widely varied with all classes and races/ethnic backgrounds. I'm sure actual statistics are kept on file somewhere but I don't have access to them.

Do you use therapeutic holds or I.M's (needles) when residents remain unresponsive to verbal de-escalation?

All staff have training in therapeutic holds. No needles here, though. That being said, I've never used a hold on a teen (or parent), but I have broken up physical fights between the teens. Verbal-D usually works very well if we can get everybody separated. For some reason, most teens seem to only like fighting when they have an audience. Remove the audience (also for their safety) and they come back down to Earth sooner or later.

Any experience with Self Injurious Behavior (S.I.B), particularly cutting?

I have seen S.I.B. and it's definitely more common with females, at least in this setting. Cutting was the most common form, by far. Rooms are checked to find and confiscate anything that could cut through skin, but they get crafty with hiding places. If it gets to be too frequent or causing visible blood loss, I called for paramedics or more acute care professionals/agencies for assistance.

When S.I.B goes beyond superficial cutting does your staff implement holds until paramedics arrive? Do you also place residents on one to one status until they can contract for safety?

If it's really major bleeding, we can do some first aid to help prevent from bleeding out until paramedics arrive. If somebody's going off (out of control flailing or resisting) and bleeding everywhere, it's time to call 911 and get everybody else to somewhere safe to avoid spreading bloodborne pathogens and the like. One to one status is used, but we don't usually rely on just contracts. If somebody's thinking about serious self-harm/suicide, they get immediately referred to a more acute/psychiatric setting for assessment.

I am considering a career in drug and alcohol counseling because of personal history. My question, Is there a high risk of becoming emotionally attached to the person you are helping? Ive heard this is the main issue with people in this line of work.

It's a risk, for sure. Look up transference and countertransference on wikipedia/Google to get some perspectives on the topic. Mental health professionals need to be aware of their own thoughts and feelings just as much if not more than those of their clients. The idea is that it's hard to give some quality, objective support and guidance if you're becoming emotionally attached. Feelers gonna feel, so I wouldn't let it steer you away from the career path, but just keep in mind working with others, regardless of their concerns and histories, will evoke memories and thoughts of our own. The good and the bad.

Thanks heaps mate.

Thanks, Heaps.

So I'm sure in your time you have seen many individuals as a result of drug use, either by them or a member of their family, close friend, etc. and so I'd like to ask a few questions about that.

Does the facility you work have specific policies in relation to drug use by those teen in the facility? Do you require a certain clean period from drug use before they can arrive? Do you allow people currently suffering from withdrawals and if so do you take actions to prevent serious withdrawal symptoms, such as the provision of Suboxone to manage opioid dependencies?

There has been a lot of talk about the medicalisation/decriminalisation/legalisation of cannabis and the effects this will have on teen usage rates, do you have an opinion on this? What do you think is the appropriate action to be taken with regards to teens and cannabis use?

Do you believe that drug abuse should be treated as a medical issue or as a criminal one? In your opinion, do harm minimisation policies such as needle exchanges, safe injection sites and heroin provision programs lead to better or worse outcome for teenagers who are drugs users or at risk of becoming drug users?

If you could make any changes to drug policy effective tomorrow, what would you change?

Sorry for the shopping list of questions, thanks for doing this AMA!

Here comes the drug questions! I have/do see drug use concerns from time to time and counselors today working with most any population need to be aware of how to manage these situations.

Let me start with this: Whenever I'm working with a teen that may be dealing with a drug use pattern from casual consumption to full-blown addiction, I'll inform the parents/family that this feature needs to be addressed first and foremost before shifting to other behaviors. The chemicals are impacting biological and neurological features of this individual and spending time on anything else would probably be wasteful.

If somebody were to enter our facility clearly under the influence of anything to the extent it inhibits their ability to consent to services and respond to basic mental status evaluation questions, they need to be taken to a medical facility and cleared by a physician (with written proof) before they can be admitted. If they go through withdrawals and cannot participate in the program due to simply feeling like shit, then we recommend for the teen to return when if he/she can reach a sustained level of sobriety as they cannot use anything while in the program other than prescribed medications. No exceptions. We cannot provide any specific services tailored to those coping with reactions to drug use or withdrawal.

Regarding teens and cannabis use: it's going to happen and will continue to happen regardless of the the laws and how they may or may not change in the future. However, if I get the sense that a teen is using in order to self-medicate for something other than a pure desire to use the drug, I try to hone in on that. It can be a good coping skill, and that's just the way it is. Some folks drink away their sorrows to numb the pain and some grab a bong. It makes sense. The tricky part that I try to reveal to these individuals is that the cannabis use is a temporary solution to a permanent problem that can lead to a permanent consequence that isn't worth the trouble. I don't focus on "Bad kid, why would you smoke that wacky weed?!" because they're going to shut their ears immediately and think I'm just another adult giving them a hard time. I level with them..."I understand it helps and you don't see a problem with using. That's fine, but what I'd like to figure out is if there's something else you can try that can also help you cope that doesn't need to be inhaled assuming you always have some nearby you can use when you need to." I think it's appropriate to find out what's initiating the behavior. Behaviors have motives; therefore, what's motivating the cannabis use and how else can that feature be addressed by other means?

I try to stay out of the medical/criminal debate. I don't use drugs, never have smoked anything. Never have drank anything, other than O'Douls, simply by choice and not motivated by any holier than thou beliefs. I realized that drug use is an issue for folks, young and old, and that treatment options should be available. I was looking into working at a regional methadone clinic earlier this year and I think places like that are great opportunities for people to get treatment they can use. However, not all those who can use the help really want it. That's the issue at the center of that debate, in my opinion.

Any changes to the policy? I don't know where to start. I think legalizing cannabis wouldn't be a bad idea. I don't know a whole lot about the political side of things but appropriate taxation seems like that could help get some areas of the nation back on their feet. All I know it, whatever happens, I still wouldn't use it. But I realized there's always folks who will and I want to be able to help them if they're ready to work.

Do you work with lower functioning teens, as well as any teens on the AD spectrum? What are the specific challenges when working with either?

I've worked with folks on the spectrum before. Toughest part for me was having to give them more personalized attention on a daily basis than what I was used to. A few of these folks thrived on structure and wouldn't be happy if something didn't happen like they thought it would, or was at a different time, or a meal isn't what they were told it was going to be the day before. I'm a patient person (except in traffic) but found myself having to adjust my communication patterns to best suit their preferences.

I will always remember a particular gentleman that cussed me out terribly over what he ate for lunch one day. He apologized later, and no hard feelings, but now it's hard for me to make a "fat-ass-mother-fucking" grilled cheese sandwich at home without flashing back.

What do you think of online, "quick-help" sites like http://7cupsoftea.com ? Helpful? Harmful? (because people go to the site rather than a real therapist)

I think something is better than nothing. I don't think nothing can be as helpful as one-on-one interactions with somebody else with the proper training, but if you can't get into that situation (or don't want to right away) but having something heavy on the mind, quick-help sites aren't a bad option.

When I was younger I was in a placement in Utah for a year and got out in record timing. (Most teens stayed up to 3 years). Most of these places are a complete hell to be in. Including physical punishment and physiological torture. So OP, how much abuse do you see on a day to day basis? How many teens do you actually believe you are helping?

I see no abuse and wouldn't be associated with an agency that demonstrated such behavior. This facility is very relaxed compared to multi-year locked down facilities like the one you've described.

That I actually believe I've helped? That's tough since most of the benefits that would come from our program would manifest themselves many weeks/months after they return home provided they're willing to use the skills and strategies they've learned during their placement. I've had a handful of teenagers call or come back to the shelter and report doing better and thank me for helping them. That's always a great feeling.

what is your degree?

I have a B.S. in Psychology and recently obtained my M.S.Ed. with a concentration in Mental Health Counseling. I'm also a National Certified Counselor (NCC) and that was obtained through a credentialing exam that I voluntarily took during my final semester of graduate studies for shits and giggles.