- [Announcer] Major support for this program was provided by Nancy and Nyle M (bright lively music) Emerson, (bright lively music) Kathy and Charlie Izard.

(bright lively music) Additional support was provided by Amanda Jensen and Scott Bonneau, Amado de Hoyos, Georgetown Health Foundation, Kristen and John Nelson.

(bright lively music) And by... (bright lively music) And also by... (bright lively music) For more information and a full list of funders, please visit us at howarewetoday.com or aptonline.org.

The information provided in this program is for general educational purposes only and is not intended to constitute medical advice.

This is not a replacement for therapy and does not constitute therapeutic services or a therapeutic relationship.

For personalized medical guidance, or in the case of an emergency, please contact a healthcare provider.

(gentle bright music) (upbeat lively music) (upbeat lively music continues) - (sniffles) Oh, hey, how are we today?

I hope you're doing okay.

And I'm fine by the way.

I'm not crying.

(sniffles) Just chopping these onions up for my secret pizza sauce recipe And by secret sauce recipe, I mean, the first thing I Googled when I Googled secret sauce recipe.

I love cooking.

It's my favorite thing to do because you get to put your own spin on any recipe and call it your own.

(sniffles) And we can kind of do the same when it comes to managing our mental health, right?

Finding our activity.

The thing that brings us joy in our life, however small or silly or unique.

And especially those things that let us connect with other people because that's the best part about cooking, sharing it.

And a home cooked meal is the perfect excuse to connect with the people that you love.

(door knocking) - Something smells good in here.

- Hey.

- The whole floor smells like a spicy of meatball.

- Well, hey, my nosy neighbors.

I'm making my favorite pizza for my favorite niece who is coming by today.

In fact, my sister should be dropping her off any second now.

- Oh, so we finally get to meet the Bella.

- That's the one.

- Oh, can't wait.

- Ah.

That's my cheese.

I know my Italian a little rusty but you know, it's been about a year since I've had an official pizza night, so I'm living close by now.

Hoping we make this a regular thing.

- Yeah.

- Well, do you need help finishing up?

Because I don't think you're gonna have it done by the time she gets here.

- Well, no, that's the thing.

It's not just about eating the pizza.

It's about making the pizza toge Bella and I have been doing this since she was a little kid.

She loves doing the dough, flipping it up in the air.

And I obviously do the onions, so she doesn't cry 'cause she's a teenager.

She's gotta be tough and strong and all that other stuff.

- Hey, grownups cry.

I cry all the time.

I cry over chopping onions, maybe watching TikToks of dogs reuniting with their owners.

And I'm a really ugly crier.

- Yeah, it's true.

She is.

- (laughs) Well, truth be told, I really hope this cheers up Bella today because she just went through a breakup and she's been feeling pretty down about it.

So, just between us two though, right?

(clicks tongue) Ah.

Buongiorno, Bella.

- Hey, Uncle Tyler.

(door shuts) - Hey, Bella.

- How's it going?

- Hello.

- So, yeah, well, I hope you remember how to make your favorite thin crust pizza because Mamma Mia, I got the dough station set up right here for you.

- Actually, I'm not hungry, Uncle Tyler.

- Oh, okay.

Yeah, that's, that's fine.

- You mind if I just chill out?

- Yeah.

Sure, sure.

Do you want me to put on a movie or something to- - No, thanks.

I'm good.

- [Mariel] Sheesh.

- [Barbara] Kids and their phones.

- (sighs) Yeah, except Bella's really good about not being on hers around other people.

It's not like her.

- Must have been some breakup then.

- I guess.

But I mean, she's a really resilient kid.

She bounces back from everything And look, I know we all love pizza, right?

But that kid loves pizza.

- Well, you know, teenage heartbreak.

It's tough on top of everything you have going on as a girl at that age.

Trust me.

(door knocking) - Come in.

Hey.

- Hi.

- What's going on, sis?

How are you?

It's good to see you.

- Good to see you.

- Oh, these are my friends.

Mariel and Barbara.

- Hey.

- Hey.

- I'm Nicole by the way.

I was just dropping off Bella's jacket in case she gets cold.

- Perfect.

Did you also come by to help me cook the pizza?

Because my sous chef apparently has hung up her apron.

- Yeah, I thought her coming here might loosen her up a bit but... - Yeah, I guess she's still pretty down from the breakup, huh?

What?

It's only been a couple weeks though.

So, she'll probably bounce back soon.

- A couple weeks?

It's actually been almost six months since the breakup.

- Six months?

Wait.

Really?

- Yeah, I hadn't added it up in a while, but this has just become her new normal.

I don't know, I just, I just chalked it up to normal teenage stuff, you know?

Like social hormones?

- I mean, I think we all know that teens can go through pretty big emotions and phases, right?

But if she's feeling this way six months later?

- Well, yeah, I thought she could be feeling depressed.

But a breakup couldn't give you actual depression, could it?

- Well, it's tough, you know?

There's a difference between being depressed and having depression.

But I guess what's the difference and how do you know?

- I mean, I don't know exactly, but I do know that, you know, when it comes to my bipolar, my depressive episodes can last for that long.

So, look, I don't wanna therapize her or put my stuff on her, right?

But this does seem like a pretty big clue.

You know, sis, come to think of it, have you seen or noticed any, I don't know, behaviors or patterns that are kind of outta sort?

- Actually, now that you mention it and I stop and think back, yeah, the clues sort of line up.

It's like a little detective mystery you didn't even know was happening.

(film reeling clacking) (gentle morose music) (gentle dramatic music) The first thing I noticed is the shift in the way that she acts, the way that she talks.

Now, it's all very pessimistic.

"I don't care anymore.

I don't wanna do this."

She's grumpy and just more irritable.

- [Mariel] That just sounds like a typical teenager dealing with hormones though, right?

- Yeah, I thought so too.

But even just trying to get her to go do something seems impossible.

She can't even get herself moving and doesn't seem to care how she looks anymore, which is the complete opposite of how she used to be.

Not to mention every teen I know And I know that teens are supposed to distance themselves from their parents.

Who wants to tell your mom about boy problems?

(gentle poignant music) And she used to do all these school activities.

Class council, theater, you name it.

But after the breakup, she stopped doing all of that.

(phone ringing) (phone receiver clicking) Apparently she's been skipping class too.

Just all these behaviors, they're not her.

Even the friends she's hanging out with seems like bad influences.

Like, those are people and activities that are just easier for her somehow?

(gentle pensive music) But what's even more concerning is that she's eating less.

(gentle pensive music) And sometimes, she hardly sleeps at night.

But then other times, she sleeps for hours.

Sometimes, in the middle of the day.

And you know how social she is, Tyler.

But she has completely flipped a switch.

She's saying no to every social event that comes her way.

Movies with friends, hangouts, everything.

(gentle solemn music) And when I try talking to her about it, we just get into these intense screaming matches.

(tense dramatic music) Bella.

Bella!

(slow somber music) But really, all the clues add up to one giant clue.

Her behavior has completely changed, and it's been like this almost every single day.

And it's not even like, she just started puberty.

But these changes seem, I don't know, scary and permanent.

And ugh, I feel like such a bad parent because despite all my sleuthing I apparently couldn't tell the difference between normal teenage issues and something that is seemingly much worse.

I don't know, I just, I just want her to be happy and healthy.

- Nicole, all of us can see that you're trying so hard, okay This isn't your fault.

I mean, all this is really difficult to manage.

And I will say after hearing all this, it might be time for her to get a mental health professional.

Again, I don't wanna put that on you, and it's not my place to say, but... - I understand.

I also don't wanna be a helicopter parent or one that lets too much slide.

I don't know.

It's just really hard to figure out.

- I don't have kids, but I know with friends and family, I can't tell when it's just normal sad or burnout.

Like, is it the length of time or?

- We still haven't figured out what's appropriate and where the boundary is and what the boundary may even be.

(soft bright music) - So many great questions.

- Dr. Erin!

- Dr. Erin!

- Yeah.

- (laughs softly) I brought that pineapple you asked for.

- Ah, thank you so much.

- Oh, you're a pineapple on pizza guy.

- Dude, you're so gross.

- Ooh, Tyler's been a pineapple on pizza guy since he was a baby.

- Dr. Erin, how do you intervene when your friend just has terrible taste?

- There is no helping that.

- I love all of you so much.

- But I think that I can actually answer some of your other questions.

So, it can be hard enough to seek treatment for yourself.

But knowing when and how to talk to somebody else, a friend, a family member, a child, a loved one, and what the appropriate boundaries are can be so difficult.

Even for me as a professional, I'm a psychologist, but I'm not Bella's psychologist, so I can't diagnose her because I know all of you.

I know her, right?

What I can tell you is what I've seen in similar situations and maybe offer some suggestions for a path moving forward.

So, when we're thinking about how to help someone who's struggling, whether it's a situation where we already know what's going on, like we have a diagnosis, or we're trying to figure out what's going on, like with Bella, it can be so hard watching from the outside.

But I'm really happy to see that she's still here in this room with us.

It shows that she has some willingness to push through the pain, which is a really hopeful sign.

- That's true.

She still is going to school and getting her work done.

Although that did make it a lot harder for me to realize something bigger was going on.

- For sure.

Yeah, it's certainly confusing, isn't it?

Because it's definitely a good sign that she's still showing up and doing the things that she's supposed to do, but that doesn't mean that she can't also be depressed at the same time.

Many people who struggle with depression are able to do all of their daily activities while still being depressed.

It's all in this spectrum of intensity and interference.

But her willingness to show up and do the things that she's supposed to do might actually mean that she's more receptive to getting help.

- Okay, so how do I help her?

Well, more than anything, you really wanna get her a provider.

- But what if she refuses to go?

- Yeah, what's that saying?

That you can lead a horse to water, but you can't make it drink?

- True.

But let's think about it a little bit differently.

(whooshing) (horse neighing) You're right, you can lead a horse to water and you can't force it to drink, so you can't force someone to do the work to help themselves.

But on the other hand, you also can't drag a horse to water.

You're her parent.

So, there's definitely ways that you can set boundaries about going to doctors.

But we can focus on some positives here.

The fact that she's still showing up the best that she can is a really good sign.

So yes, you can't drag a horse to water, but even one teensy tiny toenail step closer is a step closer.

That's showing up in the best way that they can.

And we can make it easier for her by finding a provider to move her in the right direction.

- And how do I go about finding someone?

- Okay, so we could do a whole episode on how to find a provider, but let's cover a few bases first.

- So, it's not always the most fun subject to talk about, but the first thing we have to talked about is insurance.

Your insurance company is gonna have a list of providers that are in network, meaning, you likely just pay a copay.

But unfortunately, a lot of times that list is pretty small.

The other option is an out-of-network or private pay provider.

Now, with that, you would submit a bill to insurance after the fact for reimbursement for an out-of-network service.

Obviously, out-of-network or private pay is not always an option financially, but it's another place to start if you're not happy with the initial list from your insurance companies.

- That is a good place to start.

- That's good to know.

- So, once you've found a list of providers, either in network or out of network, the next thing we wanna do is vet them as individuals.

Because ultimately this is a professional relationship that you want to work for you and for Bella.

But we can't visit every office of every provider that you find, right?

That would be exhausting.

So instead, we vet them based on the information that we have on hand, which can feel a little bit like speed dating.

The first thing you wanna look at is credentials.

You want someone who has the education and training to provide the care that you've been looking for because even though there might be a great time and place for a life coach, when you're looking at something clinical, you might want someone with a license.

- That makes sense.

- Yeah.

- So, we wanna research their credentials.

Like, their degree or their license.

This can be a number of different things depending on the provider.

You could look for a licensed psychologist, marriage and family therapist, mental health counselors, or licensed clinical social workers.

That just gives you the peace of mind that they went through the training and education to provide the care that you're looking for.

- Wait a second.

Are those all those three letters I see next to names?

- Yes.

- Okay.

Now, it makes sense.

- Okay.

- And there's even more options, but you wanna start with looking for somebody who has a credential.

Meaning they went through education and training.

Next, you wanna vet their experience and expertise.

Maybe you're just looking for someone that can give you a little bit more support in life.

So, more of a generalist is okay But maybe you're looking for something more specific.

Say, treating teen depression.

So, you'll want someone with training and evidence-based treatment of that kind.

- Didn't know that there was a difference.

- Mm-mhm.

When you're doing this research, make sure you really look at their websites or their CVs if you can get ahold of them, not just whatever boxes they clicked on an advertising website.

Now, comes the final part, which is the fit.

This is obviously the most subjective, but you want someone whose vibe connects with yours.

They could be the best trained psychologist or provider in the world, but if you don't connect with them, you're probably not gonna wanna to what they have to say, and it's not gonna work in the long run.

Sometimes that part's a little bit tricky because with Bella, she might not wanna talk to anybody.

But just see if you can notice any connection or individual resistance with the provider.

That might make a difference.

- Okay.

- Lastly, like speed dating, don't be afraid to shop around.

If you find somebody that works but they're too expensive or you can't afford it, maybe they can work out a short-term arrangement.

Or if you find somebody that you start with, but ultimately it isn't the right fit, you can switch and change.

It's okay.

That's all part of the process, and they won't be offended.

Because honestly, there's a lot of barriers to this.

Location, for example, can be a really big barrier.

If you need somebody in person, that's great, but obviously your list of options is gonna be a little bit smaller But truly the biggest barrier is usually cost.

Even if you find somebody that's a good fit, but they're private pay, don't be afraid to ask for a sliding scale if that's something that you need.

None of this is permanent.

You can figure out something that works for you.

Because remember, this is not marriage, it's speed dating.

- Good to know.

- Very different.

- Yeah.

- Absolutely.

- So, I highly recommend asking around.

Chances are you know somebody who has a provider that they like or don't like, and that's useful information.

At least a good place to start.

Okay, so Doc, while Bella's getting professional help, what can we do to help support her?

- It's a really good question.

It may sound really simple, but the most important thing that we can do is just being there for her.

We wanna be persistently present and really validate what she's going through.

For example, with teens, it can be so easy for everybody to dismiss what they're going through for a hundred reasons, especially as adults looking back with full perspectives.

We know that teenage heartbreak and high school drama doesn't hold as much weight as we get older, but we know that because we've already been through it.

She's going through it right now So, we wanna validate what she's going through.

Those experiences and the powerful emotions that they bring up.

That's really how we can support somebody is being there validating what they're going through.

Now, obviously that's not to say that empathy alone is gonna solve complex mental health issues that really need treatment, but it's a good way for us to show her love and support.

And while we're doing that, another thing that we can do to really help is bring joy back into her life.

And in fact, I have an idea for how we can do that.

- Do you have another exercise in mind?

- I have another exercise.

Do you have a calendar?

- I think I do, yeah.

- Okay, grab it.

(gentle playful music) - Here you go.

- Awesome.

Okay.

So, we have this really great tool from this treatment that's called behavioral activation.

With depression, but also mental illness and really just mental health in the logic is sometimes backwards We think when I feel better, I'l But the opposite is actually tru When you do more, you'll feel be And a great place to start is actually just to get something on the calendar.

Having some kind of structure or to engage in meaningful values-based activities can be so helpful.

Doing something that you love with someone that you love is incredibly mood boosting.

So, we wanna actually just pause and think about something that you love to do, right?

And it doesn't have to be big.

It can be really simple.

Remember the horse?

A step forward is a step forward no matter how small.

Showing up is showing up, no matter what it looks like.

So, think about something that you love to do.

What do you think?

- So, I really love to dance.

So, I might plan a solo dance party with myself, I don't know.

Thursday night maybe?

- Yes.

Put it on the calendar.

Get it.

- Okay.

- Have that time set aside.

- Okay.

- I think I'm going to finally finish that book I started a few months ago.

- Yes.

Awesome.

Good one.

Schedule it in.

- I mean, you said to do something with someone that you love.

And I love myself.

And I love getting massages.

- Oh, that's amazing.

- And I'm pretty sure I'm free Wednesday night.

- Could I switch to that actually?

- No.

Just for me.

- That's a good one.

I guess I have to go, yeah?

- Yep.

(paper rustling) - How about I add a few extra meals this week, yeah?

- Yeah.

How about I get pecan-crusted salmon on Tuesday?

- Ooh.

- Ooh.

- And then fluffy frittatas on Friday.

- Amazing.

- Oh.

- Put it on the calendar.

I'm gonna put that on mine too, so I can come eat that.

(friends laughing) - Okay, so think about something that you love to do or think about something you love to do with somebody else.

Take out your phone, put it in the calendar.

Or be like me.

Use an old school - So, now that we know how to take care of ourselves, how do we be there for others?

- Well, this doesn't have to be a solo exercise.

You can encourage your loved ones to schedule their own meaningful activities, or you can schedule things for them or things to do with them.

Really, the key is just continuing to show up.

So keep inviting them to things, keep scheduling things.

Even if they say no or we have to go really slow, just showing up for them can be so helpful.

- Can we add one more activity?

- Mm-mm.

Sis, why don't you take a breather?

- Yeah.

- It can be so hard as a parent to go through this stuff as well.

And why don't you and I come up with some other ideas that we can do with Bella, yeah?

- I think that'd be really wonderful.

Thanks, little brother.

- You got it, big sis.

(Nicole giggles) - Me too.

- Yeah.

(giggles) - Yeah.

- Mm.

Yeah.

(laughs) - You can be there by simply being present for somebody.

By engaging, by making sure that they keep doing the meaningful activities that they love to do in their lives, no matter how small.

And when it comes to inviting them, sometimes they might say no.

They might be down.

That's okay.

Keep inviting them.

Keep being there.

And when the time's ready, (plate clanking) they'll come to you.

(gentle serene music) - That smells good.

- It's your favorite.

Only if you want it.

And we can always cook together another time.

- Maybe next time I can talk you out of your whole pineapple pizza thing.

- Until next time, take heart and take care.

And cook your pizza however you want to.

It's whatever makes you happy.

Pineapple on pizza is not that weird, kid.

Sorry.

- Yes it is.

And you are weird, Uncle Tyler.

- I'm not weird.

I'm the coolest uncle that you know.

- You are so annoying.

- No, seriously.

I know.

Literally, I'm the coolest uncle ever.

- Stop.

- You think they give these out to just anybody?

- I don't know.

- You think your Uncle Kevin has one of these?

- Oh, definitely.

- No, he doesn't.

(gentle lively music) (gentle lively music continues) - [Announcer] Major support for this program was provided by Nancy and Nyle Maxwell, (bright lively music) Emerson, (bright lively music) Kathy and Charlie Izard.

(bright lively music) Additional support was provided by Amanda Jensen and Scott Bonneau, Amado de Hoyos, Georgetown Health Foundation, Kristen and John Nelson.

(bright lively music) And by... (bright lively music) And also by... (bright lively music) For more information and a full list of funders, please visit us at howarewetoday.com or aptonline.org.

(bright music) (logo whooshing) (soft flute music) (bright uplifting music)