Anxiety, Depression and our Teens, with Noha Alshugairi

Casey: Welcome to the Parenting Teens with Positive Discipline audio summit, I am your host, Casey O'Roarty, certified positive discipline trainer, coach and founder of Joyful Courage. This audio summit is designed to dig into the principles of holding the foundation of positive discipline while navigating the very real and messy experience of being a guide for our teenagers.

Special thank you to Jane Nelson and Lynn Lott, authors of Positive Discipline for Teenagers and the Positive Discipline Association whose mission it is to create a peaceful world by teaching Adlerian social and emotional life skills for respectful relationships. All the guests you will hear on this audio summit have extensive knowledge in positive discipline and have or are currently raising teenagers themselves. Thank you for listening and be sure to join us in the Joyful Courage Parents of Teens Facebook group for more discussion about this particular interview.  

My guest today is Noha Alshugairi. Noha is currently a licensed marriage and family therapist in private practice in Newport Beach, California. In addition she is a positive discipline lead trainer. Noha strongly believes that a nurturing, empowering adult-child relationship is at the core of a strong community. She has become an advocate of parenting classes and teacher trainings focused on connection and encouragement. While her philosophy is grounded in Islam, she has found in positive discipline a practical down to earth method to teach this philosophy. Since becoming a P.D. trainer in 2008. She facilitated several school wide trainings and conducted many parenting workshops. Hi, Noha,  I am thrilled to have you on the parenting teens with P.D. audio summit.

Noha:  Hi, Casey, it is such an honor and a privilege to be working with you in this segment. I'm very, very grateful because I think it's so important. Thank you.

Casey: Yes, can you tell the listeners about your experiencing with parenting through the teen years with positive discipline?

Noha:  When I was reading your question the first thing that came to my mind was that positive discipline actually saved my life during the teen years. I had started implementing P.D. principles but not as PD but more of like Adlerian Principles which is the core foundation of positive discipline earlier, with my kids, so when it came to the teen years I discovered, to my really, you know, utmost pleasure and delight, that the teen years were not as difficult for me as it was for other parents around me. It's a blessing and I really give credit to my shift in focus and parenting from a focus of control and focus of "I am the one who has to fix everything and what I do, I'm going to mold them and I'm going to shape them, it's all up to me 100 percent."

But after being introduced to the Adlerian principles I was able to shift to a really seeing my kids as their own individual beings and that they have their own personal journeys and they are not necessarily, you know, going to think or feel or behave exactly the way I want them to and that was extremely helpful for me and such a relief for me while they were going through their teen years to accept different things from them and not, you know, panic or not think of myself as having failed or haven't done, you know, my job so I'm very, very grateful to having shifted before they hit the teen years and implemented some foundational pieces before hitting the teen years. It really saved me, saved our family I think. And ultimately, it actually established the core foundation and the core connection between me and my children, which empowered me to later on dealing with more difficulties that, after all, you know, after the teen years.

Casey:  What's coming up for me as I listen to you is the difference between the experience that our teens have of the teen years but then our experience of their experience. So what I'm hearing you speak into, it just reminds me how there's the challenges and you know, the mischief and the behaviors that show up when our kids are teenagers but then there's also our response to that and how, what I'm hearing you say is, positive discipline and Adlerian philosophy really supported you in your experience of their experience.

Noha: 100 percent and not only that, if I can add a piece to that and also because my response, if you will, was more intentional and was more responsible and was more tamed then the mischief that usually happens or we we say happens a lot in the teen years, actually it wasn't a lot because they were able to receive from me that I see them as their own individual persons and that they have a right to different opinions and behaviors and so on and then we were able to work and collaborate together on something that, you know, maybe would not be 100 percent what I want but it would be more of a compromise between me and them.

Casey: Yeah.

Noha: It's really, it's really a beautiful experience and my co-author Munira Lekovic Ezzeldine in the book the Positive Parenting in the Muslim Home she, her her kids right now are teenagers so she's going through this phase right now and she is experiencing also, because of the shift, that she has also gone through this really beautiful synergy that's going on in the household right now because of all that foundation that was established earlier and I just want to say here, because sometimes when people listen to me or when Munira speak like this then they go like, "Oh, we haven't established this foundation, is it too late for us right now?" and I always say, "It's never ever too late at all."

Casey: Yeah.

Noha: One has to begin with where they are at and just focus on moving forward and being hopeful.

Casey: Yeah, yes, thank you for that. The topic that we're going to talk about today is mental health and specifically anxiety and depression in our teens and I reached out to you, just a little back story for everybody that's listening, I reached out to Noha earlier this fall and shared about the podcast that I released where I discussed navigating my own daughter's anxiety and depression and you just shared such a thoughtful response with me and really encouraged me that you would be an excellent guest for this particular interview and as I talked and really dove into my own parents of teenagers community and asked, you know, what would be useful, what are some topics that you'd like to hear discussed on this audio summit, anxiety and depression came up.

Also when I released that show, I think it was in September or October of 2018, the response I got from people who just really came out of nowhere saying "This is my story, you're sharing my story, thank you so much" so there, you know, when you look in the news, and you hear everywhere that teen, you know, depression and anxiety is on the rise. So I'm really excited to tease this apart with you but before we dive in, can you share a little bit about your own personal experience with navigating mental health with your own kids.

Noha: Absolutely, so, I mean, as you introduced me to your guest I am a marriage and family therapist so sometimes people assume that people who are experts, supposedly experts, in quotation marks, OK, in an area that nothing wrong happens in their lives pertaining to their expertise. Everything is going to be perfect in their life pertaining to their expertise and that's not the case. And it's very simply because we're actually very complex human beings, so we really, really don't have, we have some control but not, you know, all control, anyway so what happened was my youngest, who's in her teen years, was really a high achiever, I mean, beyond high achiever in her school. And she was this vibrant and passionate, you know, young woman who was always zealous about her projects and doing things and so and so and she got accepted into Stanford which was a big deal in her university, especially nowadays, and I am going to emphasize this because the culture we're living in now and this is influencing the uptick in depression and so it's across all demographics, across all age groups but especially in young people.

So there is a huge competition going on within the high schoolers, you know, world about, you know, which school you're going to go to and where are you going to be accepted and majors and so on. So anyway, it was a big deal that she was accepted to Stanford. She was, I think, one of only two from all of her high school accepted into Stanford. Anyway, very happy, excited, we worked out the plan on how we're going to cover the expenses because Stanford, as you know, is very expensive. So she's off to college, she's very excited, happy, starting a new phase and so on.

And then I started noticing in my conversations with her, you know, some, what shall I say, some disappointment in herself in terms of, like, she started beginning to compare herself to her peers and noticing that they are doing much more than she's doing and they're able to handle it. She's not able to like they are and she's wondering why isn't she able to do that, you know? I didn't really take it very seriously because I was like "OK, this is normal, it's a transition. She's moving from one, you know, environment to other and so on" The red flag for me was that she did not overcome this transition. She actually continued for the next two years to struggle with the feeling of feeling overwhelmed, lack of concentration sometimes, her sleeping patterns began to change.

She would, you know, oversleep in the morning and she would miss, you know, her first lectures and so on and so slowly I started saying, you know, "I think, you know, darling, you really need to go and do some some therapy" and she's like, "No, no, I can manage it and I'm OK." You know, I did not push because it's something she has to do. I cannot force her to go to therapy. Ultimately. I think, one time she was visiting us for spring break and she broke down and she started crying and she's saying "Mom, I'm not feeling very good. I'm just, I just don't feel good" and that's when we, you know, we looked online we found the psychiatrist and I booked an appointment for her and she goes back to college.

So she sees the psychiatrist I think at least the semester but the next semester, she's still not feeling good and then one day, she calls me and just my gut feeling, and I'm going to emphasize this for all parents, we parents have gut feelings and we need, we really, really need to trust them because we are the parents and there is something we can't explain by logic, really, you cannot explain logically but you just feel it. So my gut feeling and I have no idea how I said it or why, I said, "Darling, I think you need to come home." So this is in the middle of the semester. This is not, you know, like, you know, we have vacation or anything and I was flabbergasted that she responded, "Yes, I think I need to come home" and the next day she came back home immediately and we were, I was thinking she was coming for a week, you know, just to get her grounding and then she's going back to school. It was, you know, in the beginning of the semester. It was February, I remember. Anyway so she comes and then she says, "Mom, I think I need to drop out of school."

So I just, I didn't get angry, did not get upset. I, my action was, "I'm actually actually very proud of you that you are recognizing what you need to do to take care of yourself and I'm very grateful that you are taking care of yourself, meaning coming back to your home base." To me, it was a huge compliment that she found her grounding in our house. You know and and that's what you do too. She dropped out of school. She did not go back to school until now. So now, it's been, I think, maybe 3-4 years, I don't remember exactly but then what we did is she came back, you know, I gave her a few, couple of weeks to just unwind, figure herself so on and then we said, "You know, you really need to be productive, so you need to work so you can support yourself."

Casey: Yeah.

Noha: And I want to emphasize this point, I'm sure she didn't like that but she understood because of the foundation that we had established early on in terms of like, you need to be responsible for your life. So it wasn't a shock for her when we said "You need to work." It was something that is, you know, the same thing she heard before in her life. So this is important because sometimes, some parents when kids are struggling with depression and anxiety then they say, "OK, now, we know need to actually get them off and we don't need to ask them for anything" and that's the worst thing we can do.

Casey: Right.

Noha: So she is a productive human being. Right now she is working to support herself. She has not decided to go back to, I personally, as a parent, I'm waiting for the day that she calls me and says "Mom I decided to go back to school" because I think it, to me, education is very important but she, for us, she's not in that particular vision right now, which is fine.

Casey: Right.

Noha: As long as she is responsible for herself, I'm perfectly fine.

Casey: Noha, thank you so much for sharing that. I mean, I feel like parts of that story gave me kind of this pressure in my chest and little tears in my eyes because I mean, all I can think of is what a gift, you know, back to that conversation about your response, you know and recognizing, you know, what she needed and letting go of, you know, I'm thinking about my own experience as a teen and a college student and this idea of "Well, you have to finish, like, you have to do this" and the flip side is "You're ruining your life" and to not put any kind, which I don't believe, and but there was this expectation of, you know, no matter what is happening, you, you just have to finish this one, this "one thing" and so like and you had said in your, you know, at the very beginning about their personal journeys and I'm really hearing the way that you could recognize, there's, you know, there's the journey that you're on as the parent but there's, you know, it is separate from your daughter's journey and she's going to, you know, she's going to figure it out.

Noha: Exactly and I think it brings a lot of solace and relief for parents when they can actually conceptualize that separation and see it and believe in it. It's, I think, it's a very fundamental for our ability to empower our children, to be influential in their lives, to be able to guide them, you know, and help them and support them.

Casey: Yeah and it really allows for the message of, you know, we can say, we can use the language of, you know, "your life is yours and your decisions affect your life," we can use that language and I think parents do and how are we actually in action around that because when we're all hung up on, you know, "Why are you doing that?" and I think that there's some mixed messaging that shows up for parents too in their action versus what they're saying and I'm even, like, thinking to myself about, you know, my own, you know, that my own messiness around that, so I really appreciate that and when we were exchanging emails a few months ago, you mentioned, I loved your response, by the way, you mentioned two social changes that you believe are influencing the increased rate of depression and anxiety in youth and you know and this is inside the context, under the umbrella of just, like, culture in general right now, that is playing such a huge role but even beyond that or inside of that, that there's, you know, this phenomenon of parents who love and protect their children from life from a very young age, so there's that factor and then this social narrative that is focused on happiness.

So we're going to start first with the first one. So can you tease apart what you mean by parents who love and protect their children from life at a very, from a very young age, what does that mean to you?

Noha: OK, so I think the first time I was introduced to this concept was actually reading a book by Jane Nelson and Cheryl Erwin that actually is titled Parents Who Love Too Much and I don't think it's in print right now.

Casey: I think I have a copy of that maybe I'll read it too.

Noha: Yeah, so I just, I just really loved how they framed it, that and it's very important to frame it and I always say the sentence that parents love their children too much and sometimes this love can harm rather than actually empower and you know and you know, create a pathway of growth. It actually can suffocate and smother children and I'm seeing this nowadays and it's part of the cultural thing that we're experiencing right now and there's so many factors, it's very complicated but we'll just maybe touch on some.

So for example, my own opinion is that helicopter parenting is basically parents who love too much and they are smothering their children, they're not allowing them to do things on their own, to the degree that in the last, you know, few years, we started hearing about colleges establishing positions just to deal with the parents. Whereas before, it used to be the young man or the young woman they would handle their own college application on their own, they will communicate with the college, they knew that this was their responsibility but now with the helicopter parenting that's going on right now, you have parents who are actually interjecting and actually taking on that role, which leaves these young people believing that they are incapable, that they cannot do things, they cannot survive on their own and they need their parents or someone else there to actually be there all the time.

So this is one, you know, one kind of piece. The other piece is it's all about love. I think it has to do with living a life of ease and I'm not talking here about being rich or poor but I'm talking about our life in general is, especially in the US, is concerned, relatively speaking, an easy life. I mean, we're not struggling, for example to get water from the well or we're not worrying about electricity being cut, it's a life of ease so there is lots of, if you will, time on our hands as parents that we feel we have to dedicate to our children, meaning we're going to do more stuff for our children than we need to just because we have time and we're not worrying about, you know, other major, major things. That's one piece.

Another piece and I am praying no one will misunderstand me when I say this, there is a push in the last, you know, I would say 10-15 year, towards what people are calling attachment parenting. And attachment theory by itself is an extremely critical and foundational piece of psychology and counseling, so there is no questioning the understanding that every child needs to have a secure attachment to a caregiver. My issue is, with the over extension of that theory so that it becomes more of the helicopter parenting that we're seeing, they misunderstand it, misapply it and it means, in some situations, that the parent is just there all the time. And that's what, where, I feel that the smothering and the suffocation is happening and the child doesn't believe in his or her own abilities to stand in their own feet and it starts early, it begins very early.

So for me, the very clear example comes with, for example, sleep training. This sleep training is a big issue.

Casey: It is, oh my gosh,it makes me feel squirmy just talking about it.

Noha: Yes, so people who come from the attachment parenting perspective, they are completely against sleep training, completely and because what they say is "This is trauma for the child, we shouldn't allow the child to cry" and I want to emphasize that attachment theory does not say that. Attachment theory says the child is going to experience distress, and the goal is not to eliminate all distress but the goal in attachment theory is that the child will feel secure enough that most of the time and that the emphasis is on most, most of the time, he will be supported and he will be nurtured but there will be situations when the child will be on his own or her own and they will survive on his own or her own and they will learn that they are actually capable. So that's why the sleep training is an issue of contention.

Casey: Yeah, and it seems like, I mean, our conversation isn't about sleep training but I do want to say this, it seems like there's the, you know, when the conversation is around sleep training that there's, it's very either or.

Noha: Yeah.

Casey: There's no crying, you know or you know, just put in the earplugs, pour a glass of wine, go to the other side of the house and let them cry for as long as they need to before they pass out and then there is all this space in the middle.

Noha: Yes.

Casey: That is lost because people are hanging on to those extremes, right, so and I appreciate what you're saying about attachment parenting because I think, as my understanding of attachment has grown over the years, because I was, you know, when my kids were babies I loved my Dr Sears book, that was my first introduction to attachment parenting, I was a baby wearer, I was a co-sleeper, I was a nurser on demand and it was exhausting.

And I don't necessarily, I mean there would definitely be places where I would do things differently but I think at the core I am, I, you know, I am, I know that those things were useful to my kids and it's super personal, right, and as I learned about what attachment really is, it helps me get understand better, you know, the why's of babywearing, the why's of, you know, why I was choosing to nurse the way that I nursed or to sleep the way that worked for our family and it became less like "OK." You know, I think there's that extreme of child focused versus parents focused and there's again, it's, there's two ends of the spectrum and a lot of space in the middle around what works for for both humans.

Noha: Well said, especially this piece about child centred and parent centred. So, the one in the middle where we can, this is a big piece of positive discipline, the mutual respect piece, which is, "I'm going to respect my need as a parent and the needs of the situation. I'm also going to respect the needs of my child." So the balance between the two is critical and this is what is lost in, unfortunately, in parents who love and protect from an early age, because they are so child focused that they lose sight and let me say their child focused on the moment, they're not thinking long term, which is another positive discipline big piece, which is "What's the long term ramifications of what I'm doing right now in this moment?"

So, if me, by loving and protecting too much from my young age, I'm not empowering my child to believe in his or her abilities to face life, they're actually creating a very fragile young adult who will have a hard time dealing with life.

Casey: Yeah.

Noha: And unfortunately, I think this attitude toward leaning toward child centered parenting has led to the uptick, I think, and not all of it but some of it, to the uptick in the depression, anxiety that we're seeing in young people.

Casey: Yeah.

Noha: Because what is depression and anxiety? It's ultimately the difficulty in emotional regulation.

Casey: Right.

Noha: And to be able to do emotional regulation, children need to face distress. I'm not talking about abuse and trauma, this is not what I'm talking about, just so no one will misunderstand me but like, simple distresses of life, like going to school without homework and mom deciding "I'm not going to bring homework to your school. You will have to face your teacher" or going to school without lunch or are crying because mom is in the bathroom, for example.

Casey: She will come out.

Noha: She will come out, you know.

Casey: I love that. I think  that's so important. We get that, you know, what I recently said is, like, discomfort, that feeling of discomfort is and nervousness or worry is where resiliency is birthed and practiced and I like to think about resiliency as a muscle.

Noha: Yes.

Casey: Right and that has to be worked out to be a muscle that is useful. So what about, what about the societal narrative that's focused on happiness, what do you mean by that?

Noha: So, you know, different eras have their own different cultural messages. So, for example, during the Depression, the 1920s in the US, I mean the cultural narrative was not on being happy. It was on being, you know, we need to survive, we need to, you know, to persevere, we need to do our best, you know, but now, again, I'm going to bring again because we live a life of ease. And it's not about rich and poor, again. We, the cultural narrative is, you know, let's just be happy, you know, we have a right to be happy and I'm not saying nobody has a right to be happy but the just emphasis on happiness and everything that's attached to it because then we, how do we, what does happiness mean, right?

Casey: Yeah.

Noha: So the way we're presenting it right now, unfortunately, in our culture right now, it's attached to for example, for young people going to VIP school and getting a degree from there, OK, having a, you know, having a good degree. It's also having a lot of followers on social media, OK, you become very important and you are contributing if you have this account that everyone is, you know, into. Happiness is about following, you know, fashion designs and fashion trends and I'm cool and having the latest, you know, iPhone or the latest gadget so there isn't a lot of talk about just being authentic and real and down to earth and real and so the impact of social media on this narrative is big.

I'm going to also mention something else which is, in the nineties there was a shift in the medical field and I know this just because my husband is a doctor, it was the ship physician. So there was a shift in the medical field towards "We shouldn't allow patients to be, to experienced pain." So they implemented certain strategies so when patients come into the hospital, they will ask them rate your pain and if their pain as high then they immediately have to give them pain medications and that was the seed of the opioid epidemic that we have right now.

Casey: Yup.

Noha:  Everything is connected.

Casey: Yeah.

Noha: Everything is connected. So when, in the nineties, they're talking like the patient shouldn't feel any pain and I'm not talking, again, I don't want people to misunderstand me, but like the overdoing of things results in actually problems, so like, we're not allowed the body, we're not going to allow the body to produce its own endorphins to fight the pain, we are going to give pain killers and again, talking back to the muscle that you were talking about, when we do that, then there is no muscle that is, you know, being developed, no muscle to, you know, deal with pain and you end up with people and we've seen it, it's happening, people who can't really face pain and that's why we end up with this epidemic and now in the medical field, they're actually going back and changing their strategies, so they're being much more strict about dispensing pain medication, just because of the epidemic we ended up with.

So I see the two parallel, whether in psychology, in terms of like focusing on happiness that is not real, or in the medical field where we're focusing on not, you know, dealing or facing with pain. I see them as the same. It's all about pain, avoiding emotional pain or avoiding, you know, physical pain.

Casey: And do you think there's, like, you know because as I'm listening I feel like too there's this value placed on different emotions, right, like happy, there is a high value to "My kids are happy," right and it kind of eliminates or ignores the fact that the human experience is a kaleidoscope of emotions.

Noha: Yes.

Casey: And so I've actually been called out by my daughter.

Noha: Interesting.

Casey: Yeah, like, you just want me to be happy all the time. And I'm like, "Oh, thank you for that" and I think that that is, you know, I think it's one, for my own personal experience really important to listen and to hear what she's saying and to do my own soul searching and recognize, you know, versus "What are you talking about? That's not true." You know, like, we can get defensive because we are humans, even if we're moms and dads, so recognizing when defensiveness shows up, letting it go and really hearing from them what they're experiencing of us and getting curious about that but-

Noha: Beautiful and if I may add one more piece to this too.

Casey: Yes.

Noha: Also in the eighties, there was this self-esteem movement which was, we're just going to, you know, build the self-esteem of our children by giving them praise.

Casey: Everybody gets a medal.

Noha: Exactly and everybody is told "Oh, you're good, you're good" I mean and P.D. we distinguish between praise and encouragement which is a huge shift in dynamic and paradigm so part of the self-esteem movement, not part of it, but another parallel thing that I'm recognizing that happened and in the US, also, we emphasize a lot of emotions and we emphasize introducing our children to different emotions, however I don't think we do enough in terms of training our children or teaching our children that their emotions are their own responsibility. It doesn't mean we're going to abandon them, no, we're going to be next to them supporting them and so on, but fixing or changing their emotions is on them, it's not on us adults and I think this big piece is really lost in translation and we need to bring it into focus and emphasize it to everybody.

Casey: Yeah, well and I think it speaks into the parent's resiliency, right, because it's so uncomfortable when our kids are having a hard time that it's, you know, it's "easier" to swoop in to help them feel better and then we feel better, so we, and there's no doubt that everyone that's listening, you know, that the assumption here is we all deeply love our kids.

Noha: Absolutely.

Casey: So we do things in the name of love, though, that are not necessarily as helpful as we  think think they are.

Noha: Unfortunately and I think with awareness and this is another view, which is a beautiful piece of PD is recognizing the long term lens.

Casey: Yeah.

Noha: I know that with more awareness parents will understand, just like what happened with me, honestly, you know, before doing the parenting class I had no clue, I wasn't aware and then, oh my god, a light bulb, you know, lit in my mind and then I shifted in how I did things and it's beautiful, amazing.

Casey: So I know that people are listening right now that are hearing all of this and probably thinking "OK, this is great background, thank you for helping me understand where I'm coming from or you know the societal impacts and the history" and they're sitting with "But now I have a teen who's exhibiting signs of depression and anxiety, what should I do?" Right, so now all of those things, "OK and here I am in my household navigating this." Where would you, like, what's a first place to start?

Noha: Definitely the gut feeling thing that we talked about. I'm going to really, really emphasize this. So if there is like a nagging, small tiny voice within you is saying to yourself "Something isn't right" I would really not dismiss it, I would actually sit down and tell my teenager, "I am not sure what's going on, I just feel that there is something wrong going on and ideally want you to know that I love you and I want to help you" and I would even suggest, you know, if that gut feeling is there that I would say to my teen, "We need to go and see a counsellor. It  doesn't mean anything is wrong with you but it just means I want to make sure you have all the help and the resources that, you know, you will need to handle what it is going on."

I mean, sometimes, you know, our teenagers, when we tell them we just feel something isn't right, they actually open up and talk. Sometimes.

Casey: Righ.

Noha: Sometimes they don't.

Casey: And they might open up and talk and say, you know "I'm OK, I'm just dealing with some stuff", you know, I think that's important to emphasize too because I know in my own experience that I can very easily go into panic mode. It's my own personal life work.

Noha: As a parent you will go into panic mode.

Casey: Right and so perhaps there are, you know, and the teen years I was just actually working on, I'm having a whole conversation about brain development during this summit and you know, part of the experience of teenagers is, some you know, some moodiness. There's the stress and anxiety that is normal.

Noha: Normal.

Casey: Or even, you know, motivating to some extent.

Noha: It's true.

Casey: And then there's like, what we're talking about here, where it's like, "OK. This is beyond you and me and we're going to look for some help."

Noha: Yes and I think one key to distinguish between normal and maybe now we're moving into more serious issues is the timeframe. So normal would be something like "Oh, it happens," like, for example, for depression, like it's less than 2 weeks. OK, it's not persistent, it's not every day.

Casey: OK.

Noha: This would be normal, OK. If we're going into an area where it's happening every day and we're seeing multiple symptoms that, you know, indicate depression and they're happening every day and it's been, you know, 2 weeks and also impairment of function. This is very important whenever we're talking about mental health. It's a key diagnostic factor, is there an impairment of function and the function will depend on the age, for example, of the person. So is there an impairment of function at work or at home and social, you know, social circles at school. There has to be some kind of impairment of function in order for us to say "OK, something serious is happening here."

Casey: So is that like, withdrawing from peers.

Noha: For example.

Casey: OK.

Noha: For example because that is not normal for a teenager.

Casey: Right.

Noha: So that would be impairment in social settings, for example.

Case: OK.

Noha: Or it could be that we're beginning to miss school, in addition to also symptoms, other symptoms and for depression specifically, the two key ones are in nagging persistent feelings of sadness and loss of pleasure and in addition to a strong feeling of guilt and worthlessness. This is so and this is, I'm talking about the major depressive episodes, because under the depression we have, like, I think 8 different conditions and they vary in their severity so there are some that are not as severe as the one I'm describing right now. But this is, you know, what you mentioned in terms of, like, there is normal depression or normal anxiety that is part of everyday life that everybody experiences and that's why maybe visiting a therapist, a counsellor, a psychologist, the psychiatrist will tease out "Is this normal or is not normal" so if we go back to the gut feeling, if the gut feeling of the parents is saying "Something is not right," I would just encourage the parent just please go and take some, you know, action.

Casey: So when I was in in the depths of this with my daughter and I remember the first time I said "Hey, you know why don't we go out and I make you an appointment with a counselor" and she looked at me like I was crazy. She said, she said, "No way, not doing that" and the good news was, even though there was a lot going on with her that she wasn't sharing with me, I still experienced a thread of connection with her, even as it was so hard and like, I mean, you know, it was really, really rough there for awhile and then finally, you know and I would bring it up and I would bring it up and she would say no, and it's funny, Noha, I don't know if you ever had this experience with your kids but there are times when I think to myself, so, let me play this out in my mind. Would I be willing to literally drag you to the car and strap you in, like, and then of course the answer is "No, no I wouldn't" and so, as I'm sure people are listening, when our kids are very resistant or reluctant to for that initial intake, what are some, how do you, I mean, for me, I just kept asking and-

Noha: Yes, yeah.

Casey: And then she did finally said, "Yeah, OK." We only made about 4 sessions and she said "You know, I think I'm good," which was like, "Okay." And then for us it was finding a different modality. For us it was, you know, I go see a Reiki energy worker and that is my choice of therapy and it's actually been really useful for Rowan so.

Noha: So you're trying different things.

Casey; Yes.

Noha: I mean, that's key, that's really key, trying different things and I'm going to also emphasize, find a different therapist because-

Casey: Yes.

Noha: I was at the other day, someone called me and like "How do I know which therapist to choose?" and I responded, I said, it's not about what degree they have, it's not about what credentials and what it is about your comfort and your willingness to be open with the person. So that's why you need to go in the room with this therapist, try it, experience it, if it doesn't work out for you, there's nothing wrong with that, just you need to go and try another therapist until you find someone that you click with, because this is part of the complexity of humanity, these are things you cannot explain by logic, it's felt and therapy works. Success in therapy is dependent on the relationship.

Casey: Yes.

Noha: Much more than what technique or what theory is the therapist using. So I second what you're saying when our teens are resisting, we just have to keep mentioning, "OK, I'm seeing that you're really struggling right now. I, you know, I'm going to mention again but I think it's important that we go to counselling." They say yes, they say no, we drop it, after, you know, a bit, we mention it again. So we keep mentioning it because, as you said, we're not going to be able to drag them, they're teenagers right now.

Casey: One of the other things that I remember saying a lot is, you know, I'm counting the red flags, you know, that was something I would say, I would be explicit in my own experience of what she was going through. So I'm seeing this and I'm seeing this and I'm seeing this, I just wanting you to know that as these red flags show up, you know, we are going to move towards finding support, right and just so, being and I think that, as I say that, also, you know, putting into light her experience for her. Oh yeah, those kind of are.  Even though she's the one that's feeling the way she's feeling, helping her lift up and out of it and seeing it from, with perspective, like, "Oh yeah, that is happening and that is happening and that is happening and maybe we should"

Noha: Yes.

Casey: Maybe this is a good idea.

Noha: What you just said is so important, Casey, because our teenagers are still maturing, their brains are still developing, I mean, according to some studies their brains do not fully mature, if we can use the word mature until after 25 years of age. So they're still in the process of developing connections, especially in the prefrontal cortex, and so yes they need to mirror back to them what we are seeing because it will resonate with them because they're experiencing it, but they didn't put a name to it and without really naming it and without being aware of it, then they can't do anything about it because it's in their unconscious.

So this step of you mirroring that, counting the red flags, mentioning them to her and it's not about trying to convince her, if she says "No, I'm not, you know, doing this or that" We don't need to go into argument, we're just going to say, "OK, this was simply my observation." So no need to-

Casey: Right and well that leads me right into, so you had shared with me a few thoughts that I thought were so powerful and I just want to highlight them here, which, and the very first one is you said "Know that it's not your job to fix the Depression or the anxiety. This is the job of the young person, your job is to invite them to seek therapy, be supportive, stop nagging." Noted. "And empower the teen to face life"

Noha: Yes.

Casey: Again, I'm thinking "Oh but it's so uncomfortable for me to not want to fix it."

Noha: Yes, yes and especially as parents and especially, I'll add one more thing, especially because we know what can be done to fix the situation. OK, it's not like we don't know the solution. We know the solution. We're going to go to therapy, we're going to go do exercise, we're going to eat healthy food, we know all that, but because it is their own personal journey and they are the ones who need to, you know, they are the ones who are responsible for for their life. We need to also respect, that we need to let go without abandoning them, I'm emphasizing this, it's not about abandoning them.

Casey: Right and I'm also thinking of the flip side, yes, we know what would help, but also we know, like, the worst case scenario.

Noha: Interesting. Yeah.

Casey: And I think that percolates into our consciousness and then we're really messed up because we're like, you know, immediately dead in a ditch.

Noha: No, you're right, especially with the uptick in suicide rates, I mean, it's just so sad. Especially also some celebrities who have committed suicide in 2018 it just brings the whole issue to the forefront and you're right, it's very scary but one thing that definitely we can do is to maintain that connection even though when they are disconnecting from us. Like your teen is living with you at home, so there is opportunities for connection, even though I know they tend to isolate because this is one thing that happens, especially with depression is individuals, they become recluse, don't want to deal with anyone, so just using whatever moments are there in the day so we can connect, like giving a hug without saying anything. Just, I don't know, just you, know making sure when they're sitting eating breakfast we sit, for example, next to them and you know, say something about our day or whatever, just to try and connect on so many different levels it's so important.

I know when my daughter was in college she would go days missing in action. And I made it a point, I will call and leave a message and I would leave a voice message because it was important for me that I would let her hear my voice. So I would leave voice messages, even though she's not going to respond to, I knew that, but that wasn't the goal.

Casey: I like that.

Noha: Yeah, maintaining that connection even when they're not connecting is very powerful.

Casey: Letting go of the attachment to how they respond, I think is another piece of lifelong journey for those of us that are parents. So the other, one of the other things you mentioned was inviting our kids to engage in new activities. I love that you said that and I'm, you know and I feel like this has kind of been, for me, any time my kids have shown interest in something I get really excited and I think they found their thing and then they're like "Nah, I'm good, let me try something else and what's been really fun, just in the last few months, has been watching my daughter pick up instruments again and play and ask for different things "Hey can I get some water colors?"

Noha: Whoah.

asey: Yeah and it's been so and again, back to attachment, right, I get to let go of, "Oh, maybe painting's her thing or maybe this" and I just get to hold awesome, you know, for however long she's exploring this.

Noha: Exactly, exactly.

Casey: And it's just been really exciting to also, you know, see her experience different outlets beyond snapchat, Instagram, the outlets that I know aren't necessarily giving back to her.

Noha: Yes, yes.

Casey: So I really appreciate that too.

Noha: I love that piece because teens, as part of their development and maturation, they need to experience different things, so not to be hung up on the idea it needs to be permanent, that it's OK for them to try something and then drop it. Beautiful, beautiful invitation for parents. It's so powerful. Thank you, Casey.

Casey: Yeah, well, thank you. One of the other things was "Don't do for your teen what he or she can do for themselves. Expect them to take care of themselves and their lives" and you talked about that in sharing about your daughter as well. I think we see them down, we see them struggling and we don't, you know, there's this idea that expecting them to have responsibility is somehow adding to the weight.

Noha: Yes, when actually it's the opposite, to pull them out of anxiety and depression they need to see themselves as capable and doing something, doing something that has actually and like, I know it sounds like very silly, but for example, like, doing their laundry, like, there is a sense of achievement or I'm going to use, or accomplishment when someone does a task and it actually ends. And we're not getting that sense from being digital. Like Facebook is always going on. Instagram is always going on.

You don't reach a point of like, "OK, the task is done." So that loss of, like, "I accomplished something is actually, I think, adding to the existential angst that our teens are going through and I really believe the piece is also contributing to the uptick in depression and anxiety. . Unfortunately, I'm not, I am not an enemy of social media. I think it has brought so many beautiful things into our lives, it has brought so many connections in our lives. At the same time, it has brought a lot of anguish because there are no limits now.

So for example when a tragedy would happen, for example, a tragedy would happen somewhere in the world, OK, everybody in the whole world now immediately knows about it, versus, and instantaneously, and you see the pictures and you see the videos. Versus, before, it used to be, like, you would read about it in the newspaper and you would see some pictures but not, so now we are right now bombarded by endless news.

Casey: News and opinion. We don't have to go down that rabbit hole, but I mean, yeah. I love that idea around a task with it an end point. And then the final thing that you mentioned and I think this is so important and I want every listener, if you're doing your own task right now while listening to stop and really hear this, which is "stop trying to convince your teen that somehow they have, their thinking is wrong." And talk a little bit about what you mean, because this is, I actually spoke about, I took, I spoke a little bit about this in my podcast that I did about, you know, my own daughter and how the naturopath that we had gone to really called me out. Because it makes sense to say "Well, can't you see how this logic isn't logical?" And it wasn't, it's not useful so you say, you know, listen and ask what can you do, how can you change the situation, what do you want, so again, I'm feeling that like handing over of responsibility.

Noha: Yes, yes, it's very important because our teens are going through their own perceptions and their own beliefs about the world and they need to discover it for their own and we don't know when it's going to happen, when an idea that makes sense to you is going to make sense to them, you know, if ever. Maybe it's not never going to make sense to them-

Casey: No, don't say that.

Noha: It depends, yeah, so but the idea is what happens is when we're trying to really go into logic to convince them that their idea is wrong or their thinking is faulty, is we end up shifting from just being with them to being against them. And then the emotions come up and then the connection is lost. So, for me, I think it's more important for the parents to focus on the connection and I don't mean by that being permissive and just not expecting them to carry their weight, that's not what I mean.

Casey: Oh yeah, just talked a lot about that the difference there in some of the other interviews so listeners, make sure to listen to all the interviews.

Noha: Yeah, so but I'm talking about just being with them where where they're at. And that's what the therapist, by the way, does, when I have a client, I don't sit and you know, start, you know, shooting down all of their arguments. I stay with them, I listen to them, I sometimes ask questions back, when they respond to the question they start seeing, maybe shifting or start seeing things differently. So, yes, just being and listening and asking the questions that you mentioned, "How can I help? What can I do to help you and support you?" and "I love you" is much more powerful.

Casey: Noha, I could talk for two more hours with you. There's so much and I recognize there are so many layers to this. It's such a privilege to be in conversation with you, thank you for your contribution to this summit.

Noha: Thank you.

Casey: Yeah, if there are parents listening who want to get in touch with you, where can they find you?

Noha: So I have a website, it's called, so there is a contact, you know, if anyone wanted to contact me.

Casey: Perfect. Great, thank you so much.

Noha: Good luck, Casey, and thank you for taking the time and the effort to put the summit. I'm very excited to listen to it once it's out there in the world.