My Quest Hub
Time to Talk February 2023
Nazihah is a Quest trained therapist, working for Grow Therapeutic Coaching, She works with young people aged 11 to 18 in schools, as well as seeing private clients of all ages,
During her psychology degree Nazihah discovered just how much unmet need there is for those suffering with mental health disorders. Consequently after graduating, she studied Cognitive Behavioural Therapy and Coaching at the University of Oxford before deciding to study Cognitive Hypnotherapy at The Quest Institute. Since then, she has built up her private practice and joined Grow Therapeutic Coaching.
The 2nd February 2023 is Time to Talk Day
Talking to young people about their mental health: How and why
We all know talking about mental health is important and something we should be doing. But where do you start and how do you get it right?
The consequences of not speaking about mental health, especially for young people, can be detrimental and limit their ability to manage their own wellbeing. How to speak about mental health to anyone can be daunting, but it is the difference that makes the difference to everyone involved. In order to provide anecdotal evidence, I have interviewed young people who suffer from poor mental health and with their permission have included their responses anonymously.
Consequences of not speaking about mental health especially for young people: Belonging
A key part of growing up involves searching, at both a conscious and unconscious level, for your place in the world. At some point or another we consider the following – “where do I fit in the grand scheme of things?”, “how do I fit into the world?” and essentially “do I belong?” Growing up is hard enough with all the questions of identity. Add to that a mental health struggle and young people can be left feeling even more isolated and further questioning their belonging/place in the world. Having worked with young people, it is clear that there is a correlation between how well a young person is able to manage their wellbeing and how appropriately their mental health is discussed with them. As it is during adolescence that our sense of self develops through self-discovery, feeling that mental health cannot be discussed easily during that period can be very harmful and potentially have detrimental long-term effects on self-esteem and identity.
Brene Brown says “belonging is the innate human desire to be part of something larger than us”, describing belonging as a “fundamental human need” and so forms a crucial part of wellness. This desire to belong is deeply rooted in our biology and evolution, deriving from the need to be part of a group that would protect us and support us against threats and dangers, such as other hostile clans or predators. If we imagine here school, home, social media, etc we can see how scary the world can be for young people to navigate. The common phrase ‘there is strength in numbers’ comes to mind. This instinct is ingrained in us and is an essential part of who we are as human beings as it ensures survival and security. So, for young people, a threat to their sense of belonging can be felt as though it is a threat to their survival, at an unconscious and biological level.
Teenagers are notoriously known for going through different phases and falling victim to peer pressure. The desire to belong and “to be like others” is so powerful that they often act in ways that sacrifice their own sense of right or wrong, their values or what they truly believe in, just to fit in. Many parents report that “they care more about fitting in with their friends than us.”
So how does this relate to talking about mental health?
Neglecting the ’mental health conversation’ only reinforces the notion that those with mental health difficulties are different and do not belong, resulting in young people trying to hide or deny their issues and consequently feel isolated. This adds another layer on top of their problem, resulting often in low self-esteem and self-doubt which can fester and stay with them through into their adult lives. During their teens, many seek to experience things that make them feel more alive and they become more likely to engage in risky behaviour. If this period coincides with mental health difficulties, this can result in trying to cope with difficult feelings through self-harming behaviours and self-medicating via drink and drugs. By providing support and acceptance we can help them to feel more comfortable with themselves and confident in addressing these challenges.
How much better would it be if a young person knew that they are still accepted and still belong despite their mental health condition? That talking about mental health does not pose a threat of any sort? To know that their struggles do not make them alien or different? That they do not need to fear speaking about it and most of all they are still loved and accepted?
So now we know the dangers of not talking about mental health. Let’s think about how to talk about mental health.
How parents and teachers can help a child struggling with poor mental health?
Traditionally, talking about mental health goes hand in hand with diagnosis and medication. The medical model largely puts people into categories of anxiety, anger, low mood etc. Whilst there is no denying the benefits of having a clear-cut diagnosis, unfortunately many people do not fit neatly into these categories. This can lead to people getting less effective treatment, becoming misinformed about their illness and essentially feeling helpless and alone.
Quest Cognitive Hypnotherapy understands that everyone “does their problem differently”. This means that two people who have anxiety can have two completely different experiences. One person can have a panic attack and overwhelming thoughts and one can dissociate and self harm. According to medical classifications, treatment for both of these people would most likely be the same (CBT and/or SSRi medication), despite how different their symptoms present.
A personalised intervention is required…
In my practice I like to pinpoint exactly how each client experiences their “problem pattern”. I’d like to know what happens, when, how, for how long and where. For example instead of “I have anxiety about swimming” I’d ask questions to ensure I get a list like this – “when I hear the words swimming pool my stomach starts turning, I get this tight feeling in my chest, I start seeing myself drowning in the pool, I start thinking about the fact my legs will seize up when I’m in the water and how quickly I will drown, I can smell the chlorine and all I can think about is if the water touches me I’m in danger”. Clients report that just me probing for the very specific details of the problem is in itself so relieving. They feel heard, understood and less overwhelmed as a result. Not only this but the problem starts to become more digestible, rather than a huge, overwhelming, confused bundle of emotion, There is a beginning, middle and end with clear elements that make up the problem (see how you can use this technique during the mental health conversation below).
So when you hear “it’s time to talk about mental health” it’s not as simple as discussing a diagnosis, a box or a label – there’s so much to talk about and explore. As Aldophs and Anderson explain in their book, “The Neuroscience of Emotions”, emotions are one of the most apparent and important aspects of our lives, yet have remained one of the most enigmatic to explain scientifically.
We often believe that we understand others and see them for who they are, but this is our own interpretation and we are failing to recognise everyone’s unique experience. As Scott Killoby writes in his book “The Unfindable Inquiry” the idea that we see the world and the people in it objectively is very much just an illusion of reality. You are never really seeing another person exactly as he or she really is, your view of people is limited to what you think, feel and sense in the moment. You are seeing them through a ‘reality tunnel’ or lens that is made up of your personal experiences (memories, your personal history, your culture, your worldview, and your psychological and emotional traits along with various other influences).
This is so powerful and crucial to keep in mind during the mental health conversation. It’s so important to stay curious rather than assume that you already understand. Your neighbour’s experience of depression is not going to be the same as your cousin’s whose experience will not be the same as your daughter’s. “The greatest enemy of knowledge is not ignorance, it is the illusion of knowledge.” (Daniel J. Boorstin). With this in mind, it’s important to actively listen to what the other person is saying patiently, remaining curious about every detail of their experience. As best as you can, try to drop all preconceptions or beliefs about mental health or the diagnosis that may have been given and instead listen with a fresh outlook.
Perhaps try to really engage and empathise with their unique problem pattern. Questions you can ask to do this are:
- When does the problem (or the feeling) start?
- How long does it last for?
- How do you know when it’s stopped?
- What thoughts do you get?
- What images do you see?
- What feelings in the body come up?
- Is it always as intense every time it happens?
- Are sometimes better than other times?
- What makes it better sometimes over others?
If you sense that they want to open up more but are struggling, these questions are great conversation starters. The purpose here would not be to solve the problem but to just listen. It helps the child to really explain what’s happening for them and will most definitely contribute to their sense of being heard and validated. Bear in mind that these questions are quite probing and the young person may not want to disclose all of this straight away, or at all.
When interviewing young people for the purpose of writing this article, most of them felt that their parents thought they knew more than they really did about mental health. In particular they agreed that they wish their parents would understand that a mental health problem is completely different from one person to the next. That’s why asking young people the details of their problem and understanding that their experience is unique to them is so valuable. Many reported that their parents compared them to other people with the same diagnosis, which was invalidating and unhelpful. Parents often say “so and so has anxiety but still does x so why can’t you?” Consequently, this led them to feel like they couldn’t open up to their parents for fear of being judged.
One of the most important things to remember when having these conversations is to be non-judgmental, empathetic and try to drop all assumptions and personal beliefs about mental health. Avoid using language that stigmatises or belittles mental illness. Here are a few examples of language that should be avoided, but all of which young people have personally been told and found particularly dismissive and hurtful:
- “You’re just being dramatic.”
- “You’re just lazy.”
- “It’s all in your head.”
- “You’re overreacting”
- “Calm down”
- “Just snap out of it.
- “Other people have it worse than you”
Some helpful phrases that you could use instead are:
- “I’m here to listen if you want to talk about what you’re feeling.”
- “It sounds like you’re going through a really tough time right now.”
- “It’s not always easy to talk about mental health issues, but it’s important to seek help when you need it.”
- I might not understand exactly what you’re going through but I want to listen to you and really hear you out”
- “You are not alone”
Language like this is validating and empathising, which helps a young person to feel comfortable in opening up. Keep in mind that they are most likely going to be nervous, worried and possibly even embarrassed, so the way you receive their words will also have a direct impact.
It’s also important to create a safe and supportive physical environment. This might mean finding a quiet, private place to talk or setting aside a specific time to have the conversation when there will be minimal distractions or interruptions. Also let them know that you will maintain confidentiality (only if you’re sure you really will and make the exceptions to confidentiality clear e.g. safeguarding concerns).
When starting the conversation, try to use open-ended questions to encourage the person to share their thoughts and feelings. Some examples might include:
- “How are you feeling lately?”
- “Is there anything you would like to talk about?”
- “Is everything okay?”
If they are hesitant to talk, offer support and reassurance. Let them know that you are there to listen, and that you are not judging them. Try to avoid adding pressure and saying things like “you have to talk about it”. The conversation won’t be productive if done by force. Instead, offer some resources or information about mental health, such as helplines (listed below). Always let them know that if they change their mind and decide they want to have a chat, the offer still stands.
Some common themes that emerged when interviewing young people was that they often feel that they cannot meet the expectations that are set out for them by teachers, parents, family and sometimes friends. This results in them feeling like a failure and that they have let others down. Furthermore, young people would like adults to understand that going through mental health struggles can cause exhaustion and a lot of the time it is difficult to relax and calm your mind enough to go to sleep.
Many young people reported that parents believe mental health “doesn’t happen to young people” and expressed the desire for their parents/caregivers to understand that just because it is not always tangible or visible, it does not mean it does not exist.
In addition, many students said their parents had a fixed perception of the “answer to mental health” which was not very helpful. They explained that their parents were not open to other more helpful ideas or solutions. They expressed their desire for their parents to be more open minded about mental health and to be aware that it’s not even fully understood by experts yet.
Young people expressed that they wished teachers and parents understood their behaviour better too. When struggling with mental health problems you often need to do things slightly differently, for example taking five minutes out of class to self-regulate during an anxiety attack or sudden bursts of anger. However this can often be interpreted as time wasting or being dramatic, leading to the young person being told to ‘just calm down’, which can in fact lead to a higher level of anxiety due to not being heard or their feelings being validated; similar scenarios can also take place at home with parents. Young people expressed that dealing with poor mental health is hard enough as it is and trying to regulate in those difficult moments is actually extremely challenging; being critical of or preventing self-regulation attempts during this time often results in the problem becoming much worse.
Young people are in desperate need of more compassion, understanding and validation around their mental health struggles – none of us have a true idea about somebody’s experience until we really talk to them about it effectively. A natural, human response is to use our own experiences as a reference point to understanding others, which is one of the biggest obstacles to really validating, understanding and hearing someone.
All those that I interviewed were in agreement that although growing up with mental health difficulties can be extremely difficult and that the environment today presents many more challenges, with effective support and open conversations, it’s a lot easier to cope. Talking about mental health can be uncomfortable, especially for those who have never done it before, but with the right approach and a little bit of preparation, anyone can have an open and honest conversation. By showing support and understanding, you can make it easier for people to seek help when they need it.
Kiloby, S. (2017) The unfindable inquiry: One simple tool to overcome feelings of unworthiness and find inner peace. Oakland, CA: Non-Duality.
Adolphs, R. and Anderson, D.J. (2018) The Neuroscience of Emotion: A New Synthesis. Princeton: Princeton University Press.
Brown, B. (2019) Braving the wilderness: The quest for true belonging and the courage to stand alone. New York: Random House.