Body Image: Video-to-Share

With over a half-a-million teens estimated to have an eating disorder or disordered eating, anytime a public persona can break through the constant barrage of airbrushed media imagery to tell adolescents that how they look is more "normal" than a photo-shopped picture is worth sharing.  Take a look at a recent interview with Jennifer Lawrence:

Follow-Up: Eating Disorders in Boys

Last February, I wrote about the rise in eating disorders amongst boys, and how they can often go undiagnosed and untreated because they are most often associated with girls.

This past week, a story aired on NPR that shared the story of a boy struggling with bulimia.  Take a look at the video below:



The story goes on to highlight the differences in eating disorders between boys and girls:

• Boys and men tend to be more focused on getting lean and muscular versus girls who are often focused on becoming "skinny"
• Boys and men with eating disorders tend to have a history of being overweight versus girls who are typically thin to begin with

The similarities in both boys and girls are:

• There can be a history of perfectionism, obsessive and compulsive behaviors, and or other mental health disorders such as depression
• Very often there are some environmental stressors that trigger the eating disorder

Most treatment programs are geared towards women and girls, and so boys who enter them often feel isolated.  That is changing as more and more clinicians and medical professionals are recognizing that eating disorders are effecting boys and men in addition to girls and women.  It is important that as you share information and education about eating disorders with students and families that you make sure to include boys in your programming.  It is possible that large amounts of food being consumed by a teenage boy is simply indicative of a growth spurt, but if combined with some other risk factors, there may be some reason for concern.

For the full NPR story, click on this link.

Teen Depression from a Teen's Perspective

According to the National Institute of Mental Health, 11% of adolescents will be diagnosed with a depressive disorder by the time they reach 18 years of age.

I came across this Ted Talk that looks at this topic from the perspective of a teen who has dealt with depression throughout his life.  He describes what it is and isn't, and what it feels like to him.  The statement that struck a chord with me, though, was when he speaks to the fact that as a society, we would treat physical illness in children and teens with the utmost sense of urgency, not resting until we had made the kid well.  However, with mental illness like depression, we can have a tendency to blame rather than support the person afflicted.

For more information, watch the full video below:

School Violence and Resiliency

In the last few weeks, another school-violence plot was uncovered and thankfully stopped in Albany, Oregon.  As with any of these incidents, there are always a lot of questions raised: Why?  What warning signs were there?  How can we prevent things like this from happening in the future?

As school counselors, we are often looked to for answers to these questions in an effort to help try to make sense of what seems unthinkable, and to reassure communities that schools are safe places for students and staff.  I was able to discuss this topic this past Wednesday on KGAL Talk Radio (starts at 37:38), a station based in Albany, Oregon, where this latest incident occurred.  One of the main questions the program host had for me was, "What are the warning signs?"  The Centers for Disease Control and Prevention (CDC), has a list of risk factors for youth violence.  It is important to note that just because a student may be exhibiting or experiencing some of these risk factors does not necessarily mean that they are going to commit an act of violence--correlation and causation are not the same thing.  A few of them are:

• History of victimization
• Substance use and misuse
• History of emotional distress/mental health concerns
• Exposure to family violence
• Antisocial beliefs (spoken, written, posted online)
• Poor family functioning
• Low parental involvement
• Inconsistent, extreme, or relaxed discipline standards at home
• Social rejection amongst peers
• Membership in a delinquent or anti-social peer group
• Lack of involvement in school or community activities
• Poor academic and school performance 

source: www.cdc.gov

Does this mean that every child that has one or more of these risk-factors is planning to do harm?  Of course not.  However, as school counselors we deal with that list every day at all levels, elementary through high-school.  If a child is not having success with peers at school, we develop friendship and social-skills groups to help them build connections with other students.  We might also work with students on finding some club or activity they can participate in that would increase their connection to the school and community.  Meanwhile, we are educating our whole schools about bullying, the roles of bullying (including that of the bystander), the consequences of bullying, and how to report bullying, all in an attempt to lessen student victimization and isolation as well as increasing empathy amongst our populations.  If students are not finding success at school, we help teach study and organization skills.  We work to build relationships between teachers and students to improve communication and therefore, academic success.  If a child is struggling with mental illness, we work with the family and additional support personnel such as a school psychologist or social worker, connecting them to resources within and outside of the school to give them the help they need.  Our relationship with the families of our students can often allow us to help strengthen the connection between students and parents if they are going through a particularly difficult time together.  The very nature of our role within schools is to support all of our students, and we are uniquely qualified to help address the risk factors presented here.  Further, in my interview, one of the things that I felt was most important about this latest incident in Albany, OR, was that it was prevented.  The student in question made statements that were concerning, and ultimately someone reported this to the authorities.  Again, because our role in schools is ideally a non-punitive one, we work hard to establish relationships with all of the students on our case-loads so that they feel comfortable talking to at least one adult within building.

Beyond addressing individual risk factors, school counselors can also help to develop resiliency skills in children.  What is this, exactly?  Basically, we are teaching skills and strategies that help children develop protective factors and build coping mechanisms so that as challenges inevitably arise throughout their lives, they are more able to deal with them successfully.  By teaching these concepts, you are giving them a "toolbox" that they can open when the road gets bumpy, even if there is no one else around to give them support.  Fairfax County Public Schools in Fairfax County, Virginia, has developed a resiliency program, based upon work by Henderson and Milstein.  There are six components:

• Increase pro-social bonding
• Set clear, consistent boundaries
• Teach life skills
• Provide caring and support
• Set and communicate high-expectations
• Provide opportunities for meaningful participation

source: www.fcps.edu

If we look at these six components in more detail, school counselors are highly qualified to teach students skills, help them practice these skills, and then assist them with applying them to their own lives.  As stated before, we teach lessons and develop groups to help students develop appropriate social skills.  We teach children coping skills.  We are able to provide support to not only students, but also to families, teachers, and school personnel.  Through goal setting and post-secondary planning, we are helping to communicate high-expectations but also giving them the steps to reach these expectations.  Finally, though our lessons and groups, as well as by connecting them to activities, clubs, and groups, we are helping students to find ways to share their unique thoughts and talents in a meaningful way with their communities.  For more information and additional resources that you can use to help build resiliency in your own students, click on the links presented above.  

However, as I spoke about in my radio interview, to be able to form trusting relationships with students and families, to be able to develop and implement interventions that address possible risk factors, and to build resiliency in all students, we need to have school counselors present in every school, and we need to have reasonable ratios.  The American School Counselor Association (ASCA) recommends a ratio of 1:250.  Yet, Oregon, where this latest incident occurred, stands at 1:553.  More extreme situations exist in states like California, where the ratio sits at 1:1016, or in the city of Philadelphia, which has just enacted a school budget that will cut school counselors, in addition to arts programs, librarians, and athletics--programs that can help decrease isolation and increase connections between students and schools.  Given the opportunity, we are capable of doing so much to create safe and welcoming environments for all students, as well as develop supportive interventions for students who are struggling.

Safe at School: Feedback Needed

The American School Counselor Association, the National Association of School Psychologists, and the School Social Work Association of America are partnering with the Gay, Lesbian, and Straight Education Network (GLSEN) to gather important information about the climate of our schools and the preparation of school-based mental health and academic support personnel.  If you are not familiar with GLSEN, they are one of the leading organizations assisting schools in supporting the needs of sexual and gender minority youth.  Beyond this, they have a wealth of resources and curriculum to support educators and students in building safe and inclusive educational environments for all, and are strong advocates for creating bully-free schools.

Additionally, GLSEN does an amazing amount of research, examining everything from school climate as it relates to LGBT youth to the specific experiences of LGBT students of color.  One of their next projects is to examine the pre-professional and professional training of school counselors, school psychologists, and school social-workers with regards to creating safe and supportive environments for all students.  If you are a middle-school or high-school counselor, psychologist, or social-worker, please take 15 minutes and complete the survey at www.safeatschool.org.  The more school helping professionals that take this survey, the stronger the data will be and the better picture they will be able to paint of just where we stand in our profession with regards to this topic.

Please pass this survey on to the other mental health and academic support personnel in your building, and feel free to share this information through Facebook and Twitter.

Resource: To This Day

This video has been making the rounds, and for good reason.  Not only is its message one of importance, but it combines powerful poetry, beautiful imagery, and music to deliver a reflection on the long-term effects of bullying in its many forms.

Reflection: Crisis

As we all have been, I have been deeply saddened and shocked by the events of Friday morning.  As school counselors, we all tend to be fairly empathetic, and so my thoughts have constantly been turned to the parents of those children who have been lost, the families of those school staff members who died, and to the larger community of Newtown who will need support long after the media trucks and national focus have left as the depths of grief, loss, and trauma begin to manifest themselves in the months to come.

Many years ago, when I was still teaching, I was at a school where, for the first time, I had to go through a lockdown drill with my students.  In going through the procedures of covering my window and trying to keep 30 energetic 7th graders quiet as security came by to check that our door was locked, the thought flashed through my head, "What if this was real?"  Instinctually, I immediately knew that I would put the kids into the instrument storage closet (I taught this choir class in the band room) and would put myself outside if need be to protect those kids.  This was not a question I wrestled with, this was not something where I thought about all the possible consequences.  I knew what I would have to do in the breath of an instant.

Perhaps for this reason, I keep thinking the most about the principal and school psychologist who attempted to stop the gunman as well as the 1st grade teacher who hid her students and gave her own life to protect them.  When you go into education as a career, you do not necessarily think that you may have to give your life as part of your profession.  Yet, that is what the six adults who died on Friday did.  I think all of us who work in schools know that when it comes to the safety of our students, dare I say, "our kids", that chances are pretty high that we would do the same.  Our educational professionals have taken quite a few hits in the public arena in the last decade.  However, the vast, vast, vast majority of adults in schools that I have met in the last thirteen years are highly committed individuals who work excessively long hours, nights, and weekends, often making difficult choices between their own work and personal lives.  They are in education because they love kids, they love watching kids learn, and they love helping to facilitate that process.  They would do anything for their students, and I think we should take a moment to really acknowledge just what that could mean.

I have been inspired in the last several days by the school counseling community and their quick response with regards to sharing resources so that we all have support in working with our students, families, and school communities through this time.  The mother of all school counselor bloggers, Danielle Schultz, began to collect resources at School Counselor Blog and share them with her followers.  I am inspired by this, and believe that all of us who are school counseling bloggers have a responsibility, as collectors and sharers of information, to have these resources at hand to share with our followers whenever they are needed.  As such, I have created a page on my blog dedicated to crisis resources, and would love if other bloggers did the same, so that no matter where a school counseling professional turns, they find information to support them in their work talking to students, staff, and families in these difficult moments.  In this way, as school counselors we can continue to be prepared to lead in times of great challenge.

Transgender Kids: Inspiration and Advocacy

I am a little obsessed with NPR.  I listen to it in the car on the way to work, on the way home from work, and subscribe to multiple podcasts.  It is my secret dream to someday do something worthy of being interviewed on Fresh Air by Terry Gross.  However, my favorite hour of radio is Tell Me More, a program that seeks to explore modern life, issues, and news from a multi-cultural perspective, and multi-cultural from the broadest possible lens.  Not coincidentally, it is also my secret dream to do something worthy of being interviewed by Michel Martin, the host.  So many secret dreams, so little time.

I was driving to a meeting on Monday at just the time that Michel Martin was doing an interview that pulled me in from the moment it started.  Andy Marra is a transgender woman who was adopted by an American family from South Korea.  She recently wrote a blog entry at the Huffington Post about her experience of finding and coming out to her birth mother in Korea.  As she was going through the coming out process, she chose to delay her full transition (hormones, surgery) until she found her birth mother:

"I could never find the will to move forward with my transition -- taking hormones or surgery -- despite the opportunity to do so. And my hesitation was largely due to my unknown family living far away in Korea.  Like me, more than 200,000 Korean babies and children have been sent overseas. But less than 3 percent of us are able to find our families. The odds were clearly not in my favor. But what if I did find my family after all these years? And how would they handle meeting a young woman instead of a baby boy who should have grown into manhood? I was left with few ideas to reconcile my concerns." (source: www.huffingtonpost.com)

As she continues with her story, she finds her mother literally in the span of a few hours, and the two are reunited.  Like so many kids who are contemplating the coming-out process, she is nervous to share her gender-identity with her birth mother, a woman she has just met.  However, the turn in this story is that it is her birth mother who first broaches the subject.  She instinctually knows that there is something weighing Andy down, and after some questioning, Andy tells her that she is a transgender woman.  Her birth mother responds:

"'Mommy knew,' she said calmly through my friend, who looked just as dumbfounded as I was by her response. 'I was waiting for you to tell me'...'Hyun-gi," she said, stroking my head. 'You are beautiful and precious. I thought I gave birth to a son, but it is OK. I have a daughter instead.'" (source: www.huffingtonpost.com)

It is this moment, in this highly-charged situation of a reunited birth mother and daughter, that Andy begins to find her own self-acceptance and an ability to move forward in her own life.  You can listen to the full audio interview here.

As I've written about before, finding acceptance and support is key to the well-being of our transgender students, and, right now, the deck is stacked against them:

• More than half of all transgender students have been physically harassed (pushed or shoved) because of their sexual orientation and gender identity.
• More than a quarter of all transgender students have been physically assaulted because of their sexual orientation and gender identity.
• Almost half of transgender students report missing at least one class in the last month and one full day of school in the last month because of concerns for their safety.
• Transgender students who experience high-levels of harassment have an average GPA that is .5 lower than that of transgender students who experience low-levels of harassment. (source: www.glsen.org)

These students are at a higher-risk of truancy, bullying and harassment, assault, and poor academic performance.  Additionally, parent reactions to LGBT students makes a huge difference.  According to the Centers for Disease Control and Prevention, those students who experienced high-levels of parental rejection were:

• Nearly six times as likely to have high-levels of depression
• More than eight times as likely to have attempted suicide
• More than three times as likely to have used illegal drugs
• More than three times as likely to engage in unsafe sexual behaviors that put them at risk for sexually transmitted diseases (source: www.cdc.gov)

For students who experience more acceptance from family, such as Andy, they have a support system in place regardless of their school environment.  However, for those students who are experiencing high-levels of rejection at home and are thus at higher-risk for depression, suicide, and substance use, the school environment can be make-or-break for that child.  Transgender kids in schools can be a highly emotional issue, as currently being played out in the East Aurora School District, but the data shows that this is an issue of school safety, student achievement, mental health, and even life and death.  We, as school counselors, are charged with advocating for all students, with a focus on creating an equitable and safe environment so that every child can learn.   Our transgender students fall into this category.

For resources, I would recommend taking a look at the previously mentioned CDC website, which has tips for making schools safe places for all LGBT students.  Additionally, the Gay, Lesbian, & Straight, Education Network (GLSEN) has a sample transgender policy that can serve as a conversation starter amongst your stakeholders and give you ideas about what issues need to be addressed, from bullying/harassment policy to bathrooms and locker rooms.  All of our students should have the opportunity to do well in school and have access to supports that allow them to figure out their identity for themselves, just like Andy.

Resource: Children in Poverty

The PBS documentary program, Frontline, takes time to really go in-depth and explore topics, often filming over months or even a year to get a more thorough view of an issue.  A few weeks ago, they aired a program about poverty amongst American children.  Did you know that:

• 1 in 5, or 21.6%, of America's children were living in poverty based on Census figures
• Federal spending on children in 2011 fell for the first time since the 1980's by $5 million 
• 47.6% of children living with a single mother live in poverty
• The poverty rate for White and Asian children is below the national average (21.6%), while the rate for Black children is at 38.2% and Hispanic children is at 32.3%
• 45% of those who spent at least half of their childhood in poverty were still in poverty at age 35 (source: 2011 Census Report)
• Only three other countries in the developed world have child poverty rates higher than that in the United States (source: 2011 OECD Report)

The documentary, Poor Kids, follows six children and their families in the Quad Cities of Iowa and Illinois.  Through the program, you follow their struggles with housing, food, clothing, unemployment, and depression.  Additionally, there are some themes that emerge that directly pertain to our work as school counselors:

• Loss: In the documentary, one family has to take their young girl's dog to the pound as they can no longer afford to keep her, plus they are moving from a house into a hotel room where they can only have one pet.  Children in poverty are constantly having to say goodbye, whether it is to their home, friends in a neighborhood they are leaving, pets, or even family members.
• Hunger:  Almost every child talks about being hungry at points in the program.  We know that children who are  hungry do not perform as well in school, thus we have a national school breakfast and lunch program.  However, those programs only go so far, and are not always able to address meals outside of school and on weekends.  Thus, while a student may be full and able to focus in school, homework to be done on the evenings and on the weekends may be more of a struggle, as children need a lot of nourishment through their growing years.  One program that is highlighted is a backpack food program where kids get food on Friday that can fit into their backpacks to take home over the weekend.
• Educational Impact: They do not really get to this until the end, but if you have worked in a school long enough, you have probably observed this directly.  Kids in poverty are often moving around, as they are able to get into a house but are then evicted, move into a hotel, back into a house, then an apartment, etc.  Thus, they can be in one school or school district's boundaries one minute, then in another one the next.  One of the young girls in the documentary does not go to school for a few weeks, knowing that they are in a hotel for only a short time and will be moving into another housing situation, which puts them in a different school district.  Thus, kids in poverty run a higher risk of missing pieces of their education while they move around, even if it is within the same general area.  It is vitally important that you check with your school system to see what provisions have been made for students that may fall into the category of homeless.  There are Federal guidelines for homeless students that clearly define what constitutes a student as homeless as well as guidelines for specific concerns such as registrations, transportation, and looking out for the "best interests" of the students in these particular situations.
• Educational Aspiration: Several of the kids in this documentary speak to the fact that they know, even at the young ages of 8 or 9 years old, that education is their ticket out of poverty.  They look to school and good grades as a pathway to college and a good job.  As school counselors, we are tasked with helping all of our students succeed academically and move on to a post-secondary option that is congruent with 21st century skills and careers.  This is reassurance that our children in poverty expect and deserve no less from us than any of our other students.

You can watch the documentary for yourself below:

  

Watch Poor Kids on PBS. See more from FRONTLINE.

Watch Poor Kids on PBS. See more from FRONTLINE.

Watch Poor Kids on PBS. See more from FRONTLINE.

Watch Poor Kids on PBS. See more from FRONTLINE.

Depression: 'Tis The Season

I am still not used to the fact that it is getting dark outside around 4 o'clock in the afternoon.  There are times when I wonder about having gone into a career where I go to work in the dark, spend almost the entire day in my windowless yet tastefully decorated office, and then leave work just as the sun is beginning to set.  My already pale skin moves from its typical cream with a hint of pink to full-on pasty white.  I could easily be considered for a role as an extra in any one of the plethora of television shows and movies featuring vampires.

Sigh.  Welcome to the dog days of winter.

It has begun--the winter season.  Not only is there less daylight, but it is colder, making people less likely to partake of natural sunlight outdoors even if they could.  The holidays are coming, which means hectic travel schedules and more time with family.  This much togetherness can be positive but also has the potential to aggravate and enhance any already existing conflict or discord.  For those families who are already struggling financially, emotionally, or both, this time of year can be a true challenge.  If you've been in school counseling for a while, you know that these stressors are not confined simply to adults, but that they also can have quite a large impact on our students.

A recent article by Lynne Shallcross in Counseling Today discussed the topic of depression, and a large section of it highlighted the often invisible high-risk group of adolescents, especially adolescent girls.     According to the National Institute of Mental Health, about 11 percent of adolescents have a depressive disorder by the time they are 18 years old, and according to the World Health Organization, depression is the leading cause of disability amongst people ages 15-44.  Additionally, depression can lead to suicide, which is still the third leading cause of death amongst youth ages 10-24 years old.  You may think that this is something that you will not really address as a school-counselor.  After all, we do not provide therapy, and surely if a student is depressed, then they will be taken care of by an outside clinician.  While this may be true, it does not mean that we do not still play a key role in assisting students and families who are working through depression.  More importantly, we are in a position to be able to work towards prevention and education.

First, what is depression?  The DSM-IV-TR defines Major Depressive Disorder as having had the presence of at least one Major Depressive Episode.  A Major Depressive Episode needs to have had at least five or more of the following symptoms present during a two-week period as well as a change from previous functioning, and at least one symptom is either the first or second on the list below:

• Depressed mood most of the day, almost every day.
• Diminished interest or pleasure in typical activities
• Significant weight loss or gain
• Insomnia or hypersomnia
• Observation by others of either psychomotor agitation or excessive slowing down
• Fatigue or loss of energy nearly every day
• Feelings of worthlessness or excessive guilt nearly every day
• Diminished ability to think or concentrate nearly every day
• Recurrent thoughts of death, suicide ideation, or suicide attempts (APA, 2000)

The symptoms also need to cause significant distress in their social and/or academic functioning (APA, 2000).  It is important to note that these are the symptoms for adults.  There are some variations among children and adolescents.  First, as is discussed in the Counseling Today article, depression can often be a challenge to diagnose in adolescents because they are already typically undergoing a lot of mood shifts.  We often chalk up extreme sadness in teens to simply been a teenager.  However, if a student's sadness about a situation continues to linger over time about an event that occurred, this may be a warning sign.  Additionally, you may begin to see other areas of concern.  For example, we should also look for changes in attendance, grades, peer groups, and peer relationships, in addition to the mood alterations as well as any physical symptoms like a change in sleeping and eating habits.  Further, in children you may not see so much the diminished interest or depressed mood, but rather instead irritability and defiance.  Also, because of adolescents' quick-to-change moods, strong desire to fit-in, and a need to show a certain "face" in public, students may be depressed and yet also be observed in some situations to appear as if nothing is wrong.  It is not uncommon to have a student who will seem to be outgoing as ever in school, but when they are home by themselves report that they do nothing but cry, sleep excessively, and hide from family and friends.  Thus, often it can take some probing conversations and a careful examination of all the possible symptoms to really get at the heart of the matter.  It is important to note that, as previously stated, girls are at a higher risk of depression than boys, as are children who have suffered trauma or who have conduct or attention disorders.  Additionally, LGBTQIA children are also at a higher-risk for suicide and mental health concerns.  

So, what is your role, as a school counselor, in all of this?  First, we have a real opportunity to do preventative work with regards to depression:

• Build resiliency in all students.  While there is certainly a physical/chemical component to depression, there is often an event of some kind that will trigger an episode.  Students with few coping schools and resources are more likely, in this instance, to slip into depression.  As a high-school counselor, we often talk to our new students and our 9th graders about participating in sports, clubs, community service, and additional extra-curriculars and stress the impact this can have when they fill out college applications.  However, participation in these activities also helps to build connectivity to the school as well as assisting them in forming positive relationships not only with other students but also with the coaches and sponsors.  It is these links to other people, both peers and adults, and the trust between them, that can be invaluable when a stressful life event occurs.  Rather than feeling like he/she is alone, a student will have a network of trusted friends and mentors to go to.  School counselors can help to connect students with these activities through group orientations, through their counseling website/Twitter feed/Facebook page, or through individual meetings with students.  Further, if the activities are related to physical activity, such as club or school sports or dance, these can add another positive coping mechanism and mood-enhancer to the student's life.  Additionally, school-counselors can educate their students on the role of the school counselor as someone who can help them problem solve social/emotional issues in addition to academic and career/college concerns.  If students have a relationship with the school counselor that is based on trust, they will be more likely to come to you if they are struggling with an issue.  The goal is to build a network of support around all students before an episode of depression begins.
• Educate the school community about the signs of depression and suicide.  We do many lessons with our students, most of them focused on academic and career/college skills.  How about throwing in one or two on the warning signs of depression and suicide?  If the students know about the signs--changes in behavior with regards to attendance, grades, extra-curriculars, friends, sleep, diet, talking about harming themselves, saying goodbye to others, and giving away possessions, etc--then they will be more able to clue adults in when they become worried about their friends.  Additionally, let students know what to do if they are worried about their classmates.  They should talk to a parent, teacher, counselor, or other trusted adult about their concerns.  Honor the confidentiality of the student that reports unless there are some extreme circumstances which would make disclosure a necessity.  In this way, students will feel more comfortable with letting staff know if they have a friend about whom they are worried.  Additionally, train the staff on warning signs and develop a procedure for reporting any students of concern to the school-counselors.  This is where strong relationships with your teachers and staff can come into play.  I am always very thankful when a teacher contacts me to ask me about a student who has been missing their class, suddenly not turning in work and failing tests, or who exhibits some other extreme behavior change.  This information allows me to check in with the student to determine what the situation may be and to develop a plan of action to address the presenting issue.

If you do have a student who you are concerned about, what can you do?  In a 2009 article in School Counselor Magazine, Adriean Mancillas, Psy.D gives some excellent tips:

• Do a suicide assessment and monitor the student.  It is important that if you have a student who presents with some of the signs of depression and/or suicide, that you assess them for risk.  If you are at all concerned or are not comfortable with this, please get additional support from another counselor, school psychologist, or school social-worker.  If there is cause to believe that the student may be suicidal, it is important to immediately contact the parent and ask them to take the student to be evaluated by a mental health professional.  Do not leave the student alone for any reason until the parents arrive.  When the student returns to school, make sure to follow-up with the student and family and check on the student frequently.
• If the student presents with some of the signs of depression, contact the family and refer to their physician or recommend mental health providers.  If you have a student whose grades have dropped, who is sleeping 12 hours a day, who has stopped engaging with friends and with activities they used to love, you have cause to be concerned about this student, and you think they might be clinically depressed.  How do you address this with the parents?  Remember: school counselors do not diagnose.  You should not say that their child is suffering from depression.  However, we can tell the parents what behaviors and changes we and other school community members are observing, state that we are very concerned by these observations, and recommend that they please follow up with a visit to a primary care physician or a mental health professional.  They should start with their insurance company, but you should also have on hand a list of local providers, some that will provide services on a sliding scale.  
• Educate and work with the parents.  All parents have dreams for their children, and when a student becomes depressed, it can really interrupt and impact both their academic and social lives.    This can be a challenge sometimes for parents who are worried that this is going to ruin their child's chances to get into a certain college or achieve certain goals.  We have come a long way in this country with regards to acknowledging the legitimacy of mental illness, but there is still a long way to go until we see it in the same framework as physical illness.  People will often wonder why someone cannot simply "snap out of it" when it comes to depression, and it can be our role as school counselors to help educate parents and the community that it is indeed an illness, that it takes time to heal and recover, and that the primary focus for a child who is depressed should be on getting well.  The grades and college plans will come when the child is feeling stronger.  Additionally, some parents may simply need more information about depression in adolescents, and if they have a relationship with you as their child's school counselor, they may be more comfortable seeking answers to their questions from you versus outside providers.
• Help accommodate the student's academic and school needs.  Students who are in the throws of depression and recovery may not be able to keep up with a full-course load, or may need to lessen the rigor of their classes.  They may need reduced work-loads or access to teacher notes.  Additionally, they may need more access to you, the school psychologist, or the school social worker than other students.  You can help to coordinate with the student, the parents, the teachers, and the outside clinicians to develop a plan that will best assist that student.
• Be a support to the student during the school day.  We, as school counselors, do not provide therapy, but we can be supports to our students while they are at school.  Building that relationship early with students can be key before an issue occurs, as it will make the student more comfortable seeking you out and trusting you during their recovery process.  It may be that you will check in with the student once a week, or it may be that the student can come to you if they are feeling overwhelmed during the school day and need a safe space to gather their thoughts before they go back to class.  Either way, you can be an invaluable resource in the building to that student while they are also getting outside assistance. (Adapted from Mancillas, 2009)

As they year goes on, we will see more cases of depression in our students.  As school-counselors, we can take the steps necessary to do some preventative work and education, as well as put supports in place ahead of time to help assist our students and their families who are working through this issue.

The following work was cited within this post:

APA. (2000).  Diagnostic and Statistical Manual of Mental Disorders, 4th Ed., Text Revision.  Arlington, VA: American Psychiatric Association. pg. 356, 375.

The following work was cited within this post and is available to members of the American School Counselor Association:

Mancillas, A. (2009) Supporting Students With Depression.  Retrieved from www.ascaschoolcounselor.org. 

Poetry and Grief

Hello there, blogosphere.  I hope this post finds all of you counselors well, and for school counselors that you are getting some much needed rest and rejuvenation over the summer break.

I am currently attending a Grief and Loss Summer Institute at the George Washington University and we just finished with day one.  It was filled with excellent information, time for reflection, and some wonderful tools for all of us to take back to our work with our populations.

One of our presenters today was Mary Azoy, a therapist in the DC metro area with a lot of experience not only in crisis counseling but in life transitions.  Further, she is a Certified Poetry Therapist, using poetry and writing as a means of helping people to find and express their feelings and thoughts as well as work through the situations and challenges that bring them to her office.  One of the activities that she walked us through today was to give us a poem to read by Denise Levertov entitled:

Writing in the Dark

It's not difficult
Anyway, it's necessary.

Wait till morning, and you'll forget.
And who knows if morning will come.

Fumble for the light,
and you'll be
stark awake, but the vision
will be fading, slipping
out of reach.

You must have paper at hand.
A felt-tip pen, ballpoints don't always flow,
pencil points tend to break. There's nothing
shameful in that much prudence: those are our tools.

Never mind about crossing your t's, dotting your i's-
but take care not to cover
one word with the next.  Practice will reveal
how one hand instinctively comes to the aid of the other
to keep each line
clear of the next.

Keep writing in the dark:
a record of the night, or
words that pulled you from the depths of unknowing,
words that flew through your mind, strange birds
crying their urgency with human voices,

or opened
as flowers of a tree that blooms
only once in a lifetime:

words that may have the power
to make the sun rise again.

(source: www.allthingshealing.com)

Then, she asked us to pick one line that spoke to each of us, one line that we felt was most applicable to ourselves, and then use that as the first line in our own writing, whether that be poetry or prose.  We had five minutes--this short amount of time can help motivate people to move quickly, overcome any writer's block they may have, and can help to insure that what hits the page is what has entered the mind first, avoiding a lot of over-thinking.  In our larger group of today, you had people choosing all sorts of different lines from the original poem, and even those of us that may have chosen the same line had different reasons for our choice, and wrote entirely different pieces based on those variations.  For our students who may sometimes have a challenging time being able to verbalize and access their feelings of loss or the many emotions that come with any major life transition, this exercise could be one way to help them access and express those affectations.  You could even give students choices, allowing them to either write, develop a rap, or draw a picture about the line in a poem that particularly spoke to them.  This may be an activity to try with your next group you run on grief and loss, or it could be applied to any group of students you are bringing together to work through a major life transition--middle school to high-school, high-school to post-secondary, moving, changing families, etc.  Further, this activity and variations could work with elementary students through high-school age.  There are a variety of poems and prose available on this topic everything from Shel Silverstein to books in your personal or school library.  Additionally, Mary recommended The Sun Magazine, an ad-free publication that is available by subscription but also has some  materials available online for free that are searchable by topic.

Here was my writing based on the line I chose from the poem above, "Wait till morning, and you'll forget":

Wait till morning, and you'll forget.

You'll forget the vivid dreams that contain real conversations with those you've lost.
You'll forget the new things that you will do together.
You'll forget the words of wisdom they still have to impart to you.
You'll forget the laughter that you both will share over the most bizarre of situations or the most trivial of details.

Wait till morning, and you'll forget.
The feeling, though, of their presence will still linger.

Postcards from ASCA 2012: It Gets Better

Whoever booked Dan Savage for the 2012 American School Counselor Association Conference, "Be Brilliant," should, in my opinion, get an extra day off.  Or perhaps a raise.  Or, at the very least, an ice-cream cone.  With extra sprinkles.

I have somehow ended up in a life where I listen to a lot of speeches.  As a child, my father was heavily involved in local and national politics.  Before I was 16, I had been to more pancake breakfasts, summer cookouts, and fundraisers that involved some semblance of oratory than most people will attend in their entire lifetimes.  Moving into adulthood, the context of the speeches may have changed, but the constancy of having them in my life remains the same.  Some are good--I learn new things, perhaps even feel inspired to try something differently and step out of my comfort zone.  Some lead me to say to myself, "Self, somewhere your life has gone off course.  I'm not sure when and I'm not sure where, but it has landed you here, in this room, listening to yet another speech."  Perhaps it is just one of the realities of being in a profession where you attend graduations, professional developments, and conferences on a regular basis.

All this being said, it takes the intersection of the subject of the speech, the power of the speaker, and my emotional attachment to the topic to produce a strong reaction.  All of these things came together in the keynote address this past Saturday evening.

Dan Savage has been a public figure for quite a while--he writes an adult-themed relationship column called Savage Love, and has also written numerous books such as The Kid, which shares how he and his husband, Terry, adopted their son through open adoption.  He, like all of us, has born witness to the deluge of media reports about LGBT youth, bullying, and suicide in the last several years.  A comment from a reader sparked an idea, and with the support of his husband, they shot the very first It Gets Better video.  The purpose behind the video was to give LGBT kids a link to their possible future selves, to give them hope that even if middle school and high school were difficult, there could be happiness and fulfillment in their adult lives:

Since this original video went live, thousands upon thousands of videos have been posted to the site representing the widely diverse LGBT community, all with the hope of inspiring LGBT youth to stay with us to see adult hood and find happiness and even joy.

Dan Savage also spoke to the fact that many students are bullied for a variety of reasons in schools.  However, many students who are bullied can go home to supportive families.  In the case of LGBT kids, they may go from a hostile environment in schools to a hostile environment at home, as families can often struggle with accepting their LGBT son or daughter, especially if this goes against deeply held personal beliefs.  Thus, these students are the most high-risk of all, because there is no safe space for them in their lives--neither school nor home.  This is where we, as school counselors, can play a crucial part in advocating for these students and letting them know that there is at least one adult in their lives who will support them as they work through the issues at school and the possible issues at home.

He went on to say that there are some things that school counselors can do to help make "life better" for LGBT students right now, in the moment, so that they do not necessarily have to wait until they grow up to feel safe and supported:

• Acknowledge the existence of LGBT students.  LGBT kids are in our schools.  They're in our classrooms, they are in our communities.  And they need support.
• Sponsor or support a Gay-Straight Alliance in your school.  Dan Savage said that even if a student never attends a meeting, the mere knowledge of the fact that there is a GSA that meets regularly in the school can give them hope.
• Make it known that there are Safe Spaces in your school.  One of the most visible ways to do this is to place a Safe Space sticker or poster in your office.  As another counselor pointed out to me, the sticker is only a start--you must then follow through with unconditional positive regard (hello, Carl Rogers) and empathy for it to truly mean something.
• Anti-gay bullying makes the whole school unsafe.  All bullying must be confronted.  Think about this--what message is being sent if some bullying is allowed?  It gives tacit permission that all bullying is okay.  Anti-gay bullying can happen to students who do not identify as LGBT--they may simply be perceived, for a variety of reasons, as LGBT, yet suffer the same consequences.  Work with your school administration and district to develop policies and procedures that make all bullying and harassment unacceptable.
• Don't forget the parents.  The coming-out process is difficult both for the student but also on the entire family.  Parents need our support, understanding, and resources as they work through this process with their children.  A great outside organization to point them towards is PFLAG.  You can find a local chapter through their website.

As school counselors, we can be leaders within our schools--we can help to educate our school personnel, we can advocate for policy and procedural change, and we can be visible support to our LGBT students.  Wouldn't it be wonderful if there wasn't a need for It Gets Better because things were great now?

For additional resources, check out Dan Savage's book, It Gets Better:

Also, I have written multiple blog posts about LGBT issues in school counseling and you can check out the resources under my Links and Books tab.

What Can You Do To Help My Transgender Child?

You are an elementary school counselor.  Towards the end of the school year, the parents of a 2nd grade student named Trevor ask to meet with you.  When you are in the cafeteria during some of the lunch periods, you have noticed that Trevor is always sitting amongst girls, never amongst the boys.  While you see him come to school wearing typical male attire (t-shirts, jeans), you often see him in the halls with barrettes or pink ribbons in his hair--his female friends give them to him during the school day to wear.  His teacher has remarked that Trevor often refers to himself as a "she." As you sit down with Trevor's parents, they tell you that at home, Trevor has been dressing as a girl for the last year-and-a-half.  They have been working with a child psychologist for several years who has diagnosed Trevor with Gender Identity Disorder.  As a team, Trevor, his parents, and the psychologist have decided that starting with the next school year, Trevor will be known as "Tammy," and that he will be attending school as a girl.  They want to know how you and the school can support Tammy and their family in this transition and help to insure that Tammy will be safe.  What is your response?

You are a high-school counselor.  One of your female students, Mirabela, has been out as gay since she was 14 years-old (she is now 16), and while it was a struggle at first, her family has come to accept her.  Mirabela has always dressed in traditional "male" clothing--concert t-shirts, baggy jeans, and steel-toed boots.  She has always had short, cropped hair and speaks with a low voice.  During one of your discussions with her, she states that she feels that she may not be gay so much as that she is really a boy, and wants to know what you would think about her changing her name to "Max" and having her teachers and the school community refer to her by that name.  She also wants to know what other things the school has in place to assist transgender students.  She has not yet discussed this with her parents.  What might be some ways that you would respond?

My guess is that these were probably not scenarios you had to answer on any of your exams as you were preparing to be a school counselor in your graduate programs, nor were these likely interview questions as you were searching for a job.  Yet, these could very well be situations that suddenly appear at your door.  The more time you spend learning about and considering the issue, as well as consulting with other personnel in your building and district, the better you will be able to step into action when the time comes.

The cover story on this Sunday's Washington Post was about a transgender child and the struggles that both he (the gender the child and family have chosen) and his family have gone through as he has journeyed from being a girl to a boy.  'Tyler' expressed early on that something had gone wrong in his mother's belly.  He told his parents that he was born a girl, but was meant to be a boy:


This is one of many stories that are springing up in families and schools around the country.  A few weeks ago, one of our are high-schools featured a transgender female student in their school newspaper, where she openly discussed the challenges of going to school as the opposite gender she was born into, and about some of the harassment she faced as a result.  It should be noted that as you go through this post, I will typically refer to the "gender a child was born into" when talking about the gender that matches the sex organs a child was born with.  I have done this in an attempt to simplify things.  There are some who might dispute this terminology stating that gender should only refer to the construct a child prefers and that "sex" should refer to the gender that matches the sex organs.  In doing this, I hope to have cleared versus muddied the waters.  Time will tell.

So, what is Gender Identity Disorder?  According to the DSM-IV-TR, the criteria for Gender Identity Disorder are:

• Strong and persistent cross-gender identification.  In children, this shows up as a repeated desire to be or a strong insistence that they are the opposite sex, strong preferences for dressing as the opposite gender, strong preferences for opposite gender roles in play, strong preferences for stereotypical games of the opposite gender, and a strong preference for playmates of the other sex. 
• Persistent discomfort with gender and strong belief that their gender is wrong, often with a focus on what is wrong with their bodies in the assigned gender.  
• It is not concurrent with a physical intersex condition.
• The issue causes significant distress or impairment in social, occupational, or other areas of the person's life. (APA, 2007)

This diagnosis is not without controversy.  As the Post article points out, there are those who feel that "disorder" should be replaced with "incongruence" due to the harsh connotation of the former.  (source: www.washingtonpost.com)  Some feel strongly that to pathologize gender identity is wrong when one is born with it.  There is also concern about over-using the diagnosis of GID for any child who shows gender-variant behaviors in order to justify the use of therapies that attempt to "repair" these behaviors.  However, as noted in the same article, without a diagnosis oftentimes they cannot receive treatments later in life, such as sexual reassignment surgeries.

As counselors, we know that identity and gender association and behaviors are ever evolving and changing things, both for children and adolescents but even with adults.  It is very normal for kids to experiment and try on different roles and activities.  Boys will play with dolls.  Girls will play with trucks.  There are those boys who feel more comfortable in the company of girls, and vice-versa.  I am not referring to those children.  What tends to separate normal experimentation and gender variance from transgender children is the pervasive belief and insistence that they were born "wrong" and that they want to be or are the opposite gender, to the point that it becomes extremely disruptive in the child's life and the life of the family.  Thus, this is a male child who doesn't just prefer to play with girls, they believe with every fiber of their being they are a girl and that somehow their body is wrong.  This is a female child who not only wants to ride motorbikes and play baseball with the neighborhood boys, they believe they are a boy and exhibit a great deal of anxiety and worry about what will happen when puberty begins.  This disruption tends to go on over a lengthy period of time, and there are usually many steps involved before a family decides to move forward with a diagnosis and a possible transition into the preferred gender of the child or adolescent.

But doesn't this just mean they are gay?  This is a pretty common question amongst adults.  There is a difference, though, between sexual orientation and gender identity.  Sexual orientation refers to sexual attraction, and while lesbian, gay, bisexual, and questioning children often have a feeling that there is something "different" about them their whole lives, it is not typically an identity that will manifest itself until adolescence--late elementary or middle school at the earliest.  Gender identity has nothing to do with sexual attraction.  Rather, it is about one's perception about their own gender--male or female, or anything in between along the continuum.  Further, the concept of gender manifests itself in children much earlier, oftentimes between the ages of 3 and 6 (source: www.washingtonpost.com).  It is important that we, as school counselors, know the differences between the two concepts of sexual orientation and gender identity.  A student who is transgender is not automatically "gay," and a student who is "gay" is not automatically "transgender."  A gay boy does not necessarily want to be a girl.  A biological female who identifies as a male is not necessarily homosexual.  Sexual orientation and gender identity are two different constructs.  In this video excerpt, you meet Hailey, a child identified as a transgender female:



So how does one treat gender identity disorder in children and adolescents?  You may be aware from the multitudes of television specials, news reports, and talk shows about adults who are often treated with transitions into the opposite gender and oftentimes sexual reassignment surgery.  However, the treatment of children is very different.  NPR did a 2-part story a few years ago that looked at the two major schools of thought with regards to treating transgender children.  In this first installment, we meet two families.  Bradley only wanted to play with girls, with girls' toys, and adored the color pink.  An altercation between Bradley and some of the boys in the school-yard took his parents to see a psychologist in Toronto.  Treatment for Bradley involved forbidding him to play with girls, with girls' toys, or to have anything with "feminine" colors such as pink.  All this in an effort to get him to conform to the gender that he was born with.  At the end of this section of the story, his mother voices some concerns that Bradley is living two lives--his true life where he plays with girls at school, and the life he has at home where he tells his family what he believes they want to hear from him.  The second part of the story follows Jona, originally born Jonah.  Her mother tells the story of how Jonah begged her to let him buy dresses when she was a toddler, and when she finally gave in, how much joy she had.  She never took them off.  Her parents took her to a therapist in California who encouraged them to let Jona be whatever gender she wanted to be at that time.  As the story goes on to tell, while the therapist did not often suggest to parents that children transition into their preferred gender, she did recommend it for Jona.  Jona began kindergarten as a girl and has flourished.  These stories illustrate the two main schools of thought amongst clinicians--either try to make the children conform to the gender they were born into, or allow them to explore their gender identity freely, with a small percentage of those children actually transition, either for a time or permanently, into the opposite gender.

As children get older, there are other modes of treatment.  As the Post article discusses, there are hormone blockers that can delay the onset of puberty.  This is further discussed in the second part of the NPR series.  Here we meet 'Violet,' a transgender female who is about to begin the hormone blockers, allowing her to avoid, at least for a time, the development of male characteristics such as a "larger hands and feet, a pronounced brow, and facial and body hair that will need to be removed." (source: www.npr.org).  This can allow children and families more time to determine if this will ultimately be a permanent choice for the child.  As the child matures, a decision does have to be made as to whether to suspend the hormone blockers and either develop into an adult as the gender they were born into, or whether to begin hormone treatments for the opposite gender.  As the NPR story listed above and this story discuss, if a child begins taking hormones of the opposite gender at the beginning of puberty, they can then more accurately develop into the opposite gender, and limit the amount and cost of surgeries in the future.  However, this will be irreversible, and will render the child sterile for life.  Thus, it is a huge step and a large decision for children and their families to make.  Yet, according to the doctor interviewed in the last story, it can offer children who are truly transgender quite a bit of peace of mind.

I offer all of this information not as an endorsement of one treatment over another.  All of the treatments mentioned above, from therapies that attempt to make the child comfortable with the gender they were born into to the hormones and hormone blockers can be controversial.  These are all decisions that the children, adolescents, and their respective families will be making, and every family, child, and situation is different. Yet, as school counselors, it is important to be aware of what all is out there, as you may be able to help connect the families and their various plans to the school staff.  You may have children who ultimately go the route of the various hormones and hormone blockers, but you are just as likely to have teenagers who are just beginning to grapple with their gender identity and who desire to be called a different name by their teachers and other staff.  Wherever that student is with their gender identity, according to this report from the Gay, Lesbian, and Straight Education Network (GLSEN):

• Nearly 1/2 of transgender students regularly skips school because of concern for their safety
• Nearly 15% of transgender students face harassment that is so severe that it forces them to leave school entirely
• Transgender students who face harassment have lower grade point averages than other students and are less likely to go to college
• Ultimately, transgendered adults who were harassed in school are at a higher risk for depression, suicide ideation, and STDs/HIV. (source: www.glsen.org)

Thus, if students are missing school and not performing as well as their peers, it becomes an academic concern, not just a personal/social issue.  As I discussed in another recent blog post, LGBT issues are not typically a part of training for school counselors.  Yet, as I also discussed in that blog post, it is an ethical mandate from the American School Counselor Association that school counselors have training and an understanding of the issues facing lesbian, gay, bisexual, and transgender students so that we can remove the barriers to their academic success.  So, where do you go from here?

• Do some soul searching.  How do you feel about transgender people and children?  One of the things that good school counseling graduate programs do is help you to confront your own personal biases and norms to determine if and how they may effect your work with students and clients.  Might your personal beliefs and values prevent you from fully assisting transgender students and their families, wherever they might be on the journey?  As counselors, we are tasked with helping others make decisions that are right for them, not necessarily to make the decisions that would be right for us.  Further, our professional mission is to remove any barriers to academic success to students--if making a transgender transition smoother and more nurturing allows that child to continue to do well academically, then, in my mind, we are fulfilling that mission.
• Take the temperature in your school and educate as needed--yourself included.  Unfortunately, even if we, as school counselors, are the most loving and supportive people in the world, children cannot stay with us all day long.  It is important to feel out how much support there would be in your building and in your district for a transgender student, and then to educate others and have conversations as you go along.  I like to think that for most people in education, there is a desire for children to do well and be successful, and that on this topic there is simply a lack of exposure and understanding.  If this is the case, then conversations and the sharing of facts with other school personnel will go a long way.  If, however, there are other school and district personnel who are resistant to even broaching this topic, it might be time to seek out some allies to do some professional development.  It is important for everyone to note that there could be legal ramifications for schools that do not support transgender students.  If school personnel condone and even engage in harassment, that could be an issue.  If schools enforce a different set of rules for transgender students than other students, that could be an issue.  Here in the DC metro area there has been a recent story of a Maryland teenager who identifies as a bisexual male and who was suspended for wearing a skirt to school.  The family asserts that his skirt was no less a dress code violation than the skirts of other girls.  The school states that it was too short. In a 2000 court case, Doe v Yunits, a middle school student won a case against a Massachusetts school district where she had been suspended repeatedly for wearing women's clothing because she was born a male but identified as female.
• Remain open to every individual situation.  Gender identity, like sexual orientation, moves along a continuum, and you can expect that one transgender student situation will not be like the next.  One student and family may be ready to transition into the opposite gender yesterday, while another may only be wanting a change of nickname in the classroom.  It is important to do a lot of listening to determine what a student and their family is looking for from you and from the school.  It may simply be that they want to know there is a resource in the school where they can go if they have further questions or feel they need to make an additional transition in the future.  It is important to let students know they have options, but to allow them to make the choice that is best for them.
• Know what you can do, and what you can't.  Official school records that include birth name and gender are more than likely out of your purview, as well as that of the school.  However, as the GLSEN Model Policy on Transgender and Gender-Non-Conforming Students discusses, students are typically allowed to go by whatever nickname they prefer.  You can ask teachers to label students with their preferred gender and use the preferred pronouns.  Students can be allowed to use designated faculty or clinic bathrooms.  Students can be given a neutral space to change for physical education classes.  Students can be allowed to wear clothing in their preferred gender, as long as it conforms to the dress-code policy for the entire student body and is enforced as such.  Some things may be more difficult--field trips that involve hotel stays, or athletic participation.  Always check into local and state policies and governing bodies for answers to more complex questions.  Chances are high that at this point, you will not be the first person to have asked.  It may be that you can work with your school and district on developing a set of policies with regards to transgender children, using the GLSEN policy above as a template.  Regardless, though, of whether it is in an official policy or not, as a counselor you want to develop a set of "best practices" that include many of the items that I just discussed (name, pronouns, bathrooms, changing facilities, etc.).
• Be honest with students and families.  If a family wants to begin a transition, it is going to be difficult in school, especially the older the child is.  We and the community can do a lot to support the child and family, but there will likely be some rocky moments with peers and situations as everyone becomes used to the new identity.  As with students who are contemplating sharing the fact that they are gay or lesbian, it is important to discuss both the possible positive and negative consequences to any plan.  Ultimately the decision is up to the child and their family, but it is best if everyone has gone through all the anticipated outcomes so that it can be an informed choice.  It is important for you to ask questions when you are unsure--what would the student like you to call them?  What pronoun would they prefer?  It is okay to admit you are not familiar with a specific situation or circumstance and ask them for more information.  Timing is also a consideration.  If you have a senior in high-school who is talking about transitioning two months before the end of school, it might be worth having a discussion about whether it might make more sense to wait until starting college. 
• Nothing should ever be done in a vacuum.  Always seek out support, whether from other school counselors, school personnel, online networks (like Twitter at #scchat), groups such as GLSEN, the National Center for Transgender Equality, Gender Spectrum, or other experts and clinicians in your area.  If the family has been working with someone, ask if you can have a release to speak to them to gather more information not only to help their child, but to further your education.  Check out any presentations or conference sessions on transgender children or transgender policy in schools.  There is a book that is recommended in the Washington Post article, The Transgender Child: A Handbook for Families and Professionals that could also give you some guidance. 

This is a complex and foreign topic for many, I understand.  However, it seems to be coming to the front more and more based on anecdotal experiences here in my area as well as in the national media.  Hopefully, through this post and the information contained within, you will be able to go back to the beginning, read the two scenarios, and have some ideas of how you might approach them should they ever happen to walk into your office someday.

The following work was cited within this post:
American Psychiatric Association.  (2007).  Diagnostic and Statistics Manual, 4th edition,Text Revision.  American Psychiatric Association: Washington, DC.

Reflection: The Bully Movie

By now, I'm pretty sure most school counselors have heard of the movie, Bully, either from the publicity concerning the controversy over its rating, or from parents, students, or colleagues who are talking about it.  For those of in education, I think it has been one of the most anticipated major release films in a long time.  As school counselors, we tend to be pretty aware of the issue of bullying, as we are often some of the first people that students and parents come to when there is a concern.  Further, we work hard to implement preventative measures in our schools like the Olweus program, and we also employ mediation skills, such as restorative justice, to help resolve conflicts while teaching empathy skills.  Before the movie was released, the questions that seemed to be on everyone's mind was about whether the film would reflect what bullying truly looks like in our schools, and whether all of the various stakeholders (parents, students, school personnel, police) would be reflected in an honest way.

In the film, there are some narratives that are very powerful and, I believe, reflective of some of the realities of our students.  The story of Alex, a student who ultimately gets beaten-up on a bus by another high-school student, will resonate with many of us.  Kelby, the gay student in Oklahoma who is ostracized and harassed at her school by students and teachers alike.  Ja'Meya, a young woman who ultimately fights back, but in a way that changes her own life forever.  Because the film-makers had such unlimited access to these children, they are able to show the impact that the bullying has had on the students and their families, and, in the case of Alex, what the bullying actually looks like on a day-to-day basis.  That is, I think, the film's strength: allowing the audience to empathize and feel what the bullying has done to these adolescents.  Alex undergoes daily harassment, and yet seems to indicate at one point that the people who are harassing him are his "friends."  Kelby, by the end, no longer feels comfortable attending school.  Ja'Meya is incarcerated for a period of time, with the charges ultimately being dropped, but it is fairly clear that the bullying and resulting incident have taken a large emotional toll on both her and her family.  There are moments of hope, strength, and resiliency--Kelby and her family having grown closer and stronger through the adversity, for example.  Ultimately, I would recommend that school counselors make an effort to also see the movie, but there are some things that I believe should be taken into account.

• Do some prep work beforehand, especially if you are going in a group.  There is a guide available at FacingHistory.org that has activities for adults and students alike both before going to see the movie as well as after.  They include definitions of bullying, ostracism, and synopses with guiding questions to help as you are watching the film, and then discussion questions and role-plays to follow-up.  If you are using the film as a teaching tool or a call to action, these materials can help to make any work done before and/or after much more meaningful and structured.
• Understand that this is a film that has been edited to fit the director's vision.  This may sound harsh, but it is very clearly explained in the guide by the director himself.  The filmmakers spent a year filming a multitude of stories and at a multitude of schools, and many things did not make it into the film as they did not fit the "dramatic arc." They filmed at a high-school in Sioux City in addition to the middle school: 

"West [High School] had and continues to have really strong and good leadership, and a really strong mentoring program. The difference in culture was like night and day. You could feel it when you walked into the building. You felt it immediately that you were in a different kind of place, where people treated each other better. Ultimately we weren’t able to piece together a story out of West, in part because good climate and culture don’t manifest themselves as drama...the West High stories were really, really hard to leave out. It was the same kind of phone call: 'Hey we filmed in your school for an entire year, but you’re not in the movie. Why? Because you were doing things too well.'"  (Facing History and Ourselves, 2012). 

It is important to know this because the director has clearly organized and selected scenes from the movie for the purpose of evoking certain emotions.  Feeling moved to anger, frustration, laughter, etc. by the stories included is natural, but understand that the film is edited to help you access those feelings.

• On that note, the film does not depict programs that have succeeded in helping to create a school-culture that does not tolerate bullying.  This was one thing that concerned me about the film--it does not show examples of programs that have worked, of schools that have gotten a handle on bullying successfully.  There are some parts of the guide that seem to be "Olweus" inspired, but the film seems to be a call-to-action and a catalyst for discussion more than a means of offering solutions to the issue.  As school counselors, we should be prepared to fill in this gap and share information about successful programs if we are using this as a means to begin dialogue on the topic within our school communities. 
• Be careful of making the leap from bullying to suicide.  Two articles were forwarded to me by colleagues this week about the film.  The first, from the American Foundation for Suicide Prevention, is concerned with the film's depiction of bullying being a cause of suicide for two of the stories in the film.  The article wants to make clear that bullying can be a trigger for mental illnesses such as depression which can, in extreme cases, lead to suicide, but that bullying is almost never a direct "cause of suicide.  Further, in a Slate.com article, there are some concerns that the mental illness of one of the students in the film who committed suicide was left out of the story entirely, leaving the viewers to conclude that it was the bullying that drove him to kill himself, when in reality it may have been one of many triggers or compounding factors of his mental illness.

Overall, I believe this is an important movie that shines a light on a serious issue for our students.  However, as school counselors we must be able to separate the emotions conveyed in the film from facts and research.  If we are able to view this film with background knowledge of how it was edited, the director's intent, as well as an understanding of how bullying and suicide are linked and how they are not, it can be a very powerful and eye-opening tool for us as well as our school communities.

The following guide was referenced in this post:
Facing History and Ourselves. (2012) A guide to the film BULLY: fostering empathy and action in our schools.  Facing History and Ourselves National Foundation, Inc: Brookline, MA.
Thanks to Valerie Hardy of FCPS and Dr. Erin Mason for the two articles on the movie and its depiction of suicide.