Part One: What is coming out, and why hasn’t my child or teen come out to me?

What is coming out?

The term coming out, which was popularized in the 1920s, was borrowed from the tradition of debutante balls, which were large formal events where young women would be introduced into high society as eligible bachelorettes.

Drag balls echoed the lavish and elegant nature of mainstream debutante and masquerade balls but were built by primarily queer and trans Black and Latinx folks during the explosion of creative expression that took place during the Harlem Renaissance in New York City as welcoming spaces for other queer and trans people. Taking place in many large US cities, including Chicago, Baltimore, and New Orleans, these drag balls were some of the “largest collective manifestations of prewar gay society” (The Week).

While people often associate it with emerging from a closet, “coming out” in the context of drag balls meant stepping safely and joyfully into one’s community but didn’t carry the assumption that you had been keeping that part of your identity a secret before that point. The addition of “the closet” came later, in the 60s and it is unclear exactly why – perhaps it referred to another turn of phrase, having “skeletons in one’s closet”.

Today, the term “coming out” isn’t as readily attached to a closet and most often refers to the internal journey of exploring and recognizing one’s sexual or gender orientation or the act of externally disclosing one’s identity, more specifically, their gender identity or sexuality.

For some people, the concept of coming out is a daunting one. For others, it can be a joyful event and a way to receive support from those around them.

The important thing to note about coming out is that there is no right or wrong way to do it and that everyone places different weight and meaning to it.


Why hasn’t my child come out to me?

Firstly, don’t make assumptions about your child’s gender or sexual identity. While you may have a hunch, it is not appropriate to assume anything about someone’s gender or sexual identity.

Maybe you’ve heard your child talking about their identity around friends or other family members but they haven’t told you explicitly about that part of their life. All you want is for them to talk to you so that you can tell them that you love them no matter what!

While you can’t know exactly what is going on in your child’s mind, try to practice empathy and conceptualize the sorts of factors that may be impacting what they feel comfortable talking to you about.

While we may try our best to protect our children from them, they receive so many messages and social pressure from all directions about how not to be. Whether it’s homophobic comments by peers at school or by other adults in their life or the neverending and terrifying anti-lgbt legislature making headlines, your child may be hesitant to take the step of “coming out” because of how it might impact the way they are perceived by friends and strangers alike.

Because of the way homophobia and cisheteronormativity (the system of belief that centers and naturalizes heterosexuality and a binary system of assigned sex/gender) are so inherent in how systems in this country were built and are run, it is impossible not to be impacted by them, and everyone has internalized these messages in some way. While you can’t keep your child from hearing all sorts of messages, you can make sure that in your home, tolerance, acceptance, and unconditional love are modeled and practiced.

On the other hand, there is also societal pressure for adolescents and teens to know exactly who they are, what they like and don’t like, and what is cool or not cool. The concept of “coming out” does not particularly make room for the confusion that is inherent in identity formation. What if you come out as one thing, but then start to feel like something else? What if you feel different than your friends or siblings somehow, but you’re not quite sure in what way or what that means? Formally coming out can feel restricting for some people who may be questioning or exploring.

For other folks, their sexuality and/or gender identity does not feel like an important or particularly relevant identity to their life, and therefore doesn’t feel important to “come out” as. People aren’t expected to come out as an athlete or a pescaterian or any number of things that may feel more important to someone’s identity than their gender or sexual identity.

More and more, the concept of coming out is seen as less of a necessity or something to be expected of queer people. Some people might have a distinct memory of their “coming out” story and where it fits on their timeline, and others might not be able to point to a coming out, or want to. For one thing, it is extremely rare that someone comes out just once. Queer folks are constantly making decisions about what is safe to disclose and to whom. “Coming out” happens all the time.

With the voices of more and more queer and trans people affirming and normalizing queer identities and lives, it is becoming more understood that while straight and cis are considered the standard, sexualities and genders exist on a beautiful continuum and it doesn’t make sense to operate as though we are straight until proven otherwise.

While it will be a long time before that concept can be truly internalized, we have the ability to change our language around coming out so that queer people sharing their identities isn’t about locating oneself as different or other, but celebrating who we are, who we have been, and who we will be, at every moment and stage of life.

Once we realize that there is no right or way wrong to be, we realize that there is nothing that we need to “come out” as.

Part two: Creating a safe environment

If you bring up topics related to your child’s identity and they don’t engage, back off. Avoid leading or prying questions.

If you suspect that your child isn’t ready to come out to you, the best thing you can do is work to create a safe environment for them so that they know that they can trust you when they’re ready.

There are little ways to do that that have nothing to do with your child’s identity – showing interest in their hobbies and passions, sharing affirmations about who you know them to be, practicing active listening skills when they do share with you. What do you know is important to your child? It may not be how they identify! Show support for what you do know.

On a broader scale, model acceptance and inclusion in other ways in your home. Engage in media that features and affirms LGBTQIA+ voices. Let your child know that you support the LGBTQIA+ community, even if you’re not directly addressing your child.

When your child feels safe, they will be more likely to talk to you. What messages about other things might you be saying that are sending the message that there are people that should not be embraced or celebrated?

Remember, it is typical teen behavior and developmentally normal for teens to distance themselves from parents, no matter who they are! Be patient with them and respect their timing and pace, and try not to take it personally.

Keep in mind: Just because your kiddo hasn’t come out to you doesn’t mean that they don’t feel safe or loved in their environment. In fact, that can be a sign that they already feel loved and supported – they know that you love them no matter what, and don’t need to be scared of disclosing and know that there isn’t a big fuss about it. If your child knows that they don’t need to make a big deal out of their identity, because in the end, there is nothing to “come out” as except oneself, then congratulations!

If coming out does feel important and relevant to your child and they come out to you, don’t say “I knew it”. Rather, thank them for their trust in you and show your love and support for them exactly where they’re at, whether you saw it coming or not.

Showing unconditional love

Operate from a place of unconditional love. Your acceptance of your child on every part of their identity, whether they share the specific details of that or not, is the most important thing. You don’t need to know exactly who your child is, and when they are ready, they will share that part of themselves with you.

Part three: Additional Support

Support at home is one of the most important factors in children’s mental health and wellness, but there are other resources for kids and their parents that can help navigate this time.

Finding a licensed mental health therapist who specializes in working with LGBTQIA+ clients can be an empowering and validating experience for teenagers who may not want to open up to their parents.

There are also support groups for queer teens that provide a safe environment that prioritizes mental health and help them build community with peers, which is another crucial component of well-being for teens.

Therapy and support groups aren’t just for teens! Sentier’s Parents of Trans and Non-Binary Teens group is a support space for parents who want to share the highs and lows of their journey with their child.

Individual therapy can also be a valuable tool for parents to process their kids’ journey in a way that they can’t around their child or other family members. Seeking out a mental health professional for individual support will help your capacity to be there for your child, if ever, and whenever, they decide to take the brave step of coming out.

So…when will my child come out to me?

They don’t have to and may not ever!

You don’t need your child to come out to you as anything in order to love, support, and affirm them. There are ways to show that you love them no matter what and that don’t need them to “come out”. After all, did you “come out” as straight (if you are straight, that is)? The answer is likely no. There was not the pressure to be sure about your identity because it was the norm. You barely had to think about it.

Just because your child hasn’t come out to you does not mean you’ve done something wrong. In fact, feeling comfortable enough to just be themselves is a huge win!

Understanding and exploring one’s identity is a lifelong and deeply personal process, and there is no timeline. If your child does “come out” to you in some way, that doesn’t mean that they can’t or won’t do it again another time – as identities change, so can coming out.

Being a teen is a strange and important time, and respecting our children’s personhood and believing in them means showing love and support for everything that they are. Whether or not they come out to you does not indicate whether or not you or they are doing anything “correctly”.

Blog written by Sentier Client Care Coordinator, Ellie Struewing

What are five coping skills for anxiety?


Anxiety is a common human experience. Everyone experiences it at some point, and it is often mild enough to cope with on your own. Incorporating some basic healthy coping skills into your daily life can help manage, reduce, and even effectively alleviate anxiety symptoms.

Understanding Anxiety

The word “anxiety” gets thrown around frequently and is often confused with stress. However, while anxiety usually involves a stressful situation, it is different from stress alone. Anxiety is most often described as nervousness, apprehension, and worry and is a response to a threat. As outlined in our blog entitled Is This Anxiety?, anxiety is a complex state rooted in fear. It presents as a wide range of mental, emotional, and physical symptoms with varying degrees of severity.

Anxiety Disorders

If you often have intense feelings of anxiety or feel fearful much of the time, you may be experiencing something more clinically significant. While anxiety is a common experience, some people have more intense symptoms and may meet criteria for one or more Anxiety Disorders. According to the Diagnostic and Statistical Manual of Mental Disorders V-TR (American Psychiatric Association, 2022.), General Anxiety Disorder (GAD) is characterized by excessive anxiety and worry occuring more days than not for at least six months about a number of events or activities. People with GAD also experience three or more of the following symptoms: restlessness or feeling keyed up or edge, being easily fatigued, difficulty concentrating or mind going blank, irritability, muscle tension, sleep disturbance. These symptoms disrupt or impair normal functioning.

Additional Anxiety Disorders include Panic Disorder, Social Anxiety Disorder, Specific Phobias, and Obsessive Compulsive Disorder. While they all have different symptoms and diagnostic criteria, the mental, emotional, and physical symptoms of each one must cause distress or impairment in social, occupational, or other important areas of functioning. Additionally, the symptoms cannot be attributable to the physiological effects of a substance or other medical condition in order to meet criteria for diagnosis.

When Should You Seek Help?

Anxiety is a very treatable condition. That is great news for nearly 20% of the adult population in the United States who experience an anxiety disorder (Anxiety & Depression Association of America, October 2022.) If you believe your anxiety is causing significant impairment in your life, consider working with a mental health professional to identify an appropriate treatment plan and build skills for healthy functioning. You may also benefit from services like the Teen Calm and Kid Calm groups at Sentier Psychotherapy. Our groups focus on educating clients and helping them to build a calm toolkit to increase skills and reduce anxiety.

Image credit: Anxiety & Depression Association of America

Coping Skills for Anxiety

Everything that we perceive as a threat has the potential to cause a fear response. The initial neurological process may take place regardless of the size or intensity of the threat. That means that, whether you are nervous to take a simple test or are in a truly dangerous situation, your brain initially reacts in the same way. It sends signals to your nervous system and results in those first physical signs of anxiety at even the slightest perception of threat.

Early signs of anxiety may be physical, emotional, and/or cognitive (thought-based). Your body may exhibit symptoms such as flushed skin and increased heart rate while your mind races or – in some cases – goes blank as you start to feel nervous. That is why it is so important to know how even mild anxiety feels to you and learn to cope with it. Most of the time, it is possible to interrupt it and begin returning to a calm state on your own relatively quickly.

Try incorporating one or all of these coping strategies into your daily routine to find relief in those moments and prevent anxiety from growing too strong.

  1. Get grounded in your body. Our bodies tell us when something is wrong – even if our brains have perceived danger where there isn’t really a threat. When you feel anxious, you may be mentally preoccupied with the difficult situation. Getting grounded means being aware of your body and connected to reality, time, and place so that you can mentally calm down. To ground your body, first get “planted” like a tree with deep roots. To do this, you can stand strong with your feet in a wide stance, sit down in a firm chair or on the floor against a wall, or even lay down. Next, notice the soles of your feet making contact with the surface under them – whether that is the ground, floor, or your socks/shoes. Slowly move up from there and notice how different parts of your body feel as you move foot to head and back again, keeping your feet planted throughout.
  2. Use your senses. Your physical senses are always with you. Try using the Five Senses Meditation to be in your body, focusing on only one thing at a time. Ask yourself these questions and use your senses to answer them one at a time:
  • What are five things I can touch? (example given: this chair, pants, water bottle, necklace, hair)
  • What are four things I can see? (e.g., my teacher, tree outside, backpack, lamp)
  • What are three things I can hear? (e.g., the clock ticking, walking in hallway, car outside)
  • What are two things I can smell? (e.g., the shampoo I used, coffee brewing)
  • What is one thing I can taste? (e.g., the gum in my mouth)
  1. Follow your breath. Nearly every article about anxiety recommends breathing exercises. This is because shallow, rapid breathing is also a common early sign of anxiety. By consciously focusing on your breath and gradually engaging in deeper, slower breaths, you can activate the body’s relaxation response, promoting a sense of calmness in the nervous system. Simply notice your inhales and be sure to exhale completely. Your breath is another grounding tool you can never forget at home and can utilize without anyone else noticing!
  2. Restructure your thoughts. When a person feels threatened, it is common to engage in distorted thinking patterns that amplify worries and fear. Cognitive restructuring is a simple process in which you identify a negative thought, question the validity of the thought, and replace the thought with more rational and positive alternatives, which may include planning for next steps. Taking time to zero in on unhelpful thoughts that are leading to anxiety helps you gain a more realistic perspective in the moment and healthier thinking patterns over time.
Identify Negative Thought“I did horribly on that presentation. I am going to be fired.”
Check on Validity of the Thought“It is true I was not well enough prepared today, but I did receive positive performance review feedback last month and have been on top of everything else lately. It is unlikely I will be fired.”
Replace with Rational, Constructive Thought(s) and Make a Plan“I feel really embarrassed about today’s presentation.”

“I want to be more prepared next time.”

“I need to have better time management at work.”

“I’m going to talk to my boss and take responsibility for not being ready today.”

“I will ask if there is anything I can do to help clarify my message to the team.”


  1. Break it down. When experiencing anxiety, our minds can start racing and even simple tasks can feel overwhelming. Looking at any task as small steps is a way to feel more in control. Using sticky notes like Post-Its, write one step of a task on a note and stick it on your wall or desk. Keep going until every step is listed. Then begin by focusing on only one note at a time. When you complete each step, crumple up the note and move to the next. This keeps each step manageable, gives you a visual indicator of your progress, and increases the likelihood of task completion.


While occasional anxiety is a common human experience and can be challenging to deal with, it should not control your activities, affect your quality of life, or impair you at work, school, or in relationships. There are very effective self-help skills that can help you better manage and reduce the impact of anxiety on your daily life. Experiment with different techniques to find what works best for you, and remember that seeking professional help is an option if anxiety becomes overwhelming. With consistency, these skills can help you manage anxiety and function in a healthier way.


Diagnostic and statistical manual of mental disorders (5th ed., text rev.).


Blog written by Sentier therapist, Sarah Souder Johnson, MEd

How High School Students Prepare for College: Tips to Manage Stress & Anxiety

The transition from high school to college is often one of the largest transitions a teen has made in their life thus far. Entering college involves many new experiences including living independently, making new friends, and navigating new coursework and instructors. The college transition, however, often begins earlier than many parents expect.

For many students, stress levels can peak during their junior year as pressure builds regarding post-high school decisions that they feel may impact the rest of their lives. Juniors in high school feel pressure to keep their grades up and receive enough credits so that they can get into the college that they want, all while pursuing extracurricular activities, preparing for and taking the ACT / SAT, considering career choices, researching colleges, and touring schools.

Stress and anxiety in general has recently worsened for many teens. According to the American Psychological Association’s Stress in America 2020 survey, teens who are already under stress due to the normal pressures of high school have felt even more stress in recent years, thanks to the pandemic. About 43 percent of teens surveyed in 2020 said their stress levels had gone up and 45 percent said they had a hard time concentrating on schoolwork. Many reported feeling a lack of motivation.

It’s no wonder that high school students feel stressed, anxious and overwhelmed. A quick google search on preparing for college as a high school student will result in hundreds of websites providing extensive lists of recommended steps for high school students to take starting on the first day of freshman year.

Yet oftentimes these sites focus on helping your teen prepare academically for college and development of a post high school plan. However, it is equally important to help your teen learn how to strengthen their resilience and ability to manage stressors before walking onto a college campus.

 Importance of Preparing Ahead

Ask any college freshman how their first year of college is going, and more often than not, you will hear stories about the ups and downs of being new to college. For many students, stress and anxiety can worsen during those first months of being away from home.

The American College Health Association’s  (2019) found that 87% of college students felt “overwhelmed by all they had to do” in the past year and 54% of students reported anxiety that had affected their academic performance (Coiro, Bettis, & Compas, 2017; Houston et al., 2017). In addition, many college counseling centers on campus are overwhelmed with the demand for services causing students to wait weeks or longer to begin short term care.

Knowing this, how do we as parents help ensure that our teens have the skills needed to safely navigate to rough waters of life after college and have the ability to handle any unexpected problems that come from this experience? How can we help our teens gain the skills needed that will allow them to go through difficult times and still bounce back?

What is Resilience?

As humans, one key factor that allows us to “bounce back” during challenging times and when faced with adversity is resilience. Resilience is the ability to withstand, address, adapt and adjust to difficulties in life, to overcome obstacles, and to bounce back from perceived failure, disappointment, or rejection.

Building resilience is key to helping high school students develop the ability to overcome stressful and challenging experiences that they may have in college and beyond. But just like building strong muscles in our body takes time and intentionality, building resilience does as well.

When building resilience, there are several core areas to focus, two of which are building and strengthening connection, and developing and maintaining healthy thinking. Ensuring that your teen has solid skills in these areas prior to heading to college is a great step to strengthening their resilience.

Building and Strengthening Connection

  • Before your teen heads off for college, help them identify the players on their support team – the people that they can contact during stressful moments or when they need to laugh or cry. Encourage your teen to take a few minutes to think about who then can call when they need to laugh, need to vent or need a good distraction.
  • Ensure that your teen is aware of resources on campus as well. Take some time to identify the school specific mental health resources available on campus and determine ahead of time what steps need to be taken to schedule an appointment. Ask what mental health resources are available to students after hours as well. Many campuses also have an active chapter of Active Minds, a club that focuses on mental health well being on campus, which can be a great way to begin to develop connections on campus.
  • As your college student begins to make social connections on campus, it will be critical that they are able to express their thoughts assertively and learn how to set boundaries when needed. Both are important steps in maintaining healthy social connections. This may mean helping your teen talk through current difficult situations with their friends and exploring steps that they can take to establish boundaries within these friendships.

Maintaining Healthy Thinking

Managing the Self-Doubt that Comes with Growth

  • It is not uncommon for college-bound kids who were high achievers and self-confident in high school to lose their confidence, doubt their ability to succeed, and question their ability to make friends once they get to college, leading to a loss of identity at times. It is common for college students to struggle with imposter syndrome and question if they are smart enough to be at college even though they made it there through hard work.
  • As a parent it can be heartbreaking to see your child go through this struggle. Although some self doubt is normal, as a parent, there are steps you can help your teen take so that they rebound from this self doubt.
    • Take time to normalize that these feelings are often a part of the growth process of moving from high school to college and are temporary feelings that will come and go.
    • Sharing your own experience of being a freshman college student, if this is applicable, can be helpful at times.
    • When you hear your teen or college student expressing feelings of defeat or self doubt, or questioning if they are smart enough, help them challenge this thought by asking: “What would you tell your best friend if they were feeling the way you feel right now?” This can be a great way of helping your teen tap into their own self-compassion.

Setting Realistic Expectations of Self

  • Make sure that your college student’s expectations about college are realistic even before they get to campus so the challenges and associated feelings of self-doubt they will certainly experience during this new stage are understood as being normal and expected.
  • If your teen didn’t need to apply much effort in high school to succeed, alert them to what’s coming: new and more difficult academic demands that can leave a freshman feeling discouraged and defeated. Your child may falsely conclude that she is not smart enough, and effort would be futile.
  • Share with your teen that it is okay and normal to have some difficulty adjusting to a college course load and talk through where they can go for academic help when this occurs.

Addressing the All or Nothing Thinking

  • All or nothing thinking is one of the most common faulty thought patterns that we can develop over time that makes us more prone to negative thoughts and conclusions. All or nothing thinking is a negative thinking pattern that polarizes situations, experiences and people leading people to place everything into boxes of either good or bad, leaving no room for a more balanced perspective while ignoring conflicting or ambiguous information.
  • For many of us, stress magnifies all-or-nothing thinking. In the college setting, this might mean that when a grade or one’s performance falls short of your teen’s expectation, it is seen as a complete failure. When these moments occur, help your teen remember that each time they have learned a new skill, whether learning how to tie their shoes or learning how to drive, they weren’t proficient from day one. Rather, it took time to master those skills. Help your child recognize that there are degrees of success versus only two options: success or failure.
  • Help your teen become aware of when all or nothing thoughts are surfacing so that they can take some time to question the accuracy of this thought. For example, if you hear your teen say I am a complete failure because I failed this one test, ask them to argue the opposite view point of this: why they are not a complete failure because they failed one test. The more this skill is practiced, the more automatic it will become.
  • Finally, as cliché as it sounds, help your teen and college student remember that they are not alone. Knowing you’re not alone also extends to knowing that feeling nervous or overwhelmed during big life transitions is normal – it doesn’t mean you don’t belong there, nor does it mean that they can’t handle the challenges that they are currently facing.


Blog written by Sentier therapist, Becky Lawyer, MA, LPCC, LPC

Team Strengths Training

Earlier this summer, the Sentier team gathered at the House of HeART in St. Paul for our annual overnight. This year’s special guest was coach and consultant Dr. Jennifer Engler, who specializes in using the Clifton Strengths Assessment with individuals and teams to help them better understand their individual strengths and how they operate in different environments, including the workplace.

In her training, Dr. Engler spoke to the Sentier team about how we can individually and collectively function more harmoniously by utilizing our strengths and understanding and appreciating the strengths of our team members.

The Clifton Strengths Assessment is part of a strengths philosophy within the field of Positive Psychology. Before our gathering, each member of the team completed the assessment to identify our top five themes from a list of 34 total themes.

Some of these themes include Achiever, Intellection, Developer, Empathy, and Relator.

Each of these themes also fits into one of four domains of leadership strength – Executing, Influencing, Relationship Building, and Strategic Thinking.

Below is a chart showing all of the themes that came up for our team and how many people shared those themes.

Perhaps it’s not surprising that this room full of therapists had a majority of our themes in the “Relationship Building” domains, with the number one most common theme by far being “Empathy”!

With Dr. Engler’s help, we were able to look more deeply at how we each landed in the strengths framework and how our strengths play into how we show up at our jobs. It was particularly helpful to connect with others who operate under similar themes to share what they look like in our lives and see how they may present differently for others.

Putting names to certain characteristics of ours helped the team appreciate parts of who we are or things that we do that we may not have recognized as a strength. “I was encouraged by the takeaway that just because something comes easy to me and is a strength of mine, doesn’t mean it comes easy for everyone else,” says Sentier therapist Tana Welter.

It is important to remember that not having a high score in a particular theme doesn’t mean you don’t have that strength at all – it just means that you are perhaps better at some other things. Having an understanding of where we naturally flow in our strengths can help us dive deeper into how to thrive and grow through our challenges. “It was fun to learn how to leverage my biggest strengths to carry me through areas that I find difficult,” remembers Sentier therapist and clinic owner Megan Sigmon-Olsen.

Dr. Engler emphasized that while it is helpful to highling each other’s strengths, we should be careful not to reduce ourselves or one another to our top strengths. Knowing someone’s particular strength doesn’t mean that if it’s not one of your top strengths, certain tasks can be offloaded to them. If everyone only did things that were easy, we wouldn’t grow individually or as a team.

Dr. Engler’s workshop was informative, empowering, and a great lens through which to appreciate and affirm our team’s strengths. “It helped me better understand my own areas of strengths, but also those of my coworkers, which helps us to relate better and work more efficiently together,” reflects Welter.

Dr. Engler and Sentier therapist Bridgett Brye at the team Strengths training.

A few weeks later, at a team meeting, we returned to the strengths mindset by each answering the following questions, which are part of the Strengths Manifesto. With these questions, the team was able to better understand how to support one another.

  1. You get the best of me when…
  2. You get the worst of me when…
  3. You can count on me to…
  4. What I need from you is…

How would you answer the questions? Trying reflecting on them together with a friend or partner!

Blog written by Sentier’s Client Care Coordinator, Ellie Struewing

Are Video Games Good For Your Brain?

What Kinds of Video Games are Good for your Brain?

Video games have come a long way since the days of Pong and Pac-Man. Even the worlds of Sonic and Super Mario are six generations behind video games being released now! What was once dismissed by the majority of the population as a mindless form of entertainment has evolved into a powerful medium with numerous cognitive and therapeutic benefits. In this blog, we will explore the fascinating evolution of video games and delve into the brain-boosting advantages that they offer.

The Evolution of Video Games

To understand the impact of video games on our brains, we must first examine their evolution. In the first generation of video games, consoles were able to play only one or two specific games and had 0-16 KB of memory. We are currently within the 8th and 9th generations of video games. These 8th generation gaming systems include Nintendo Wii U, Sony Playstation 4, Microsoft Xbox One, and Nintendo Switch. The 9th generation gaming systems include Xbox Series X and Playstation 5. These consoles have 2-16GB of memory and can play a limitless number of games. They are designed utilizing state of the art technology, with the ability to make fantasy worlds look just as real as live action movies.

From the early days of simplistic arcade games to the present era of immersive virtual worlds, video games have become tools with the potential to enhance our brain functioning. This metamorphosis itself is like the growth of a character in a role-playing game. Each level or milestone met unlocks new skills and abilities. Similarly, video games have transcended mere entertainment and now engage players on deeper levels.

The Brain-Boosting Benefits of Video Games

Contrary to common misconceptions, research has shown that video games offer a wide range of cognitive benefits. Some of these benefits include:

  • Problem-solving skills are honed as players navigate intricate puzzles and overcome challenges.
  • Memory is enhanced through the constant retrieval and utilization of information within the game.
  • Fine motor skills are strengthened through the need to use the control, keyboard, or mouse in specific and repeated ways.
  • Hand-eye coordination is also put to practice through exploring the worlds of video games

This is only a short list of benefits. The more that we have been researching video games, the more we are discovering how beneficial they can be to our brains. The Cleveland Clinic outlines several scientific studies that show how video games can benefit our cognitive functioning- including attention and focus! This even includes results that show video games can increase gray brain matter. Gray matter plays a major role in regulating emotions and memory retention, among other critical brain functions.


The Role of Video Games in Psychotherapy

The therapeutic potential of video games extends beyond the benefits to cognition in individuals who play them. In recent years, mental health professionals have started incorporating video games into their practices. These unconventional therapists can provide a safe space for individuals to explore their emotions, confront fears, and develop coping skills. Case studies have highlighted the effectiveness of video games in addressing a wide range of mental health issues, including anxiety, depression, and post-traumatic stress disorder. Thus, video games can be a vital part of the journey toward healing and self-discovery.


Spotlight on Brain-Healthy Video Games

Different types of video games can help in different ways on that journey. Here is a list of genres and specific games that can have a positive impact on our brains.

  • Massive multiplayer online games (MMOs): Encourages teamwork, cooperation, and communication skills (e.g. World of Warcraft, The Elderscrolls Online, and Final Fantasy XIV: A Realm Reborn)
  • Puzzle games: Enhancing problem-solving skills and memory processing (e.g., Tetris, Portal, and Candy Crush Saga)
  • Role-playing games (RPGs): Improving social skills, perspective taking, and empathy (e.g., Mass Effect, Pokemon Yellow, and The Witcher)
  • Strategy games: Boosting critical thinking and decision-making skills (e.g., Starcraft, Civilization, and BattleTech)

There are many games that also target specific therapeutic topics. Grief is a topic that can be processed through many different video games. That Dragon, Cancer is a game designed by parents who lost their 5 year old young son to cancer. Games like Spiritfarer, What Remains of Edith Finch, and Brothers: A Tale of Two Sons are also games that help players process grief.

PTSD is another major area that can benefit from playing video games. An article by Mike Richman (2019) outlines how video games specifically can be used to help veterans recover from PTSD and cope with their experiences of trauma. The original study can be found here. In this study, researchers found that a large percentage of veterans report that video games have helped them with their mental health recovery. Games like Call of Duty, Tetris, and Night in the Woods and Pry have all been used therapeutically to help veterans heal from PTSD.

The Under-Served Population: Video Games for the Elderly

We often only think of video games in relation to younger populations. However, video games have the potential to revolutionize cognitive health for the elderly. Research findings have indicated that engaging in video games can slow cognitive decline, improve memory, and enhance overall well-being in older adults. Despite this, the stereotype persists that video games are exclusively for the young. Here lies the irony: a form of entertainment initially associated with youth is proving to be a powerful tool in promoting cognitive health among the elderly. Let’s challenge this stereotype and unlock the untapped potential benefits of video games for all generations!



Video games have transcended their humble origins to become catalysts for cognitive growth and emotional well-being. Throughout this blog, we have witnessed the evolution of video games, explored their brain-boosting benefits, and examined their role in therapy. We have shed light on brain-healthy genres and confronted stereotypes by highlighting the potential for video games to enhance the lives of the elderly. It is time to embrace this transformative medium, unlocking its potential to improve our cognition and overall well-being. So, grab a controller, embark on a new quest, and let the power of video games guide you toward a stronger, healthier mind.

Blog written by Sentier therapist, MARY/MAGGIE DEVORAK, MS LMFT (they/she)

mary devorak


Colder Carras M, Kalbarczyk A, Wells K, Banks J, Kowert R, Gillespie C, Latkin C. Connection, meaning, and distraction: A qualitative study of video game play and mental health recovery in veterans treated for mental and/or behavioral health problems. Soc Sci Med. 2018 Nov;216:124-132. doi: 10.1016/j.socscimed.2018.08.044. Epub 2018 Sep 24. PMID: 30257787; PMCID: PMC6193255.

Manos, M. Are Video Games Good for You and Your Brain? Cleveland Clinic. 2022 Nov.

Richman M. Study: Video games can help Veterans recover from mental health challenges. US Department of Veteran Affairs. 2019 May.

My Kid Is Getting Bullied

My Kid Is Getting Bullied

What is bullying and why does it happen?

If your perspective on bullying was influenced by Hollywood, you may picture a bully as a snobby teen or a menacing neighbor kid. In our day-to-day lives, however, there are many forms of bullying and bullies can be coworkers, family members, and even people we consider friends.

Though bullies exist in adulthood, bullying among children is particularly concerning. According to StopBullying.Org, a site dedicated to addressing childhood bullying among kids, childhood bullying is described as “unwanted, aggressive behavior among school aged children that involves a real or perceived power imbalance” (What Is Bullying, 2022). Bullying can be understood through two main identifiers:

  • There’s an imbalance of power: the bully is seen as bigger, stronger, more socially connected, or better resourced than the target or victim of bullying.
  • It is repetitive: the unwanted behavior keeps happening, despite objections or efforts for it to stop.

Keep in mind that the power imbalance inherent in bullying can be real or perceived. A child others consider non-threatening can be seen as threatening to the person they are targeting.

It is also important to note that bullying isn’t just interpersonal conflict. It happens within a community and can be influenced or extinguished through community awareness and action.

The following image helps demystify bullying. It comes from the work of Dan Olweus, the late psychologist and bully prevention researcher and advocate. Olweus’ circle describes the link between the bully, the target, and those who watch, participate in, or resist the behavior.

(Olweus, 2012)

As you consider this visual, think of a time you were part of a bullying circle. Maybe you haven’t been a target, but you have almost certainly experienced one of the other roles. The good news is this: anyone can learn to be a resistor and defender (described by the letter “G”).

Another word for a resistor or defender is “upstander”. Upstanders notice bullying and speak up for the target. If afraid of physical or social repercussions, they seek help from someone who can address the problem. Bullying exists when no one is aware of it or those who are aware participate or ignore it.

Where does bullying happen?

Since kids spend most of their time in school, we tend to think of bullying as a school problem. In reality, bullying happens wherever people are, and opportunities for bullying exist in a variety of settings including online, during after school activities, and within families. With the advent of multi-player video games and social media, bullying tends to move between online and in-person interactions.

For children who struggle to vocalize that they’re being bullied, warning signs of bullying can include:

  • A sudden loss of interest in school or change in academic performance
  • Frequent complaints of physical illness that weren’t present before
  • Avoidance of social situations and activities with peers–refusing to go to school, attend after school activities, or spend time with peers
  • Changes in sleep, appetite, and activity levels

It’s important to note that these signs aren’t unique to childhood bullying and could point to a number of other challenges. If you suspect your child is struggling, talking with them is the first step (Stomp Out Bullying, n.d.).

How to talk with your child about bullying:

Bullying tends to bring up feelings of shame and inadequacy. Because of this, I encourage adults to have regular, non-judgmental conversations about friendships, peers, and bullying.

Here are some conversation starters:

  • Tell me about your class.
  • What is your teacher like?
  • Who do you spend time with during the day?
  • Is there anyone you don’t get along with?
  • What do you like about your friends?
  • When your friends do or say things you don’t like, what can you do?
  • Do you notice kids who are being bullied? How can you help?
  • When you need help and don’t know what to do, what adults can you talk to?

Have these conversations during neutral times (i.e. not when your child is upset, hungry, or exhausted). If your child says something that activates your protective parent nerves, check-in with yourself before responding.

If we respond to bullying with anger or threats of violence, we send the message that conflict can only be solved by causing harm to the aggressor. While it’s natural to want revenge in moments where we feel powerless, causing harm to someone else isn’t the answer.

When your protective parent mode is on full blast, remind yourself of this question:

If the problem solving skills we are teaching children now would lead to legal involvement or job termination in the future, is this the best way to handle the situation? If the answer is no, give yourself some time to cool down before offering suggestions.


What to do if your child is being bullied:

Bullying isn’t a big scary monster that can’t be defeated. Bullying is a community issue that can and must be addressed. Here are some things to consider and action steps to take if your child is being bullied:

Things to consider

  • Is the behavior repeated?
    • Does it keep happening, despite your child asking for help from an adult or telling the bully to stop?
    • Or, does your child feel powerless to ask for help when the bullying occurs?
  • Where is it happening?
  • When is it happening
    • What time of day does it occur?
    • Who is around?
    • Who is not around when it happens?
  • What has been your child’s response to the bullying, up until now?
  • Where does your child feel empowered, competent, and worthwhile?
    • As much as possible, increase their time in the settings and with people where they feel their best

How to proceed

  • Instill hope in your child. This is the first, and perhaps most important, step. Bullying can and will stop when we address it
  • Teach your child how bullying works and why it continues. Remember that knowledge is power and raising awareness of bullying helps cultivate more safe environments. You can use the “Bullying Circle” visual included with this blog to start the conversation.
  • Remind your child that bullies are only bullies because they think they are in charge. The only person in charge of how we feel about ourselves is the person living our life… us!
  • Empower your child to speak up for others when they see bullying.
  • Teach your child a simple three step process called “Stop, Walk, and Talk” (pictured below).
    • Though a child may feel powerless to stand up to someone bullying them, their confidence builds as they learn to stick up for others.
  • Notify school staff or trusted adults who can step in or offer support if your child is being bullied in a place where you aren’t. This includes adults at school, friends’ houses, and at extracurricular activities.
  • Follow up with your child
  • Efforts to stop bullying take time. Plan regular intervals where you’ll check-in with your child until the situation is resolved


stop walk talk

Stop, Walk, and Talk (PBIS World, 2023)


How to handle relational aggression

The bully who spreads gossip, starts rumors, or tries to turn others against your child may not leave visible evidence but their impact is just as significant, especially at a developmental stage where approval from peers is so important to kids’ self-image. This kind of bullying behavior is called relational aggression. It can happen at any age, though it tends to reach its peak in middle and high school. Because it damages relationships and can erode one’s sense of self, it’s critical to recognize when it’s happening and respond right away. Here are some ways to help your tweens and teens navigate relational aggression:

  • Help your child recognize the difference between real friends and fake friends.
    • Real friends are trustworthy, enjoyable to be around, and respect our boundaries.
    • Fake friends can look like real friends, however, they don’t respect our boundaries and leave us feeling hurt and confused rather than loved and accepted.
  • Remind your child that relational aggression is about power and control- the bully often thinks the only way to feel good about themselves is to put others down.
    • Encourage your child to pursue activities and relationships that add to their lives.

Bully Free Communities

Though bullying exists in our communities, it doesn’t have to. As we teach kids to recognize bullying and act against it, we are creating a generation of upstanders. As we help children find their voice, we teach them that empowerment comes from finding that voice, not silencing or causing harm to someone else.

If you or your child need support (either responding to bullying or recovering from its affects) reach out to a school counselor or trained mental health professional. Together we can heal from bullying and build communities that are safe, respectful, and supportive.


Blog written by Sentier therapist, Lily Ferreira, MSW, LICSW

Lilly Ferreira


Home Bullying What Is Bullying. (2022, June 30). Retrieved January 26, 2023, from

Olweus, D. (2012, April 13). As ‘Bully’ Opens, the Bullied, Bullies and Bystanders Weigh In. PBS. Retrieved January 26, 2023, from

PBIS World. (2023). Bullying Resources / Bullying Resources. Nassau County School District. Retrieved January 26, 2023, from

Stomp Out Bullying. (n.d.). Signs Your Child Is Being Bullied – Tip Sheet. STOMP Out Bullying. Retrieved January 26, 2023, from


This blog was written by Sentier therapist, Lily Ferreira, MSW, LICSW


Does My Kid Have Sensory Processing Disorder?

We as humans are constantly absorbing different sensations in our daily lives, whether that be smelling our cup of coffee in the morning, hearing the sound of birds chirping, or feeling the warm sunshine on our faces. Many of us can tolerate these constant sensory experiences, but to some they can feel like too much or not enough.

As adults, we have probably grown accustomed to knowing what we need more of and what we don’t enjoy when it comes to sensory input and processing. When it comes to our children, however, the concept of understanding what their bodies feel and need in order to be safe can be an extremely overwhelming process and sometimes lead to sensory processing issues.

This blog will shed light on Sensory Processing Disorders, which is an increasingly common diagnosis, and help parents understand how it presents, how it impacts their child, ways to provide support, and when to seek professional help for sensory challenges.

What is Sensory Processing Disorder?

Sensory Processing Disorder (SPD) is categorized as a set of behaviors related to trouble processing information from the senses. It is estimated that “nearly one out of 20 school-aged children have SPD, but the actual number may be much higher because it’s tough to diagnose” (Bayliff, 2021).

As Lisa Dion, LPC, RPT-S, and the creator of Synergetic Play Therapy describes sensory integration, “imagine every sensory channel has a window of tolerance or sweet spot of how it takes in or processes information.” SPD is often associated with folks with Autism Spectrum Disorder (ASD) but the two are not mutually exclusive and one can have SPD without having ASD.

Humans have eight sensory systems: visual, auditory, tactile, olfactory, gustatory, vestibular (sense of balance), proprioception (body awareness/position), and interoception (internal body sensations) (Miller, n.d.). Children with SPD can fall into one of two categories – being over responsive or under responsive to these systems.

A child who is overly responsive or “sensory avoiding” tends to display behaviors that appear defiant such as yelling or throwing tantrums. Under-responsive children, on the other hand, may appear as “thrill seekers or sensory seeking” because they cannot get the sensations they need.

For example, an overly responsive child could feel a poke in the arm as equal to being stabbed by a needle while an under responsive child would not recognize any sensation or the feeling would feel more like being touched by a feather.

Potential Signs of Sensory Seeking

  • Excessive head banging, especially in connection to their needs such as hunger or being too tired
  • Eating or drinking too fast
  • Chewing on non-food items
  • Scratching skin surfaces
  • Rubbing eyes, lips, or ears
  • Picking at skin excessively
  • Approaching all new stimuli
  • Getting in the face of others or appearing to struggle with personal space/boundaries
  • Rocking extremities or whole body back and forth (similar to the movement of a rocking horse)
  • Frequently being under stimulated or bored

Potential Signs of Sensory Avoiding

  • Becoming “wiggly” when being held, struggles with dressing (e.g. can’t tolerate tags on clothing or seams on socks)
  • Pushing away from touch
  • Extreme response such as crying, screaming, screeching when touched or approached for a hug. May fight cuddling and physical games like tag or tickling
  • Becoming stiff and sometimes rigid
  • Running away from things they do not like
  • Irritability if touched in the wrong spot
  • Argumentative at dinner or when having to do homework
  • Losing homework and objects easily. (This is due to under-stimulation, where they forget what has happened recently.)

(Bayliff, 2021)

How is SPD Diagnosed?

There are multiple factors that are thought to contribute to SPD, including premature birth and genetic links. It is important to be aware that we are all inherently unique persons with different needs, and what is required or needed for one person is not the same for another. If your child struggles with SPD, that does not mean that there is something wrong with them! It could be helpful to look at their sensory processing as a unique and special way that they absorb their experiences in the world.

In order to receive the diagnosis of SPD, your child must complete a sensory integration evaluation by an Occupational Therapist (OT). OTs and mental health therapists work collaboratively when addressing children’s needs while coping with SPD. Mental health therapists aim to address the trauma resulting from our children not feeling safe in their bodies while occupational therapy addresses the physical symptoms and sensations of SPD by helping kids learn strategies for managing sensory processing difficulties experienced in their daily lives.

How Can I Best Support My Child?

As a parent, get curious about your own sensory needs. What makes you feel overwhelmed and what sorts of sensations do you seek out? Keep in mind that “If we are not in tune with our body it spills over into difficulties in being in relation to others” (Dion, n.d.)

  • Educate yourself on SPD and how your child’s body responds to their sensory processing challenges.
  • Relearn your expectations for parenting. Learn to value your child’s strengths amid their sensory issues. Yes, this requires patience and being aware of your own sensory needs!
  • Utilize the Sensory checklist to help determine next steps for your child (Biel & Penske, 2018)
  • Seek professional help if needed.

Additional Resources for Parents:

  • Out of sync child: Recognizing and Coping with Sensory Processing Differences by Carol Stock Kranowitz
  • Raising a Sensory Smart Child: The definitive handbook for Helping Your Child with Sensory Processing Issues by Lindsey Biel and Nancy Peske
  • The Explosive Child by Dr Ross Greene

This blog was written by Sentier therapist, Bridgett Brye, MSW, LICSW.


Bayliff, J. (2021, September 20). The warning signs of sensory processing disorder.

Biel, L. & Penske, N. (2018) Sensory Checklist.

Dion, L. (n.d). Sensory processing disorder in the playroom.

Miller, L. J. (n.d.). Understanding sensory processing disorder. Star Institute. Retrieved June 13, 2023, from

How To Support Transgender People: Tips for Cisgender Allies

How To Support Transgender People: Tips for Cisgender Allies

2023 has already been a record breaking year for anti-transgender legislation in the United States and the American Civil Liberties Union (ACLU) is currently tracking 491 bills that would directly threaten the rights of LGBTQIA+ folks. Examples of proposed and passed legislature include bills that:

  • Restrict access to gender-affirming health care.
  • Restrict access to bathrooms and other public spaces.
  • Restrict participation in sports.
  • Censor LGBTQIA+ topics, history, and terms in schools.

Hearing about these active efforts by the federal government to undermine their rights can take a huge toll on the daily life, mental health, and livelihood of transgender and LGBTQIA+ individuals and communities, including youth who are in crucial stages of their identity development. In a study by the Trevor Project, a staggering 93% of transgender and nonbinary youth reported that “they have worried about transgender people being denied access to gender-affirming medical care due to state or local laws.”

Having one’s identity questioned and challenged so consistently and systematically can have devastating impacts. Last year, 45% of LGBTQ+ youth reported seriously considering a suicide attempt, including more than half of transgender and non-binary youth surveyed.

Blatant attacks on the rights and humanity of LGBTQIA+ and more specifically trans folks can make it a scary time to be a part of those communities, and it is crucial for allies to stand up for the gender diverse people in their life and the larger community whose lives are both directly and indirectly impacted by these policy changes and trends.

Supporting and advocating for the rights of trans and queer people is more than just about embodying the value of unconditional love and support for fellow humans. It is about ensuring the safety and survival of vulnerable members of the queer community.

Below are some tips for allies to show up for their trans friends, family members, co-workers, and strangers.

A note on terminology: “Transgender” is an umbrella term for people whose gender identity and/or expression is different from cultural expectations based on the sex they were assigned at birth. Being transgender does not imply any specific sexual orientation. Transgender is often shortened to “Trans” as it is more inclusive than transgender because it includes transgender, transmasc, transfem, and those who simply use the word trans. “Cisgender” or “cis” refers to folks whose gender identity correlates to their sex assigned at birth.


There are many online resources with more extensive information on vocabulary that allies should familiarize themselves with. Keep in mind that terminology is always shifting and that these words and identities mean different things to different individuals. Parents can read our blog My Teen is Queer – I’m Confused for a breakdown of more terms.

Tips for allies:

  • Never make assumptions about someone’s identity.

You can’t tell by looking at someone what their gender identity or sexuality is. Rather than making an assumption about someone’s identity when you meet them, step back and follow their lead. Use the language that the person uses for themself, and if you’re unsure, ask their pronouns. There is not one way to be or present as trans or queer and it is never appropriate to assume that someone is trans, cis, non-binary, queer, or anything else, based on how they appear.

  • Make gender neutral language your norm.

Make a habit of practicing gender neutral language in your life more broadly. As mentioned previously, there is no way to immediately identify a queer or trans person, and using gender neutral language allows people to feel comfortable and seen in all sorts of settings. “Hi y’all” or “Welcome folks” gets across the same message as “Hi guys” or “Welcome ladies and gentlemen” without excluding or invalidating gender expansive people that may or may not be present.

Everyone uses pronouns, including cis folks! Introducing yourself with your pronouns creates a culture of not assuming things about people and is an act of solidarity to queer and trans folks who may not want to draw attention to themselves by sharing their pronouns when nobody else in the room is. For more information about pronouns and what to do when you accidentally misgender someone, see our blog on misgendering do’s and don’ts.

Avoiding gendered compliments/comments can also go a huge way in avoiding accidentally disrespecting someone’s identity or lived experience. Beyond gendered language in compliments, try to avoid comments about physical appearance generally. More information on how to do that can be found in our blog about giving compliments that are not about appearance.

  • Listen to the trans people in your life and outside of it and make increasing your own awareness a priority.

One of the best ways that allies can show up for trans people is simply by listening and having open arms and ears to hold their stories and experiences. The desire to feel heard and understood is inherent to human nature. Listen and learn from the queer and trans people in your life. If there are not trans people in your immediate communities, seek out content and resources online from queer and trans creators.


Trans people have always existed, all around the world. If you aren’t aware of the history of trans people and trans liberation in the U.S and around the world, do some research, and center trans voices in your sources. If you don’t understand a term or idea related to gender, look it up. In a world where people in power are trying to erase their humanity, listen closely to and affirm gender diverse people here today and the testimonies of those no longer with us.

  • Trans people don’t owe you an explanation.

Listening to trans voices is important, but keep in mind that trans people don’t need to talk specifically about their trans identity or experience for their ideas and thoughts to be respected and appreciated.

It is societally understood that cisgender folks aren’t expected to be bombarded with intrusive questions about their reality, identity, or anatomy, so why would it be okay to ask those questions of anyone else? If it would make you uncomfortable to be asked a question, don’t ask it to someone else. Although someone’s life and identities may be different from yours in ways that may be hard to understand, there is no reason to question or invalidate someone’s gender identity or expect them to justify or defend it.

Trans folks just want to navigate the world safely, and the extent to which they disclose their gender identity, history, and experience to someone is up to them. Respect the disclosures that trans people share with you by not sharing them with others. Again, this is about safety, and it is often a strategic approach for trans people to disclose only certain things to certain people, so take that into consideration when processing what information has been shared with you.

  • Call out transphobia.

Calling out transphobia and other discriminatory or disrespectful behaviors or policies isn’t always safe for trans people. Use your privilege to speak up when you notice something anti-trans. This might feel uncomfortable or unnatural at first, but pushing through that discomfort and addressing something you saw or heard with friends, at work, or out in public, shows that you actively care about creating a world that is safe for queer and trans people.

  • Think about your own gender.

In addition to calling out transphobia you observe in the world around you, be aware of the messages about heteronormativity that you have internalized. This one might not come easily, but taking the time to think intentionally about your own gender will make all of these other things make more sense and come much more naturally.

Similar to the way in which white people can operate for much of their life without thinking about their race because it is seen as the standard, cisgender people may not look as closely at their own gender simply because they have never had to justify it.

Just because your gender identity has not been questioned, policed, or controlled, doesn’t mean that you aren’t able to explore it. Your gender identity is unique to you, and thinking about what it looks and feels like to be yourself can be empowering to people across the gender continuum.

When cisgender is the norm, it can be easy to question or be confused by an identity that falls out of the binary without even thinking about your own. Try asking yourself: “What does it mean to me to be a woman/man/____?” Think beyond answers about gender stereotypes (anatomy, etc.). “What makes me feel secure in my gender identity?” “When do I feel most like myself?” “What sorts of things inform how I present to the world?”

Your gender, just like everyone else’s, is beautiful and unique!

To allies: we need you. Just as lawmakers are attacking our rights through legislation, trans people, particularly Black trans women, are over four times more likely than cisgender people to experience violent victimization.

The news of all of these sorts of attacks can’t be ignored and is deeply impacting the queer and trans folks around you. Let them know you are there, that you care, and commit to building a safer world together.

Blog written by Sentier’s Client Care Coordinator, Ellie Struewing

My Client Just Came Out as Trans or Non-binary. What Should I Do?

A study conducted by the Trevor Project in 2021 found that over one in four LGBTQ youth identify as non-binary. An additional 20% said they are not sure or questioning whether they identify as non-binary.

If you are a therapist and a client comes out during session, here are a few things to keep in mind:

Don’t panic!

You do not have to have all of the answers or know all of the “correct” things to say when working with trans or nonbinary youth. The experience of gender identity and exploration is completely unique to each individual client you work with and they are the expert on themselves. The best thing that you can do as a clinician is to stay open-minded, ask the client about their own experiences with gender and what it means to them, and not let fear of saying the wrong thing or not understanding get in the way of being genuinely present with and validating your client’s experience of their gender.

gender therapy

click to view larger image

Remember the Iceberg

As a clinician, it can be very easy to fall into the idea that when a client comes out, their gender identity is then the main focus of therapy. It is important to remember, however, that gender is just one piece of a person’s identity and the scope and importance of that piece both in their everyday life and in their therapeutic goals varies widely from person to person.

One great way to think about working with transgender and nonbinary clients is by keeping in mind the idea of gender identity as an iceberg (see image). In the same way that we see only the 10% of an iceberg that is above water, clinicians must be careful not to focus only on the obvious topics and concerns around gender–things like pronouns, social transition, medical transition, coming out etc.

While these are all very important topics to touch on and talk about, it is imperative that we as clinicians don’t overlook some of the other underlying and equally important topics that the client is still dealing with. Our clients may come out as trans or nonbinary and still experience depression, anxiety, trauma, ADHD,  academic difficulties, pandemic stress, social stress, and all of the other aspects of being a teenager. Unfortunately, coming out does not negate all of the other factors that could contribute to the myriad of other adolescent mental health struggles.

While gender could be an important topic of focus for some clients, it is not necessarily the main focus for all gender expansive clients. How much a client’s gender impacts their daily life is wholly dependent on the client themselves. There are some clients whose gender and gender dysphoria create significant sources of anxiety and depression for them and their other clients whose gender is just a part of how they identify and the depression and anxiety they experience is completely unrelated to gender. Be careful not to pathologize gender and honor it instead. Someone’s gender and gender exploration is never wrong or bad.

Let your client take the lead

A client-focused approach to therapy allows clients to take the lead in their therapy. If a client wants to use their sessions to talk about gender and transition, it is important to be present with those topics. If a client just came out as nonbinary and is asking you to use they/them pronouns but is more concerned about their physical anxiety symptoms around their AP Physics Exam, then it is important to help them cope with that anxiety. Our clients are the experts in their experiences and it is okay to lean into that when working with them rather than feeling pressure to have “answers”.

Important points to remember.

It’s okay not to know everything! You may be an expert in that you are a trained clinican, but the client is always the expert on themselves and their gender identity.

Trust your clients’ experience–they know what it’s like to be in their brain and in their body.

You’re going to make mistakes and when you do, you can correct them quickly and respectfully without putting pressure on the client to care-take (check out our blog on misgendering do’s and dont’s for more information on misgendering!)

Do your research to stay up to date on gender expansive issues and terminology so that your clients don’t have to spend time teaching out that they would rather spend talking about other things. And be sure to check your sources so that you are getting accurate information.

When in doubt, refer out. While it is important to not shy away from working with certain populations just because you are not used to that work, trust your gut to know when you can’t provide the best care to a client and help them find a provider who can better suit their needs.

Finally, while coming out may relieve some of the mental health symptoms that your client is experiencing it does not magically erase the symptoms or struggles that your clients may be dealing with. Keep looking below the surface so we don’t forget to talk about all the other things going on under the water.


Blog written by Sentier therapist, Ashley Groshek, LMFT

Why Do Teens Vape?

Vaping and e-cigarettes have become increasingly popular and accessible over the last several years, especially among teenagers. Vaping can be concerning for many parents because there is often a lack of information or understanding about what vaping really is, how teens access them, and what to do if you find out your teen is vaping. We hope to break down some of the information for you and provide practical steps to support your teen if they are struggling with vaping.

What is vaping and how does it work?

Vaping is the term used for the use of electronic cigarettes to smoke tobacco. Vapes can also be used for smoking marijuana and have a cannabis oil in them that often contains a high level of THC (NPR, 2021). Unlike regular cigarettes, vapes are battery operated and produce an aerosol by heating a liquid containing nicotine, flavoring, and other chemicals. The liquid then turns in a vapor which users inhale into their lungs through the vaping device.

The battery powered smoking devices have changed and evolved over the years. Some e-cigarettes are made to look like regular cigarettes, but this is more uncommon today. Many of the popular vaping devices used among teens today look like markers, usb drives, or pens. “Vape pen” is a commonly used term for describing vaping devices today.

Why is your teen vaping?

During the rise in popularity of vaping, many device manufacturers developed very attractive, teen-friendly marketing. Packaging of vaping devices are branded to look cool and trendy and more enticing to the teenage brain. A wide variety of flavors exist and many are fruity and candylike. In popular media and movies smoking has never really stopped being cool, just the way in which they smoke has changed to vaping.

It is important for parents to know that many teens believe vaping isn’t as dangerous as smoking regular cigarettes and some even believe there is no harm at all. They believe that the devices are full of mostly flavors and not the addictive and harmful substances.

According to the National Youth Tobacco Survey, the three most common reasons teens vape include:

  1. Because a friend or family member vapes
  2. The wide variety and availability of flavors (mint, candy, fruit, etc.)
  3. Belief that vaping is less harmful than other forms of tobacco

Once teens try vaping, they can very easily and quickly become addicted. Many teens are surprised at how they crave and need nicotine and have intense difficulty trying to quit. Teens not only become addicted to the substance, but also to the idea of vaping as a stress reliever. One popular myth among teens is that vaping reduces stress, which is appealing when school, relationships, and identity exploration can be especially confusing and stressful during this time of life. The action of vaping then becomes associated with relieving anxiety and stress and creates a harmful, addictive cycle of needing to vape in order to manage difficult emotions and situations.

Vaping does not relieve stress and in the long-term, creates more. According to the Truth Initiative, 90% of people who quit vaping felt less anxious, stressed, or depressed.

Another myth surrounding vaping, is the belief that it will help you have more fun and experience more pleasure. Yes, teens are often initially exposed to vaping in a social setting and it can feel exciting to try something new and different. However, vaping in and of itself does not create increased feelings of pleasure or excitement and the consequences of becoming addicted quickly outweigh that initial fun factor.

talk to your teen about vaping

How to talk to your teen about vaping?

Approaching the topic of vaping without judgment is key to creating a space in which your teen is willing to talk about their vaping habit. If possible, try approaching the topic as a listener and learner, wanting to understand the “why” behind why your teen started vaping and continues to vape. This might give you clues to other action steps to take, such as providing more academic resources if they are stressed about school or beginning mental health therapy if they are having difficulty managing their emotions in healthy ways.

Taking a non-judgmental approach can be helpful in keeping communication open with your teen. When teens feel judged or disapproved of, this rarely helps them want to create change, but can actually have the opposite effect and may push them to hide their use from you more.

How can you help your teen to quit vaping?

It might be helpful to approach the topic of quitting vaping by focusing on more short-term consequences rather than long-term. Adolescent brains are wired to think more in the here and now, and fear tactics do not usually prove effective. Focusing on the immediate dangers or impacts, including the cost to keep up the habit and how quickly one can become addicted, are more beneficial than the long-term health effects.

When taking away something in a teen’s life, it is helpful to understand what need that behavior or action was meeting. If you take something away that was meeting a need in their life, it is best to replace it with something else. Healthy distractions, movement and exercise, positive support systems for accountability, and celebrating accomplishments on the quitting journey are all helpful, positive approaches to take. (Truth Initiative, 2023)

When should I contact a professional?

Your teen might need professional help if they express a desire to quit or reduce vaping and have not been successful and/or if vaping is impacting their functioning across multiple areas in their life (i.e. social relationships, school, sleep, etc.).

A licensed mental health professional who specializes in substance use is a good place to start. In a safe, supportive therapeutic environment your teen may be able to start exploring their “why” for vaping, as mentioned above, and then get practical support for quitting.

Other resources include My Life, My Quit and This is Quitting. Both are free and confidential and provide non-judgmental support for helping young people to quit vaping.

If you have concerns about your teen’s physical health related to vaping, it is best to seek medical advice from a physician.

Remember, you are not alone. Most teenagers have been exposed to vaping at some point in their lives. With the right help and support, your teen can quit vaping and develop healthier ways to cope with difficult things in their life.


How to Break Up with Your Therapist

Breakups are tough. We may tend to associate them with friends or romantic partners, but there are certainly other relationship endings that don’t get discussed as frequently and can be just as tricky to navigate. That includes ending a relationship with your therapist.

When is it time to break up with a therapist?

There are many reasons you may find yourself feeling ready to end a therapeutic relationship, including the following:

  1. You feel as though you have met your therapy goals and do not need therapy anymore.
  2. You don’t feel like you’re making progress towards your therapeutic goals with that particular therapist and they are not receptive to your feedback about your therapy sessions.
  3. You feel as though your therapist is not sensitive to your needs, identities, and/or what you bring to sessions.
  4. You do not trust your therapist and don’t feel as though you can be fully honest with them about how you are doing, what you are feeling, and/or what you are looking for.
  5. You and your therapist are not on the same page about why you are in therapy, what your treatment goals are, and/or what approach to therapy you are looking for.
  6. You cannot afford your therapist’s fees.
  7. You are moving out of state for school/work/any other reason.
  8. Your therapist is behaving unethically or inappropriately.
  9. You just don’t like your therapist.

how to break up with your therapist

If you’re considering terminating therapy, it is important to ask yourself a few questions before making a decision:

  • “Why do I want to leave?”

    • If any of the reasons listed above speak to you, expand on those by thinking about what isn’t clicking.
      • What are your therapy goals that aren’t being met? What is it that your therapist is doing that makes you feel uncomfortable or makes sessions unproductive? How has your therapist responded to feedback in the past? What tools have you learned from therapy that are helping you cope and thrive in your daily life?
    • Writing out your answer to this question may be helpful! Having these things in writing is also a good way to help guide a conversation about ending services should you decide to have it.
  • “Can the relationship be repaired?”

    • Therapy is a vulnerable space, and you should feel safe in that space. It is also a great place to practice hard things, and as mental health professionals, therapists are trained to receive feedback and adapt to their clients’ needs. If there are specific things that are not working about your therapy, there may be opportunities to improve on them rather than ending services. If you have specific needs that are not being met in therapy, your therapist wants to know that so that they can better serve you. You may be surprised at how wonderful it can feel to advocate for yourself and have those needs respected by a therapist!
    • If after bringing up your thoughts about therapy, that feedback is not taken seriously by your therapist or you feel that your boundaries have been crossed, that is a clear sign that it’s time to move on.

How to have the conversation:

Okay so you’ve thought about it, and you’re ready to leave your therapist. Here are some things to keep in mind:

If at all possible, don’t ghost them.

  • Maybe your instinct is to cut off communication with your therapist without an explanation, or just to send a brief email stating that you would not like to continue services. If this sounds like you, ask yourself:
    • Does this instinct echo other patterns of avoidance in your life?
    • Could this be an opportunity to safely face the discomfort of confrontation instead?
  • For people who are generally avoidant in relationships or avoid tough conversations, ghosting a therapist may come easily. If this sounds like you, think about challenging this pattern by having a conversation in person or via telehealth directly about why you are leaving.
  • Unlike other settings, therapy is a space where you are encouraged to go outside your comfort zone to communicate how you are feeling. If you find yourself avoiding the breakup conversation, ask yourself why. If you are worried about your therapist’s reaction or hurting their feelings, remember that they are trained for this! They will not be mad at you.
  • The goal of therapy is not necessarily to be comfortable all the time. Difficult conversations and advocating for yourself can be a catalyst for emotional growth.

If comfortable, tell your therapist in-person or at a telehealth session.

  • For therapists who you have only seen a few times, an email is appropriate. But if you’ve been seeing a therapist for a while, chances are they may ask for a termination session, or one more session post “break-up” to wrap up loose ends and provide a place for you to reflect on the work you have done together.
  • You can also tell your therapist via email that you have decided to stop seeing them and that the next session will be your last. That way, they know ahead of time and can plan for the last session and make room for you to give feedback.
  • Having a termination session with a therapist allows you the space to share your thoughts about the therapy and allows the therapist to have a sense of why you are leaving which will help them develop and improve their own practice. Therapists are trained for this. Your well-being is their priority, and therapists value feedback in order to be better providers.
  • You don’t NEED to have a termination session. That being said, if anxiety around hurting your therapist’s feelings is what is holding you back from doing so, I’d encourage you to be brave and do that session.

You are in charge of how much you say.

  • At the end of the day, you are in the driver’s seat. Trust your gut and do what feels safe to you in the moment.
  • If you feel unsafe, you do not need to tell your therapist why you are leaving. If there is any fear of safety, either physical or emotional, you do not need to tell your therapist in-person or in detail about why you are leaving. If you feel as though your therapist has made an ethical violation, you can also make an anonymous report through the governing board of their licensure (LICSW, LPCC, LMFT, etc.)
  • If you can’t afford services, you can inquire with your therapist about whether they offer sliding scale fees. If not, you can ask them for referrals in the area that do.
  • If you are moving out of state, check with your therapist to see if they are dually licensed in the state you are moving to. If not, ask for referrals for therapists in your new area

Things to keep in mind:

  • There are SO many different kinds of therapy, and unless you get really lucky, you might not find the perfect fit on your first try. It can be a lot of work to find a therapist and effective treatment style for you, but there are location-specific resources out there to help tailor your search to providers who can fit your needs.
  • Therapists should not try to change your mind or get defensive if you tell them you would like to end services. It is natural for them to ask questions, but they should not be trying to convince you to stay. If they do, this is further evidence that they are not the right fit.
  • Trust your gut. Only you know whether it is time to end the relationship and whether that therapy is right for you. Instincts are powerful.

You’ve got this! Therapy can be a beautiful experience, and by trusting your gut with a provider, you can direct your therapy path into the right place for you.