How Social Media is Affecting our Teens

Jan Hamilton, Founder, Doorways Teen Counseling and Psychiatric Services Phoenix ArizonaBy Jan Hamilton, MS, PMHNP

Psychiatric Nurse Practitioner


Since computers starting coming into the home and video games left the arcade, parents have expressed concerns about how much is too much and how these virtual interfaces will impact the lives of our children over the long term. For years, the main concerns around overuse of electronic media have centered on physical activity levels, studying, and the effect of violent, sexist, and racist themes on young minds. Recently I was asked my thoughts on the impact things like Facebook, Twitter, and video games are having on today’s youth. My answers might surprise you.

One of the main problems that I see is an increase in teens and young adults with significant social anxiety problems that seem to stem from spending too much time interacting with a computer and not enough time interacting with actual people. I call this “Social Phobia.” This is especially pertinent for teens that are in the 12 to 15 year old range that are actively developing and refining the social skills that will help them throughout their lives.

The more time a child spends in isolation posting on Facebook, playing Xbox, chatting online, texting, and watching YouTube videos, the less time they spend interacting with their peers and families. These real-world interactions are necessary for developing social skills, understanding social protocols, and building interpersonal relationships.

What Parents Should Look For

  • Parents should trust their instincts and if they are concerned there might be a problem, seek the opinion of a professional.
  • Parents also need to make the distinction between what is normal behavior and what is healthy behavior. Your son might spend 12 hours a day playing video games which seems normal when compared to his friends, but most health professionals would agree that even if it is normal, 12 hours of video game play in a day is definitely not healthy.
  • Watch for resistance to social situations and avoidance of social interactions. If your child is having a significant emotional response to a situation that requires social interaction, there may be a social problem that needs to be addressed.

What Parents Can Do

  • The most important step parents can take is to start young. Set expectations and ground rules about media use early in childhood which will help your child develop good habits as they grow into teenagers.
  • Provide multiple social outlet opportunities for your children through church, community, sports, and educational activities. But, beware of over-scheduling, children need downtime too.
  • Don’t accommodate their anxiety; it’s ok for them to be uncomfortable in social situations because they are learning how to manage those types of interactions. Giving in and allowing them to avoid socializing only reinforces the avoidance behaviors.

How Do You Know When Your Teen’s Warning Signs are Really Red Flags?

By Jan Hamilton, Founder, Doorways Teen Counseling and Psychiatric Services Phoenix ArizonaJan Hamilton, MS, PMHNP-BC


For parents with children who are suffering from a mental illness, it can be very difficult to know when their child’s problems are typical and manageable, and when those problems begin to endanger other people.

There are warning signs you can watch for if you are concerned that there may be something going on with your child that might endanger themselves or others.  Here are four tips parents can use in these difficult situations.

1.     When Something Feels Off, Pay Attention

As parents, we know our children better than anyone and the most important thing you can do is to trust your instincts.  If something feels off, check it out.  If your child’s behavior seems to change overnight or they suddenly stop participating in things they used to enjoy, talk to them and don’t stop talking and listening until you find out what is going on.

2.     Challenges with Peers

Often times, the peers of teens who act out in dangerous ways or harmed their families also sensed something was off or strange about them.  If your child is having difficulty interacting with their peers, getting bullied, or having trouble fitting in with others in their age group, seek a second opinion.  Often, as parents, we are too close to form an objective opinion about whether our child is struggling to fit in because they have some social anxiety, a few extra pounds, or braces and when their peers avoid them because they sense they are anti-social, odd, or dangerous.  Someone outside the situation can provide valuable insight into what is normal and what needs immediate attention.

3.     Keep Lines of Communication Open

One of the biggest challenges every parent faces is keeping communication going when times get tough.  Often, the times when our children need us the most are also the times they are least likely to seek our counsel or ask for our help.  Create safe spaces for your child to open up about things you don’t approve of so that they don’t let small problems become life-altering situations simply because they didn’t want to get in trouble.  Remember that communicating is a two way street and that you need to listen at least as much as you talk.

4.      No Such Thing as Perfect Parents

Remind yourself that there is no such thing as perfect parents or perfect children.  Be the best parent you can and provide your children with a solid foundation, room to learn to make mistakes, and opportunities to make decisions, even bad ones.  Be there for them in whatever ways you can when they falter but remember that they have free will and they are going to make their own choices.  Even amazing parents can have children who make very bad choices.   But, the opposite is also true, even when parents seem to do everything wrong, most adolescents turn out to be amazing, wonderful adults!


Jan Hamilton, MS, PMHNP-BC

Jan is a nationally Board Certified Psychiatric Nurse Practitioner who specializes in adolescent treatment.  She earned her Master’s of Science and Psychiatric Nurse Practitioner certification through the University of Arizona. She then worked for over eight years at Remuda Ranch providing inpatient services for adolescents and adults suffering from eating disorders. Jan has been a registered nurse for 31 years and worked in a wide variety of medical settings, including 30 years of serving young people through her work with Young Life, an interdenominational outreach program. Her desire to provide quality psychological and psychiatric care for adolescents and young adults in an outpatient, faith based setting has led to the opening of Doorways in 2008.

Reasons Why Teens Today Are Under So Much Stress

Many parents don’t fully understand why the lives of their teens are so very stressful. However, the topic of stress is so important that the entire month of April is designated as National Stress Awareness Month. So, let’s spend April reflecting on what causes stress in our teens and young adults.

Teenage Sleep Deprivation

Modern-day school life denies teenagers the 8-10 hours of sleep recommended by the National Sleep Foundation. Brown University School of Medicine surveyed 3,000 high school students and found that they only averaged about 7.5 hours of sleep on a school night. Sleep deprivation was found to be more pronounced in boys than in girls. The sleep problem is compounded by teenage circadian rhythms that are approximately two hours behind those of adults. This turns your teenager into the night owl that you recognize and results in the hard morning task of getting your teen out of bed to get to school on time. Sleep deprivation in teens can lead to performance decline, memory lapses, mood swings, and other behavioral problems.

“Sending kids to school at 7 a.m. is the equivalent
of sending an adult to work at 4 in the morning.”

-William Dement,
Stanford University Professor of Psychiatry and Behavioral Sciences.

Teenage Hormones

Teenage hormones and the strong emotions they release in your teen may be causing you parental stress. However, try to recall what it was like when you were a teen carrying around that burden of emotions 24/7. And it’s not only hormones – your teen may also have to deal with rapid growth spurts, acne, periods, and unreliable vocal cords. Trying to cope with these changes can trigger anxiety and depression. A National Institutes of Health (NIH) study found that major depressive episodes in adolescents went from 8.7 percent in 2005 to 11.3 percent in 2014, with adolescent girls suffering more than boys.

Teens Don’t Own Their Lives

Many aspects of students’ lives are decided for them – what subjects they study, what they wear to school, what schedules they must follow. Adults have much more autonomy to do as they please, but if teenagers try it, they are regarded as being rebellious. In addition, many parents add to a teen’s stress by expecting perfection in everything. The Journal of Psychoeducational Assessment found that students find school to be more enjoyable and are more motivated to try harder when they are allowed to set their own expectations.

Struggle for Identity

The struggle to find out who they are is hard on teenagers. Peers, parents, teachers, and society are all giving them messages on how they should behave in order to feel accepted and valued. The University of Illinois Department of Psychology conducted a study of 500 adolescents and found that peer-related stress undermines their social security and identity and contributes to depression. Stressful events may include everything from a friend’s death to physical fights to not being invited to a party. Girls are more sensitive to the opinions of peers because they put more emphasis on interpersonal connectedness than do boys.

Uncertain Futures

As a teenager you probably didn’t worry about joblessness and lack of financial security; you naturally expected that a well-paid job would be available to you. Unfortunately, the future job market is much more uncertain. With increasing globalization and the growing use of artificial intelligence, students in high school and college are caught up in a world where economies and labor markets are being uprooted. Cathy Davidson, wrote a book entitled Now You See It: How the Brain Science of Attention Will Transform the Way We Live, Work and Learn, and forecast that sixty-percent of students now entering grade school will eventually have jobs that have not yet been invented. While this is an exciting prospect, it makes it hard for a student to plan for the future – and this can be terrifying.

Help for Your Teenager or Young Adult is Available

This article has discussed just some of the modern day stresses placed on today’s teenagers. If your teenager or young adult is trying to cope with stressors that are causing acute anxiety, depression, or behavioral problems, Doorways is here to help you. You don’t have to struggle on your own – give us a call to find out how our support can help you and your teenager.

Help Your High-Schooler Manage Stress with these 4 Easy Tactics

High school is full of challenges, academic and otherwise, that can add up to some serious stress for your teen. They’re tackling homework and navigating complex social dynamics, all while balancing time spent with friends, family, and on activities. The demands and schedule might start to feel overwhelming. As the parent, helping your teenager navigate these rough waters is crucial.

Here are some tactics to keep your high schooler from feeling overly stressed when they’re swamped with school work and obligations:

1. Tackle tough homework incrementally.
A large project can sometimes feel like an impossible hurdle, especially if your teen struggles with organization or focus. Instead of jumping straight in, encourage your teenager to break the assignment down into more manageable pieces. Start with a brainstorming session one day, research the next, and so on. This will help the project seem much more achievable. Then, your high schooler can keep a To-Do list of the various steps and check things off as they get completed. Each time he or she gets to tick a box they will feel less stressed about the impending deadline.

2. Familiarize before diving in.
The unknown or unfamiliar can leave teens feeling uneasy. If your high schooler is diving into a new opportunity – a part-time job, an internship, a new club or group — help them to familiarize themselves with what is to come. Check out websites, visit the location, or meet with someone already involved. If their new venture feels familiar it can cut back on your teenager’s nerves about the unknown.

3. Keep things organized at home.
Returning home to a disorganized environment with little structure can have a snowball effect on a teen already stressed after a jam-packed day of high school. Help your teen to create order in his or her room and the rest of the house as well. Make sure your high schooler has a neat and tidy space to work on assignments. Display a calendar with activities and obligations in the kitchen. Establish a predictable framework for after school hours and weekends, too. Disorganization and lack of a clear plan can cause many teenagers to feel apprehensive and distressed.

4. Offer stress relief opportunities.
If your teen needs to relieve some stress, give them the space to do so. Encourage them to tap into activities that make them feel better when school and responsibilities become overwhelming. They might love playing an instrument or writing poetry or riding horses. Whatever gives them a release and brings them joy is worth exploring. And while your teen may not be a varsity athlete, consistent exercise is a wonderful antidote to stress. Help them find an exercise outlet they enjoy. If team sports aren’t their thing, they could always try swimming, dance, or long walks around the neighborhood.

If your high schooler needs additional help with stress management, we encourage you to speak to the staff at Doorways to find out if our services might be the right fit for your family. We provide counseling and psychiatric services exclusively for teens, young adults, and their families in the Phoenix, Arizona area. Each of our staff is dedicated to the specialized needs of high schoolers and committed to the compassionate understanding of their struggles.

How to Help Your Family Prioritize Mental Health After Disaster

In light of the recent hurricanes, earthquakes, and fires which wreaked havoc on our globe; we thought it was important to discuss why and how to help your family focus on mental health after disaster strikes. The victims of these unprecedented weather events remain in our prayers. Their strife serves as an important reminder about disaster preparedness. No doubt families around the world watched the news with heavy hearts but also found opportunity to discuss the details of their emergency plans. Physical safety is of the utmost importance when it comes to natural disasters. Evacuation is often necessary and heeding warnings from authorities is key. But as people trickle back into the affected area, and news crews pack up and go home, the real work begins. This road to recovery is often overlooked.

After a natural disaster, recovery starts as businesses and schools begin to reopen. Returning to a normal routine is a great first step for prioritizing mental health. Your family’s routine, along with making sure everyone’s basic needs are being met (plenty of sleep and enough food) will go a long way. However, healing is a process and we have a few more recommendations that could help:

A mix of emotions is normal. After a natural disaster, your family will likely experience an abundance of emotions. You are grieving for your town, your house, or your own sense of normalcy and safety. You might feel shocked, sad, angry, anxious, or all of these (all at once!). But you don’t have to sit with these feelings in silence. Talk about how you’re feeling.

Take breaks from the news. Has your family been glued to the news for days? Take a break. You’ve been living and breathing this natural disaster 24/7 and keeping up-to-date too. It can become overwhelming. Especially when the news focuses on tragic outcomes and horrific effects. So give yourself a little space each day. Lead by example and put your phone on silent, close down your laptop, and turn off the television. Instead, do something that brings you joy. Encourage other members of the family to do the same.

Get out of the house. If it’s safe to do so, remove yourself from the lure of news channels and spinning thoughts. Whether your family is feeling physically trapped, by loss of power or a long stint indoors as the weather rolled through, or emotionally trapped, by sadness weighing heavy on their hearts, offer a way out. Visit a friend or a business that’s reopened. Even a walk around the block will work wonders to help all of you feel less cooped up and to begin processing.

Help out where you can. As each of you processes your feelings, you may feel called to give back. Helping out where you can is a great way to turn hopelessness into hope. Research ways you can give back to your community as a family. Is a shelter in need of bed linens? Could a blood bank use donations? Was there a call for volunteers to help with cleanup efforts? Anything you do will not only prioritize your mental health but the mental health of the people in your community too. Any act of giving, even if it’s just being there for someone who is feeling down, will feel good. But keep in mind, you can’t take care of others without taking care of yourself.

No one wants to experience a natural disaster. However, being prepared in case you do is key and being prepared for the recovery process is just as important. By prioritizing your family’s mental health in the wake of disaster, it is our hope that your road to recovery will feel a little less difficult.

Managing Back-To-School Anxiety And Pressure

For teenagers returning to high school, or young adults beginning college, starting a new school year often comes with a lot of stress and anxiety.

Gone are the days of a relaxing summer spent with friends outdoors and easy-going vacation time. With today’s competitive society, many teens and young adults feel pressure to find an internship, practice for standardized tests, or continue to study through the summer. Add to that the pressure of social media, with many experiencing the feeling of FOMO (Fear Of Missing Out) when seeing all the fun things their peers are doing during the summer. It can lead to feelings of self-doubt and worry.

A parent might begin to see some troubling patterns emerge from their anxious teen. Patterns of anxiety can be internalized or externalized. Internalized anxiety may include insomnia, excessive headaches or stomachaches, changes in eating, moodiness, and lashing out. Externalizing anxiety can include partying, consuming alcohol, doing drugs, playing hours of video games, or watching TV excessively.

When should a parent be concerned? It’s the duration of the behavior that can be troubling. A headache from stress is normal. When it is days or weeks of headaches, or other troubling behavior, it’s time to intervene. Here are some suggestions to help guide your teen with stress:

  • Make sure your teen or young adult is getting the sleep they need. According to the National Sleep Foundation, teens need about 8 to 10 hours of sleep each night to function best. Most teens do not get enough sleep — one study found that only 15% reported sleeping 8 1/2 hours on school nights. Getting the right amount of sleep will help with their mood and agitation level.
  • Manage your own expectations and stress. It’s okay if your teen doesn’t make the team or get the lead in the play. Don’t allow your own stress to become theirs. Being a parent means helping your teen overcome failure and disappointment. They will face many challenges going forward in life, so this is the time to help them cope with issues as they arise.
  • Keep the lines of communication open. Help them navigate their feelings of being happy, sad, disappointed, frustrated, etc. Don’t just ask them about their studies or grades. Ask them how they felt about their day. Ask leading questions that will encourage dialog and sharing.
  • For teens still living at home, limit their digital time. Being connected at all hours to social media, or the internet, can compound the feelings of stress or inadequacy. It can also lead to “digital insomnia”, whereas the light from televisions, phones, and computers is processed by our bodies is similar to the way we process daylight. This leads back to teens not getting the sleep they need to be healthy and less stressed.
  • Set your teen up for success with goals and achievements they can accomplish. This will help build their self-esteem and guide them through the feelings of inadequacy. Creating mini-goals that are not time consuming, but affirming their skills and knowledge, will help them feel good about their achievements.
  • If your teen has turned to drinking or drugs to deal with the stress and anxiety, it may be time to get professional help. According to The National Center on Addiction and Substance Abuse (CASA), the studies found that highly stressed teens, compared to low-stressed teens are much more likely to become involved in substance abuse. If you see troubling behavior that suggests problems with alcohol or drugs, get help immediately.

Going back to school, or starting a new one, is never easy for teens and young adults. As with any new beginning, it can lead to stress and worry, which are expected. By guiding your teen, being alert to their behavior, and keeping the lines of communication open, it can be the start of a whole new adventure on the path to success.




Help Your Teen Manage the Stress of High School

Teens are increasingly finding themselves stressed out. The American Psychological Association, reports that stress is incredibly common among teens. And, it comes as no surprise that teens’ biggest source of stress is school. As a parent, find out how you can help your teen identify and manage their stress.

Doorways Arizona Blog: Help Your Teen Manage the Stress of High School

The American Academy of Child & Adolescent Psychiatry identifies several teen stressors which include:

  • Issues with others at school
  • Internal feelings about themselves
  • Living in an unsafe area
  • Parent’s separation or divorce
  • Body changes
  • Death of a loved one
  • Financial problems at home
  • Recent move or school change
  • Family health problems
  • Being involved in too many activities
  • Setting extremely high standards for themselves

If your teen is struggling with stress from these pressures, it is important that they learn how to manage that stress instead of shutting down or coping in a way that is unhealthy.

Here are some healthy ways from the American Psychological Association for your teen to manage that stress:

  1. Exercise. This is one of the most effective ways to cope with stress. Keep in mind that exercising doesn’t just mean going for a run. Make it fun by getting a few friends involved. Try activities like yoga, skateboarding, hiking or kayaking.
  2. Find a Balance. What we mean by this is don’t just focus on school work, but also make having fun a priority.
  3. Getting enough sleep. This one is huge since most teens don’t get enough sleep as it is. Sleep is necessary for our physical and emotional well-being. To get to sleep, minimize caffeine intake later in the day as well as screen time close to bedtime.
  4. Do things that you are good at. By doing this it helps you focus on your strengths so that stresses can be put into focus.
  5. Do things you enjoy. Find a hobby. This could be watching movies, listening to music, or art.

Parents can help by encouraging the above things. Additionally, pay attention and listen to your teen. Make sure they are not over loaded with school and activities. Look for signs that stress isn’t being managed. Also, encourage your teen to talk you about their stress.

If you find that your teen’s stress still isn’t manageable then maybe it is time to talk to a mental health professional.

3 Questions About Self-Injury You Should Be Able to Answer as the Parent of a Teen

March was Self-Injury Awareness Month, which is a time reserved each year to increase awareness of teenage self-injury, and help teens who suffer from this harmful compulsion to feel supported enough to seek help.

3 Questions About Self-Injury You Should Be Able to Answer as the Parent of a Teen

While March is a month dedicated to awareness and support for those practicing self-injury, this is a condition that can impact your teen any time of the year. As the parent of a teenager, you undoubtedly want your teen to be safe and healthy as they continuously grow and mature toward adulthood.

Here are three questions about self-injury that you should know how to answer so you can make sure your teen is living a safe and healthy life, and is not inflicting harm upon themselves:

  1. What is Self-Injury?

According to the Mayo Clinic, self-injury is the non-suicidal act of purposefully and repeatedly harming your body through some type of mutilation. This condition can present in many forms, such as:

  • Cutting slits into the surface of the skin, and drawing blood
  • Burning the skin with lighters, matches, or cigarette butts
  • Punching or hitting yourself
  • Picking at skin to the point of bleeding
  • Drinking harmful liquids such as paint, glue, or bleach
  • Pulling large portions of hair out of the head
  • Excessive exercise or starvation attempts
  • Excessive alcohol or drug use

Teens who self-injure often do so to achieve an emotional release from feelings of stress, anxiety, sadness, or rejection.  While self-injury is not an attempt at suicide, it can have lasting mental and physical health implications is left untreated.

  1. What are signs my teen might be hurting themselves?

Due to feelings of fear or shame, most teenagers will not usually come forward or seek help for their self-injury habit. However, there are some signals and symptoms of this harmful disorder that you can know and recognize to help keep your teen safe from themselves, and intervene should you discover they are harming themselves.

According to the National Health Service, these are the most common signs of self-injury:

  • Unexplained burns, cuts, bruises, or scabs on the body (particularly on the wrists, arms, legs, and stomach)
  • Patches of missing hair that look to have been pulled out
  • Wearing long sleeves, even in hot weather
  • Loss of interest in school, family, or friends
  • Depression or self-loathing
  • Self-blame and expressions of feeling inadequate or unworthy
  • Unusual weight loss or weight gain
  • Changes in eating or sleeping habits
  • Drug or alcohol abuse


  1. How can I help my teen if I suspect they are practicing self-injury?

If you begin regularly noticing any of the symptoms of self-injury, it is important to intervene and try to help your teen immediately.  Mental Health America suggests the following things you can do to help your teen if you think they are purposefully injuring themselves:

  • Don’t wait for your teen to come to you. Bring up the topic yourself, and express love and support for your teen.
  • Listen to your teen, and encourage them to speak openly with no fear or shame.
  • Let your teen know they are not alone and that they can get better, and offer options for helping them overcome self-injury actions.

While self-injury is not typically an attempt to commit suicide, teens can easily take their self-injury too far, and seriously harm themselves. It is very important that you seek professional help for your teen if they continue to injure themselves after you’ve intervened and tried to help as a parent. A professional counselor or therapist can help you both deal with your emotions, and get back to leading a healthy, safe life.



Teen Cutting: Everything You Should Know as the Parent of a Teenager

As your teen is developing and begins to experience more complex emotions within themselves, they will look for support, understanding, and outlets in the immediate world around them. This world typically includes family, friends, and social media as main influences that shape your teen and aid in their decision making as they grow toward adulthood.

Teen Cutting: Everything You Should Know as the Parent of a Teenager

Many of the outlets and explorations teens engage in to better understand themselves are perfectly normal and healthy experiences for them. However, there are also many unhealthy patterns and behaviors teens can develop. A disturbing trend of emotional outlet developing among many teenagers is self-injury through cutting.

What is Cutting?

According to Teens Health, cutting is a form of non-suicidal self-injury (NSSI) in which a teen purposely harms themselves by using a sharp object make cuts on the skin of their arms, wrists, legs or stomach. Some teens might also engage in NSSI by burning their skin with a match, lighter or cigarette.

What Parents Should Know About Teen Cutting

As the parent of a teen, you know that teenage emotions and behavior can lean towards the erratic and dramatic. In many instances, occasional dramatic outbursts and emotional struggles are a perfectly normal part of your teen’s growth and development.

However, there are some warning signs you can look for if you notice your teen is consistently struggling emotionally, and suspect they might be dealing with their feelings in a harmful manner.

According to WebMD, David Rosen, who is professor of Pediatrics and director of the Section for Teenage and Young Adult Health at the University of Michigan, says these are common warning signs that teens are cutting:
• Small, linear cuts on the skin
• Unexplained scratches or cuts, which appear on a regular basis
• Drastic changes in mood such as depression, anxiety, performance at school
• Changes in friendships or relationships

As time goes by, teen cutting can escalate and occur more and more often. While it may not be intentional, this escalation can often lead to more serious injuries.

Why do Teens Cut?

Cutting is typically an attempt to control or relieve feelings of anxiety, stress, or sadness. The reasons that a teen cuts can vary based on their personality, emotions, and stressors. However, according to WebMD, some common triggers include uncontrolled feelings of:
• Stress
• Anxiety
• Sadness
• Confusion
• Overwhelm
• Hopelessness

Additionally, a study published in the Journal of Adolescent Health, has identified that cutting may be stemming from a desire to belong or fit in, as it has become a trend and a community on social media. During this study, researchers conducted a search on the hashtag #selfharmmm, and then developed a list of other hashtags used along with it. They found these other hashtags were used as a code to signal posts from people who participate in self-injury:
• #blithe
• #cat
• #selfinjuryy
• #MySecretFamily

What You Should Do if Your Teen is Cutting

In an interview with US News and World Report: Health, Wendy Lader, the president and clinical director of S.A.F.E. (Self-Abuse Finally Ends) Alternatives in St. Louis, Missouri, offers these “do’s and don’ts” for parents who suspect their teen is cutting.

• Only engage in a conversation over cutting with your teen while you are calm, and address the matter from a nonjudgmental, concerned stance.
• Be open to listening and talking to your teen about their feelings.
• Share your own feelings, and let your teen know you struggle as well so you can work through things together.
• Engage or respond in a conversation while you are upset.
• Feel guilty or blame yourself for your teen’s behaviors.
• Ignore the warning signals and avoid bringing up the topic with your teen.
• Focus on the self-injury. Instead focus on the feelings driving their actions.

If your teen has been experiencing extreme emotional struggles, and you have discovered or suspect they are self-injuring through cutting or other means, you may feel overwhelmed yourself. It is a great idea to seek out the help of a professional teen therapist who can help you and your teen identify and manage the feelings, emotions, or issues causing the cutting.