One Thing Mental Health Practitioners Who Work With Teens Must Know

Meeting teens where they are is crucial in supporting their mental health. Lora Henderson, an expert clinical psychologist, shares why using culturally responsive approaches in therapeutic settings matters.

By iThrive Games
April 21, 2022

This post is the next in our series, Supporting Teen Mental Health, which shares tools and insights that support educators, parents, and youth-serving adults in showing up for teens in this moment of need. Read earlier posts in the series about mindfully managing difficult emotions, using social media actively and intentionally, and nurturing the teen brain with school-based social and emotional learning opportunities. 

Teens' mental health difficulties and needs have peaked since the start of the pandemic, culminating in what leading U.S. child and adolescent health organizations have deemed a national emergency. As mental health practitioners strive to meet diverse teens where they are at this time of crisis—in part one spurred on and exacerbated by racial inequities—they need tools and approaches that offer authentic entry points for building rapport and trust. 

The U.S. Surgeon General's 2021 Advisory, Protecting Youth Mental Health, stresses the need to "recognize that a variety of cultural and other factors shape whether children and families are able or willing to seek mental health services. Accordingly, services should be culturally appropriate, offered in multiple languages (including ASL), and delivered by a diverse mental health workforce." Using culturally appropriate tools and approaches invites teens and their families to engage as equal partners in improving and maintaining young people's mental health. Critically, this approach also amplifies and celebrates existing strengths and connections that are unique to each young person's cultural background and social network. 

At iThrive, we've witnessed how games can be a powerful part of culturally responsive approaches to supporting teens' social and emotional skills, which are critical for mental health across the lifespan, both in schools and in therapeutic settings. That's because games of all kinds have the power to tell compelling stories, not just about the characters within them but about the players who play them, revealing truths about who they are and the world they inhabit. As one high school senior said of iThrive Curriculum: Museum of Me, our unit based around the game What Remains of Edith Finch: "You learn some things about yourself and others. It's nice to know that your [sic] not alone in seeing yourself a certain way. It's kind of relieving to know other people feel the same ways about themselves."

In an effort to help youth-serving practitioners better support teens with culturally responsive tools and approaches, iThrive's Senior Director of Learning Michelle Bertoli  interviewed Lora Henderson, a licensed clinical psychologist, former educator, and assistant professor at James Madison University who specializes in supporting the mental health of young people in underserved populations. In the interview transcribed below, she shares best practices and tools — including game-based approaches — for engaging authentically with diverse teens in support of their health and healing. The interview has been edited for length and clarity.

Michelle: In your own work, how do you identify and define culturally responsive tools and practices?  

Lora: I work at the intersection of education, mental health, and social and emotional learning. I define culturally responsive practices, or CRPs, as actions practitioners can take to build on students' strengths and cultural frames of reference. In the classroom, this might mean drawing connections between the curriculum and students' home lives and cultural experiences. In a clinical setting, it might include showcasing materials, games, books, and posters that reflect students' cultural backgrounds and experiences. 

Michelle: And how do you get a sense of what's going to be culturally relevant and useful to students? It takes time to get to know them and you don't want to make assumptions.

Lora: Yes, that can be difficult because you don't want to fall into stereotypes about groups. We often go into our interactions with children and families with our own biases and assumptions about their cultural groups. Sometimes those things map onto their experiences and other times they don't. So, I do a lot of building relationships with kids, asking them what they did over the weekend, how their family celebrates holidays. Those small things aren't therapy, per se, but are really important to getting to know kids and their families and what culture means to them and looks like in their own contexts. 

Michelle: At iThrive, we design our games and game-based tools with equity, representation, and accessibility as core pillars. From a practitioner's perspective, how do these design principles make a difference for supporting teen mental health and well-being?

Lora: We can expect youth to have improved outcomes when they can connect to the materials, games, or information being shared with them. When we design with youth, put them at the center, and make them experts, like everyone at iThrive really does, it can maximize positive youth engagement with the tools you're creating. At iThrive, it's a bidirectional process: the youth designers get to build social and emotional skills and increase their well-being, and peers who play the games also get to learn from the youth designers' expertise and experiences. That process can have large positive effects for the designers and their peers alike. 

Michelle: What tools, including games or game-based approaches, do you use to strengthen young people's awareness and embracing of their cultural identities? 

Lora: From my time as an elementary school teacher to my current role as an assistant professor and licensed clinical psychologist, my first job is to build rapport and authentic relationships with youth. All of the other positive outcomes are couched in that initial positive relationship that creates a safe space for youth and families to feel accepted. That's how I demonstrate my respect, openness, and acceptance of their cultural identities. In my classroom and therapy office, I ensured that the books, pictures, and posters reflected the diversity of my clients so that youth could see themselves in my office and know that it was a safe space to be themselves. 

In therapy, I play lots of tabletop, board, and card games with youth. As one example, I've played a lot of Spades with Black families who play it at home, to bring an aspect of their culture into the room. I have emotions/feelings playing cards, so as we're playing Spades, and they get a "9" with an angry face on it, we talk about times when they were angry or observed someone else being angry, and how they managed those feelings. I really like to incorporate games that youth are already playing and then infuse mental health and social and emotional components into them. In in-patient settings, youth have taught me card games that they learned while in the hospital or juvenile detention. I let them lead the play. It's one way I demonstrate that I accept and value their lived experiences.

Michelle: How has embracing your own cultural identity as a practitioner helped you hone your professional skills? How have games played a role in this?

Lora: As a Black woman, I have had to examine my own biases and experiences to help me acknowledge the systemic racism that I experience in this country AND the privileges that I have as an employed, cisgender professional with a doctoral degree. While games have to be facilitated thoughtfully and in a sensitive way, gameful activities like "Step in the Circle," "Cross the Line," "Four Corners," and the "Privilege Walk" have helped me with my own personal exploration. I have moved away from the "Privilege Walk" activity because it visually moves privileged individuals ahead and those with less privilege behind and can perpetuate bias, but it was a meaningful activity for me when I did it about 10 years ago. It was the first time that I was really able to reflect on my privileges and challenges as a Black woman. The other activities that I mentioned still have the visual component of stepping into the circle, crossing the line, or going to the corner that aligns with youth experiences, but they remove the cumulative visual effect of moving further ahead or further behind.

Michelle: How would you recommend other clinicians who are not as practiced in culturally responsive approaches with young people begin to build those muscles?

Lora: The best way to become more culturally responsive is to engage with youth and listen to them. Reading the literature and learning about cultural responsiveness, humility, and competence is important, and still there's nothing like just talking to youth. Inevitably, they'll tell you that it doesn't work exactly how it's explained in textbooks or scholarly articles. 

But before talking to youth, anyone who wants to be culturally responsive needs to engage in self-reflection about their own biases and assumptions about people from other cultural groups. It can help to have a group that you talk to about these things for accountability and outside perspectives. I can't stress how important doing that personal work is before stepping into work with youth. We don't want them to be our test subjects or to cause unintentional harm by doing things we think are culturally responsive but might be missing the mark and actually doing harm. 

Talk to youth about what they like to do, what they enjoy, how they celebrate holidays. Get to know them in an authentic way.

Michelle: How can practitioners manage the fear or uncertainty they may have about making mistakes or unintentionally doing harm when striving to be more culturally responsive?

Lora: I think mindfulness-based techniques are really helpful. If you feel yourself getting nervous or unsure, stop and take a few breaths. Center yourself and remind yourself why you're doing this work. So many of us go from meeting to meeting to facilitating a workshop, etc. Sometimes just taking that breath can help settle your nerves and get you ready for those intersections.

Also, I think it can be fine and even acceptable to acknowledge differences between youth. You can highlight both obvious differences and similarities to help youth notice commonalities they share. Let youth know that you're trying, that you're maybe from a different cultural background and you might stumble, and you want to know about it if you do so you can do better next time. You need a safe space, too, in order to learn when you've made a mistake. It all comes back to authentic relationships because if you don't have that and you miss the mark, youth won't tell you. They might keep trucking along with the program or activity but the outcomes may not be as positive as they could have been.

Michelle: What are some resources you would recommend to practitioners who want to learn more about culturally responsive practices?

Lora: I lean heavily on the Double-Check framework. It's from education but applies in therapy as well. A shorthand tool it uses is the acronym CARES: Connections with curriculum, Authentic relationships, Reflective thinking, Effective communication, and Sensitivity to students' cultures.

For people who want to go even deeper, I also recommend this review of CRPs from an education perspective. 

Michelle: Thank you so much for your time and insights, Lora!

[End of Interview]

Mental health practitioners seeking to find new ways to meaningfully engage and support teens from a diversity of backgrounds can also find inspiration in iThrive's Game Guides, which highlight unique ways to check in with teens and touch on their emotional experiences through the lens of some of their favorite games including Minecraft, Fortnite, and Super Smash Bros. Ultimate.

iThrive's Game Design Studio Toolkit is another rich resource for using games as systems to engage teens in complex, aspirational thinking that has its roots in awareness of their unique personal experiences. Individuals who aspire to something even more innovative can also make use of iThrive's design services to envision and realize completely fresh game-based approaches. 

What are some ways you use games or game-based approaches in therapeutic interactions with young people? Let us know at!