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Hosted by James Kennedy, PMHNP-BC and Jon Murphy, PMHNP-BC, Compass Point Institute is a clinician-led podcast for psychiatric providers, therapists, and the future of mental healthcare.
We break down the real-world clinical issues that matter—ADHD, trauma, pharmacotherapy, professional advocacy, and more—through grounded dialogue, lived experience, and evidence-based insight.
Disclaimer:
This podcast is for educational and informational purposes only and is not a substitute for professional mental health advice or treatment. The views expressed are my own, drawn from clinical experience and personal perspective. If you’re in crisis, please seek support from a licensed professional or emergency services.
Gen Z
===
[00:00:00]
Jon Murphy, PMHNP-BC: Ready? Alright. Compass Point Institute Rolling.
James Kennedy: Welcome back to the Compass Point Institute. I'm James Kennedy, nurse practitioner and CEO of Modern Mentality, a psychiatry practice in New Hampshire and Massachusetts.
Jon Murphy, PMHNP-BC: And I'm Jonathan Murphy, owner and creator of Focus Path. Today, we're tackling something that's been on both of our minds, why Generation Z seems to be struggling more than any generation before them, and why the typical solutions aren't cutting it.
James Kennedy: before we dive in, quick reminder that everything we discuss is educational, not personalized medical advice. If you're struggling, please reach out to a qualified professional.
Jon Murphy, PMHNP-BC: All right, James. I have a theory about this and
I know.
you've got the research to back it up, we've seen clinically, but first let's just talk about what we're actually seeing.
Do you have patients that are from Generation Z at your practice? Maybe we should define Gen Z. How old is Gen Z?
James Kennedy: Generation Z, also known as Gen Z, generally includes individuals born between 1997 and 2012. This translates to an age range of roughly [00:01:00] 12 to 28 years of age.
Jon Murphy, PMHNP-BC: So in year 2000, you're talking about three-year-old, So then, um, brought five, six. So I was playing with Nintendo, but people like, you know, instead of Nintendo, it would've been,
James Kennedy: Oh, you got Xbox at the beginning of that and you got Halo out there. I think that was really when things started to ramp up on that front. MySpace. MySpace was the.
Jon Murphy, PMHNP-BC: they grew up on social media. I guess that's the sort of take home. it is the growing up on social media, but they don't necessarily have iPhones. But the iPhones are coming in pretty darn early, aren't they? The iPads, you know, this might be the first iPad generation.
James Kennedy: yeah, I definitely think that tracks, and I mean Facebook, I know it was, you know, came out when we were in college around that, you know, 2003 mark or so, but these individuals, I mean, this is all they've known and they didn't have just these limited Facebook accounts that we had that really, you know, it's just your wallet.
It's, they just, you know, it's a whole ecosystem of, of social media that was really at that point kind of firing in all cylinders and pretty encompassing, um, which is very different than I think [00:02:00] our generational, you know, our experiences.
We had our chat rooms and aim and, and such, but nothing.
Oh yeah. Good old aim.
Jon Murphy, PMHNP-BC: Something that I remember reflecting on when I was younger was how we, our generation, the millennials is sort of the first generation, like once we come of age. We might be the first old people playing video games, but I think that's not true.
I think we've already, you know, that's already been going on for quite a while.
So we're so much deeper than that. So the Gen Z, let's track how old the adolescent Gen Z is. What year is that?
James Kennedy: So at this point they're 12 to 28 ish in that sort of range.
Jon Murphy, PMHNP-BC: So right when Instagram's
James Kennedy: Mm-hmm.
Jon Murphy, PMHNP-BC: adolescents, that's the key here. So it's like the full on. So, 'cause I remember this time I was working, we were both working, I think we were probably getting our undergrads at around this time, right? So, um, wouldn't have fancy that at Boston, um, at uh, UMass Boston.
But so that timeframe, I remember getting the iPhone three Gs and looking at it and going, oh [00:03:00] my God, I am in heaven. It was the greatest piece of technology I've ever consumed. At the time, I had this sort of naive look at. everything's unfolding so conveniently for me. Oh. How things have changed.
So that's the thing. We ha we move through this together culturally, this sort of cultural societal learning that we all do together, but we're so much past that naive point. However, the adolescents of this time do possess a sort of unique crossing over point where are, do you feel like you're seeing any 28 year olds or 25 year olds talk about this?
James Kennedy: For sure. I think one thing that I've thought about for several years here, so you know, we're growing up, especially in those formative adolescent years, like in high school and such. You know, if you had troubles at school, if there was, you know, poor interactions and bullying, you at least got to leave school at the end of the day and you go home and you know, yeah, we'd have an instant messenger, but nothing elaborate like Facebook and
this generation just has [00:04:00] not, you're not fully detached from everything. And I think for individuals especially that have those poor interactions and those bullying experiences, it's like the bullying doesn't stop when you, get off the bus. It's right there all the time on Instagram, on Facebook.
And I think that's a really different complication that you or I did not have, you know, that didn't exist.
Jon Murphy, PMHNP-BC: Wow. Yeah. Because I suffered from bullying and I know that I can't even imagine how catastrophic it would've been if it was sort of shot out to the entire universe. Right. so that's a sort of tragedy
So let's take some time to really break this down. What does the data actually tell us?
James Kennedy: So the numbers are staggering. , According to the A PA 2020 Data, gen Z reports the highest stress levels of any generation. 6.1 out of 10 compared to an average of 5.0 for all adults. The national survey on drug use and health shows, anxiety disorders among young adults have increased dramatically.
We're talking 60 to 84% increases depending on the timeframe that you look at. But Jon, what do we actually [00:05:00] do about it? Our kids are on these devices constantly. Why
Jon Murphy, PMHNP-BC: This is where my.
Framework comes in. I'm calling it developmental reinforcement theory, DRT during adolescence social bonds aren't just nice to have. They're neurobiologically necessary. The nervous system literally requires co-regulation with other nervous systems to develop properly.
James Kennedy: And what Gen Z got instead was junk food, social connection
Jon Murphy, PMHNP-BC: Exactly. Their brains
were getting dopamine hits from likes and comments, but their nervous systems were getting nothing. Now, here's the real talk. Any authentic human interaction is better than screen time period. Eye contact with your kid while they're talking beats any educational app.
James Kennedy: So with that in mind, digital detox strategies, any thoughts on that?
Jon Murphy, PMHNP-BC: Start small phone free meals, actual conversations in cars instead of everyone on devices. Parents, you first, You can't ask your kids to do what you won't do. And look, we need to address something here. Trigger warning, we're talking [00:06:00] about pornography. Research shows the average age of first exposure is now between 11 and 13 years old, with many studies citing 12 as the average.
This isn't about being prudish, about developing brains, getting their first ideas about intimacy from content designed to be as extreme as possible.
James Kennedy: Yeah, the neuroscience here is very compelling. So studies from Cambridge and the Max Plank Institute show that regular pornography use affects the brain's reward pathways in ways that mirror substance addiction patterns. We're seeing reduced stratium volume and altered dopamine pathways.
Now, researchers are careful to note these are correlational findings, but the pattern is concerning.
Jon Murphy, PMHNP-BC: Parents. I get it. This is uncomfortable, but being naive isn't protecting anyone.
you need to know
what world your kids are actually navigating.
the way out
isn't to panic or shame, it's to focus on yourself
first.
Lead by example. Create the kind of connection at home that makes a screen feel boring by comparison, because here's the truth, a screen is never a substitute [00:07:00] for real presence and connection.
James Kennedy: Alright, so we've talked about the crisis and some solutions, but let's get real about what happens when people try to get help.
Jon Murphy, PMHNP-BC: All right. Well, do you have any thoughts on this?
James Kennedy: I think a lot what you said earlier about therapy, not necessarily feeling comfortable in that conversation we had, I think. For a lot of these individuals that are having challenges and these Gen Z somewhat specific problems too. You know, they've had this kind of insulated life where, you know, quick access to dopamine, you can sit here and scroll all day and a lot of needs are just met very superficially, but very quickly.
And with therapy, you know, it's a completely different process that is almost the opposite of what their day to day is like. And you know, it's not necessarily gonna be a two weeks, you're gonna feel better. You know, in two weeks you're probably gonna feel a little bit worse because you're diving into things.
So I think trying to. Convey that right off the jump with our patients that are, you know, first time engagements with therapy. It's important, you know, if therapy is feeling comfortable every time, you're probably not sitting here actually getting into the things that are affecting you and whether [00:08:00] it's attachment based or otherwise.
it's a good point to sit there and really take a deeper dive and deeper assessment into, you know, what do you need to work on? what should we be talking about and how do we get you a little bit outta that comfort zone and work towards better resilience and a better situation overall?
Jon Murphy, PMHNP-BC: I am glad we're talking about this because come to think of it, I realize that
I take for granted the fact that the first time I was introduced to pornography, it was like a piece of paper, you know, that took forever to download and it wasn't instant access.
Granted, I do think our generation was exposed to pornography more than the previous generation. So it goes, but nothing compared to what is out there now. And I have patients that. Talk about their shame and guilt surrounding cannabis use and alcohol.
Okay, well, let's not make yourself so filled with shame. Maybe there's a harm reduction thing. Um, it doesn't necessarily strike me as outright bad
Given how much our culture actually is. We do have adult choices to navigate,
[00:09:00] but if someone brought up their,
their pornography use, I would probably say
oh,
dear,
that's a problem.
Those are the things that aren't brought up because there is so much shame and that it's imbued with this sense of, I think for the people that have fallen into porn consumption trap, it can feel like a very deep, dark place. So I'm gonna do some brainstorming about ways to engage, the conversation with folks because I think it's maybe been hinted at in it earlier in my career
I was a little nervous to get into it, but I think I'm prepared to talk about it now.
James Kennedy: Yeah, and I think patients, oftentimes are appreciative when you're direct, especially on an intake, going through this. And another one that I, you know, earlier in my career didn't really talk about too much was gambling. And that's, you know, another thing that, you know, obviously really high stakes consequences.
And for this generation too, like at their fingertips, you know, you can go on
Jon Murphy, PMHNP-BC: Mm-hmm.
all
James Kennedy: sorts of different apps make all sorts of, you know, proposition bets or large scale bets. And it's something that I think oftentimes is not really brought into the space as much as it should be. Um, and, you know, share some similarities of pornography
it's that instant dopamine rush. And, [00:10:00] you know, it's something that they have just kind of grown up with here, especially the last five years or so with this proliferation of sports that you can just do on your phone in the app store, whatever ecosystem out there.
Jon Murphy, PMHNP-BC: Yeah, I think we're distilling something interesting here where you're looking at the DSM and
what
is the line between a substance abuse disorder or cannabis use disorder? What is that line? And there is this mismatch, sort of culturally accepted versus what is pathological and I tend to think people with ADHD generally, uh, have better impulse control and tend to drink less and consume less substances than they would and many people with ADHD don't consume substances at all.
Certainly there are those patients with addiction. We're thinking opioids, we're thinking alcohol, we're thinking these other addictive substances, they can become their own pathology. That's gravely concerning, but never gonna hear pornography and think. That's good at all It's just, um, sort of my [00:11:00] attitude about it based off what we know. It's sort of my opinion. And then the other piece on gambling, I mean, it's so destructive it's catastrophically and financially destructive to the point now you're destroying other people's lives.
So I think those are two issues that are, I'm gonna be mulling over for sure.
James Kennedy: No, I think it's a great thing to take into consideration and with these two, I mean, even if you're asking these questions and you hear, oh, you know, every so often I'm, I'm going to, you know, X, y, z, it's okay. I think trying to figure out what that balance looks like, it's like not everything necessarily needs to be a hundred percent abstinence from, I mean, some people are fine gambling every so often, and that's great.
You've checked that box, you've gotten that,
Jon Murphy, PMHNP-BC: true.
James Kennedy: you know, you ask the question, you can move on to. The other things that matter. But again, I think asking these questions is really important just to, you know, create a dialogue for, and there are a lot of patients that really do want to dive into it deeper, and they don't necessarily link it with, you know, ADHD or psychopathology
it's just, oh, this is my habit. and it's a good thing to dive into.
Jon Murphy, PMHNP-BC: Yeah. Well, I think gambling absolutely is an [00:12:00] adult choice that we need to navigate. And I do take for granted the fact I like to play a game of cards or two.
I've never had that.
problem though. And I think as clinicians, when we are self-disclosing, when we have ADHD, we have our own issues
we can empathize. Well, that doesn't mean we're gonna be able to empathize with something that's so destructive and, uh, in regards to pornography, certainly people can consume that responsibly, but when you go into the sort of industry side, what you're fueling a lot of, uh, horrible statistics in terms of trafficking and otherwise.
So I think there's the societal implications as well. But nonetheless, we don't get to make the choices for our patients. It's just helping people make the choices that work best for them.
James Kennedy: Exactly well said.
So let's break down what's really happening in therapy. Jon and I both went to Boston College, but training was completely different. My psychotherapy education was pretty sparse, kinda surface level in some ways, His experience and his training was a bit more comprehensive.
Jon Murphy, PMHNP-BC: Right, and there's this massive problem in nursing school we tend to get a garden variety approach to therapy, which everyone thinks being [00:13:00] eclectic is good, but sometimes that just means unfocused. That's actually why I rebranded everything at Focus Path. I'm actually working toward a more focused approach, especially around boundary setting and clear treatment goals.
James Kennedy: And here's something people don't understand. There are stages of change. As PMHNPs, we have a unique advantage because we can do both therapy and medication management. Sometimes you literally can't process trauma when you're in acute distress from bipolar disorder or severe panic or anxiety.
Jon Murphy, PMHNP-BC: Exactly. People complain about CBT, but it's not supposed to be one size fits all. It's a tool and it's a great tool at the top cognitive distortions, mindfulness techniques, but therapists need to know when to use what.
James Kennedy: Exactly. And the research on motivational interviewing is fascinating here. Miller and Rolnick, who developed the approach have actually abandoned the term resistance entirely in their recent work. And they now see it as normal ambivalence, not pathology. Studies consistently show that confrontational approaches increase what they call [00:14:00] sustained talk statements, opposing change, which correlates with worse outcomes.
Jon Murphy, PMHNP-BC: Let's be real. There's old school therapy and there's new school therapy. I'm a therapist myself and honestly, joining a Facebook group for Scapegoat children was more healing for me than some of my formal training.
James Kennedy: Here's what you need to know. Sometimes you need medication first. If your brain chemistry is so dysregulated that you can't focus for five minutes, therapy is not going to be as effective as possible. That's not a failure. That's just biology.
Jon Murphy, PMHNP-BC: And sometimes the most healing thing isn't in your therapist's office. It's finding your people. It's understanding your story. A good therapist can point the way, but they're never going to
unlock everything
for you.
we have to walk the walk ourselves.
James Kennedy: Lambert and Barley's research model shows that about 40% of therapy outcomes come from client life circumstances, 30% from the therapeutic alliance and common factors, and only about 15% from specific techniques. The client's readiness and life context matter enormously
Jon Murphy, PMHNP-BC: You need to educate [00:15:00] yourself about what you need.
sometimes
you just need to spill everything and therapy's the right place for that. But be careful of therapists who only validate without helping you understand patterns. Every therapist can rest on the power of the phrase that seems hard, at some point we need to build a deeper set of skills.
James Kennedy: And there's this modern phenomenon of therapists who wants you to become an activist for your own trauma. That's not healing. That's activism.
Jon Murphy, PMHNP-BC: Your healing is about learning your life story so you can know what you need.
Not everyone
needs the same approach. Some people need to process trauma. Some people need practical skills. Some need to understand their family patterns, and some need medication to get stable enough to do the work. You have the right to know what you're getting.
James Kennedy: Bottom line, if your therapist isn't helping you, understand yourself better. Find someone who will, you're paying for expertise, not just a listening ear or a friend.
Jon Murphy, PMHNP-BC: We've gone to some interesting issues about Gen Z and some of the kind of modern struggles that we're have or the modern issues that are [00:16:00] important that we address as clinicians. What did you get out of this, podcast today?
What do you take home?
James Kennedy: Yeah, I mean, I think just for us kind of delineating the differences between our childhood, our adolescence, and that what we had, you know, is formative things around us and the differences that they have. I think that's the big takeaway here. And again, too, it's like, well, we can be empathetic and understand as much as we can
as a clinician, it's like, well, we also didn't live that life too, and, and know what that's like or also just the downstream kind of conditioning that comes from that. So I think this is a great place too, where, you know, people wanna comment or get engaged and, and, you know, drop their insights about this.
I think it really could lead to, you know, ongoing discussions about this and, and I'm sure there's some stuff that we miss. Uh, but no, it's fascinating. Yeah.
Jon Murphy, PMHNP-BC: And let us know in the comments if you've gone to a therapist and had any issues that you were nervous to bring up and then they didn't bring them up. I think oftentimes it's just asking that question and people are waiting to be asked and um, they aren't. So that's what I'm gonna be thinking about.
But until [00:17:00] next time, this is Compass Point Institute. I'm Jon Murphy, psychiatric nurse practitioner.
James Kennedy: I'm James Kennedy, psychiatric nurse practitioner, and we will see you next time.