Things Your Therapist Should Never Do

by Bethany Raab Monday, July 6, 2015

You will find all sorts of blogs and checklists out there of what to look for in a therapist. These can be incredibly helpful. However, the DO NOTs of therapy deserve some attention, too.

There are many obvious things a therapist shouldn’t do (see: psych central blog).

Here are some less obvious problems that should raise a red flag.

They fail to seek your informed consent.
Any therapist you see will have you sign a consent form at the beginning of your relationship. This is good, ethical practice. However, they should continually seek your consent as you move forward. Before any exercise, whether it be written, verbal, art or something else, they should check in with you to ensure you’re comfortable with what they are asking. You are always allowed to say no.

They do not ask for feedback from you (or can’t accept it).
Your therapist will be asking about how you are doing and what your experience is with various interventions and conversations. This is good. If they’re not asking, tell them. If they don’t listen, get a new therapist.

Manipulate you into remaining as a client.
Assuming you are attending therapy voluntarily and are not a danger to yourself or others, you have a right to decide who you see for therapy and how long you see them. (Patients in hospitals and in involuntary treatment have rights, too, but that’s a different conversation.) Signing a consent form is not a contract for length of services. You are free to leave whenever you want. If a therapist does not feel like a good fit for you, you can decide to see someone else.

Talk to other people about you.
Your therapist should never talk about your case with anyone. Exceptions do exist to this rule including: you give written permission, the therapist receives a court order, you are suicidal/homicidal or discuss child/elder abuse. This also applies to your written therapy record. If these boundaries are crossed, it is inappropriate and grounds for you to file a complaint against the therapist with their licensing board.

Try to be your friend, business partner or lover.
This is a big no-no. Your therapist is expected to follow the ethics of their profession regarding personal relationships with clients. These rules go something like this: No personal relationship with a current client is ever appropriate. Some professions allow for relationships if your therapy ended 2 years ago. Many professionals err on the side of keeping that boundary in place permanently. If your therapist is making sexual advances, suggesting you grab a drink or asks to borrow money from you, stop seeing them immediately and call the licensing board in your state. This is completely unacceptable behavior.

There are countless wonderful, ethical therapists but there are also a few bad apples. Keep an eye out for these red flags to protect yourself when you see a therapist.

Bethany Raab is a licensed clinical social worker in Denver, Colorado. She owns a private therapy practice where she works with teens, families and young adults.
www.raabcounseling.com

The Drawbacks of Online Scheduling

by Sherry Katz Tuesday, June 30, 2015

The obvious value of online scheduling is efficiency and convenience.  Therapist and patient do not need to talk with each other to schedule their appointments.

Since our entire method of professionally offering service relies on talking to people, what, if any, areas of our work are affected by utilizing online appointment scheduling? 

The initial phone contact from the patient was once referred to as an “intake”.  

This was a chance for the therapist to assess an overview of the case and whether they or their agency, would be able to handle the level of care required.

This was also a way for a prospective patient to get a firsthand feel of working with either the particular therapist or the overall view of how the agency would address their matter.

The question for therapists to consider is whether the demographic and “check the box” information of online scheduling, is an equal substitute for a phone assessment intake.

Maybe in fact the first in person session has become the former phone intake. 

Only now we have a hopeful new patient sitting in front of us who may not be a good fit for the type of therapy work we do.

What if, when scheduling an initial appointment, instead of prioritizing time efficiency and convenience only, we limit our online scheduling gadgets to situations which do not actively require our professional skills?

Sherry Katz, LCSW is clinically trained in systems relational therapy, and practices marriage and family therapy in her solo practice located in Ridgewood, NJ.  Comments and questions are welcome www.newviewsfamilytherapy.com.

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Advise | Anxiety | Mental Health | Self-Awareness | Social Work | Stress | Therapeutic Relationship | Therapy | Video Therapy | Wisdom

Surprise! They’re Not Changing. How About You?

by Sherry Katz Friday, June 12, 2015

Is one of your reasons for starting therapy because every approach you’ve tried in a particular relationship increases your frustration, hurt, and sadness?

And after explaining your outlook and reasoning to this person many times, the relationship patterns are still the same?

Therapy will give your sincere and heartfelt effort and concern, a new direction. 

Step One is accepting the profound realization that you are only able to change yourself. 

Despite your many good ideas and earnest care, the other person in the relationship, whether partner, sibling, adult child, any meaningful family member, may not want to understand your point, or want to agree with it.

The deeper problem is not necessarily that you have bad ideas or that the other person is intentionally being difficult.  

The discontent you are facing in the stressed relationship, is a pathway to knowing more about your own standards and satisfactions in relating.

If you are upset because the other person does not accept your suggestions, instead of inwardly disapproving, utilize this feeling of rejection as a sign of how highly you value that your advice is followed. 

If the other person criticizes what you consider key points in your value system, then allow yourself to appreciate that you have a clear value system.

If the other person dismisses your feelings, then this is your moment to be even more aware that your emotions are a way to express yourself.

All of these interactions are painful and tiring to some degree. 

Your reason for talking with a therapist is to stabilize and ground your perspective, believe in your right to be who you are, and strengthen your confidence in handling your part in a relationship that is currently stressed, and any relationship that develops in your world.

Sherry Katz, LCSW is clinically trained in systems relational therapy, and practices marriage and family therapy in her solo practice located in Ridgewood, NJ.  Comments and questions are welcome.  www.newviewsfamilytherapy.com

Video Sessions Improve Therapy

by Buck Black Thursday, December 11, 2014

In this age of connectivity, clients expect therapy to be accessible. I continue to see unmet demand for video therapy. Few therapists offer this service which I started doing a few years ago. My clients benefit from video therapy in many ways. I have clients traveling who want to keep their appointments.  I use video to meet with college students who return home for the summer and breaks. I use video to meet with clients during snow days, transportation problems, forgotten appointments (just log-on for a session so the appointment time can still be used) and for those whose illness was contagious, yet they needed their session because they felt so bad, both mentally and physically. I also have business people who want their session, but cannot afford the travel time on account of their busy schedule.

It is difficult for rural residents to get services.  Video sessions make this easier.  Rural clients, however, often do not have a fast enough internet connection, but this will improve in time.  Some rural clients have a high quality cell signal, which allows them to hold a session, but this cuts into their data allotment. I have had success relying on a phone call for the audio and tolerating a lower quality video feed.

In my experience offering the option for video sessions helps me give my clients a higher level of care and means my clients are more likely to keep their appointments. If the client is comfortable with the technology, it works well. If their internet connection goes out, then the phone is a backup. There are many clients not comfortable with video sessions and choose to only come to the office. This is OK too. Over time I believe more people will be comfortable with video sessions. 

There are some situations where video sessions are not appropriate. Examples include clients who pose a high risk, such as homicidal and/or suicidal ideation, psychosis, or who simply need a more intense services.  I never use video sessions with someone who is court ordered or having problems with denial. I don’t feel video sessions are powerful enough in this situation.  However, if someone is looking to better themselves and is higher functioning, video sessions are often ideal.

Remember, it is important for both therapist and client to have a history of using video conferencing services and have quality internet, a high quality router and computer, and good lighting. We need to ensure the technology adds to the therapy experience.

Therapy must embrace technology to remain relevant and to help clients.  If licensed therapists do not embrace video therapy, those in need of therapy will seek less qualified people who are using video services.  Lets not let our profession be left behind.

Buck Black LCSW, CST is a therapist who has several years of experience using video conferencing with clients to address anger, stress, and relationship issues.  Therapy appointments are also available at his office. His information is at www.BuckBlack.com Follow him on twitter @BuckBlack

Let's Get High

by Julie Davis Thursday, December 4, 2014

Smoke a joint … Drink a shot of tequila … Eat a donut … Get angry … Worry … Run on a treadmill … Climb a mountain ... Hunt for a fashion bargain. 

You can get “high” by ingesting a substance, activating a thought, or moving the body in a way that triggers a chemical reaction leading to a feeling of “high.” 

Until you are comfortable NOT being “high” you will search and find how to get “high.” You might stop drinking alcohol but find yourself reaching for more sweets.  When you are unable to exercise you might become agitated, start shopping, drink alcohol, caffeine, or soda.

Do you think you have an addiction/motivation/discipline problem with alcohol, food, anger, worry, spending?  Are you are interested in eliminating unhealthy substances and processes that make you “high?”  Good!  However, until you are willing and able to be “NOT HIGH” you might find yourself seeking other forms of getting “high.”  

This week, I invite you to consider how you might feel “NOT HIGH:”       

Confused? Embarrassed? Out of control? Terrified? Lonely? Edgy? Depressed?  Anxious? Calm? Bored? Unimportant?

These are the experiences that might require understanding and attention before you stop thinking, “Let’s get high!”

Julie Davis uncovers and clears up deeply embedded beliefs and unresolved emotions that keeppeople stuck (www.juliedavismft.com).  She also coaches people how to stay clear, calm and strategic in everyday life with healthy ways of thinking, feeling and behaving (www.rapidresolutiontherapy.com).  Get free weekly insight and guidance by joining Julie’s Tuesday Email service (text JULIETUESDAY to 22828). Julie is a Certified Rapid Resolution Therapist, Licensed Marriage and Family Therapist (North Carolina, California, New York), Board Certified Hypnotherapist, and New Life Network Christian Counselor (www.newlife.com).  704-807-1101.

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Anger | Animal Instinct | Anxiety | Healing | Intimacy | marriage | Marriage and Family Therapy | Mental Health | Mood | Mood Booster | Pet Therapy | Primitive Mind | Stress | Therapeutic Relationship | Therapy | Trauma | Treatment Modalities | Wisdom

Aftermath of Suicide: How To Help Survivors

by Dennis Potter Wednesday, November 5, 2014

Three Universal Reactions to suicide: Guilt, Anger and Grief

Guilt is usually connected to thoughts survivors have about what they should/could/would have done differently. These are usually the result of “Monday Morning Quarterbacking” where the person reinterprets their actions knowing the outcome. This is particularly true after a suicide or death of a colleague. It is very destructive and usually inaccurate. It helps to discuss that people are in pain and “wish” the suicide had not happened. There is no guarantee that had they done anything differently, it could have altered the outcome.

Anger is usually about wanting to blame someone or something for the suicide. If the anger is at the person who completed suicide, it is probably pretty healthy. Anger at God or spiritual traditions are most commonly referred back to their spiritual leadership for answers. We cannot address spiritual issues, except to validate them and state that they are common reactions. When anger is placed toward the work environment, ex’s, or family members it is generally unhealthy and unhelpful. We can acknowledge the loss of the person, and that we never really know how they might have interpreted accurately or inaccurately what others did or did not do. You might acknowledge it is too bad that the person did not confide more with others to see an alternative to suicide.

Grief after the loss of someone you care about is easy to understand. Suicide can trigger a variety of much more intangible losses. One most common is the loss of sense of personal safety. If this type of event can happen to the deceased, it can happen to me, or my family, or my friends etc. Suicides happen because we have no control over them. This temporary feeling of the loss of our illusions of control and safety can be profound. We can help people understand their multiple losses, and that grief is a process they will move through over the next few days or longer. Providing information on understanding they are grieving and things they can do to move through the grieving process is helpful.

Dennis Potter, LMSW, CAADC, ICCS, FAAETS, serves as Manager, Consultant Relations and Training for Crisis Care Network. He is a licensed social worker and certified addiction counselor. Dennis is recognized as a Fellow, by the American Academy of Experts in Traumatic Stress. He was awarded the ICISF Excellence in Training and Educations Award at the ICISF 2011 World Congress.

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Advise | Mental Health | Social Work | Stress | Suicide Bereavement | Suicide Prevention | Therapeutic Relationship | Therapy | Trauma | Wisdom

Seeking Wisdom

by Julie Davis Saturday, October 18, 2014

Seek wisdom before, during, and after a big decision, but remember not everyone has your best interest in mind!  People often filter advice through their own experience; depending on personal comfort levels:

It sounds reckless and dangerous!  Don’t do it!

It sounds adventurous!  Go for it! 

Others might benefit directly/indirectly from your decisions and advise accordingly. It’s common to guide to gain - with “enmeshed” and “codependent” relationships forming as a result:

Stay here (and keep me company) while you figure out what you want to do.

I should stay (you pay for rent and food) while I figure out what I want to do.

When advised from the two categories above, say “thank you” – without explaining, defending, arguing - and seek wisdom elsewhere; preferably from outside your circle of influence.  However, even counselors, coaches and pastors can have a “tint on their lens.”  Look for someone who has:

1.    Nothing to lose or gain from your decisions.

2.    Statistics (not opinions) about the risks/gains of each options.

3.    Insight into what’s in your best interest.

4.    Ability/willingness to be honest. 

Say “thank you” – without explaining, defending, arguing -- and for big decisions, seek advice from at least three wise sources –  and then move forward. Yes, move forward.  Even the wisest decision can end up in a tangle.  If you do a good job of seeking/receiving sound advice but struggle with moving forward, check back later for more on Fear of Failure!

Julie Davis uncovers and clears up deeply embedded beliefs and unresolved emotions that keep people stuck (www.rapidresolutiontherapy.com) and coaches people how to stay clear, calm and strategic in everyday life with healthy ways of thinking, feeling and behaving (www.juliedavismft.com).  Get free weekly insight and guidance by joining Julie’s Tuesday Email service.  Send “subscribe” in subject line to: julie@juliedavismft.com.  Julie is a Certified Rapid Resolution Therapist, Licensed Marriage and Family Therapist (North Carolina, California; New York – pending), Board Certified Hypnotherapist, and New Life Network Christian Counselor (www.newlife.com).  704-807-1101.

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Advise | Mood | Mood Booster | relationships, friendships | Self-Awareness | Social Work | Therapeutic Relationship | Wisdom

A New Language

by Julie Davis Tuesday, September 30, 2014

At the dinner table, we said, “Hey, pass the stew,” and “Give me the gravy when you’re done.”  We didn’t say “Please” and we didn’t say “Thank you.”  We talked over each other and cut each other off.  Conversations were loud and there was a lot of joking and making fun of each other. 

My first dinner date with my future husband was almost the last (I found out years later…).

At his dinner table, they said, “Please, when you can, pass the stew.  Thank you.  Are you sure you are done?” and “Would you like more? Can I get you anything?  I’m fine.  Thank you.  Please take the last roll.”  They talked in turn and listened patiently.  Conversations were soft and light – usually about something outside of the room. 

My language was interpreted initially as rude and crude.  His language was boring and superficial to me.  It’s amazing we had a second date!

But we took the time to ask questions and discovered that the language was different but the intention the same.  We both wanted to be heard and understood and were interested in hearing and understanding each other.  So we created our own language.  He became bolder in expressing raw thoughts and feelings and I became softer and added “Please” and “Thank you” to my vocabulary.

What language is comfortable for you?  If you feel “in conflict” with someone (child, boss, spouse, employee, friend, etc) take a moment to consider:

This person isn’t purposefully rude/avoidant/loud/dismissive/disrespectful; he/she just speaks a different language.  Underneath this language is someone wanting to be heard and understood and accepted. 

If this person is interested (it takes two to communicate and grow closer) then initiate a discussion on how YOU can learn his/her language:

What do I say that makes you feel closer to/more distant from me?

What can I say that would make you feel closer to me?

Listen to the answers. Say “Thank-you.” Work together. Create a new language that works for both of you.

Julie Davis uncovers and clears up deeply embedded beliefs and unresolved emotions that keep people stuck (www.rapidresolutiontherapy.com).  She also coaches people how to stay clear, calm and strategic in everyday life with healthy ways of thinking, feeling and behaving (www.juliedavismft.com).  Get free weekly insight and guidance by joining Julie’s Tuesday Email service.  Send “subscribe” in subject line to: julie@juliedavismft.com.  Julie is a Certified Rapid Resolution Therapist, Licensed Marriage and Family Therapist (North Carolina, California; New York), Board Certified Hypnotherapist, and New Life Network Christian Counselor (www.newlife.com).  704-807-1101.

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Couples | Intimacy | marriage | Marriage and Family Therapy | Self-Awareness | Social Work | Therapeutic Relationship | Therapy

Black and White Thinking

by Julie Davis Sunday, September 21, 2014

Believing “black and white” (always/never/all/nothing) thoughts about yourself and others can trigger feelings and actions that harm health, relationships, productivity, and emotional stability: 

Belief

Feeling

Action

I always screw up

Ashamed, angry, hopeless, defeated

Beat self up, medicate,   screw up more, quit,       isolate

He never helps around the house

Angry, resentful, helpless, victim,

Nag, control, complain,       fix, explain, defend, manipulate, fight

All the good jobs are taken

Hopeless, scared, angry

Give up, settle,         medicate, complain

There’s nothing I can do about it

Powerless, afraid, angry

Give in, quit, seethe,        hide,

Over time, black and white thinking can lead to depression, obsessions, addiction, panic, rage, and trauma.  Thus, it is important to “hold every thought captive!” This week, I invite you to catch your black/white thinking and reframe it in a way that leaves you feeling calm, open, flexible:

Absolute

Reframe

Feeling

Action

I always screw up

Sometimes I blow it. 

Humble, interested, motivated

Improve skills,     try again.

He never helps around the house

Sometimes he forgets/puts things off. 

Curious, collaborative

Ask for clarity; discuss and       set  boundaries.

All the good jobs are taken

Many good jobs are taken.   

Disappointed yet determined, creative

Keep looking.     Ask for help.

There’s nothing I can do about it

There is something I can do. 

Curious, creative, collaborative

Get wise advice. Ask for help. 

Julie Davis uncovers and clears up deeply embedded beliefs and unresolved emotions that keep people stuck (www.rapidresolutiontherapy.com).  She also coaches people how to stay clear, calm and strategic in everyday life with healthy ways of thinking, feeling and behaving (www.juliedavismft.com).  Get free weekly insight and guidance by joining Julie’s Tuesday Email service.  Send “subscribe” in subject line to: julie@juliedavismft.com.  Julie is a Certified Rapid Resolution Therapist, Licensed Marriage and Family Therapist (North Carolina, California; New York – pending), Board Certified Hypnotherapist, and New Life Network Christian Counselor (www.newlife.com).  704-807-1101.

 

Trauma, Betrayal & Intimacy

by Gil Shepard Tuesday, September 16, 2014

Most people crave intimacy. Many wars have been fought to get it. 

But traumatic events can create confusion about whether intimacy is even desirable. It is true that all of us have a natural urge to be close, to share and to be able to trust another person. This is even true in the animal kingdom. I watch turkey chicks follow their mother in a row. I have seen many UTube videos of unlikely animals joining each other; natural enemies, like a cat and a parakeet, an elephant and a dog, or a lion and a baby gazelle become inseparable companions when these animals have lost a parent.

The trauma of betrayal by a loved one or spouse often undermines the very ability to trust. This is even more devastating if the betrayer was a parent and the betrayed is an infant or a little child who is sexually abused, beaten or neglected. This is betrayal because a child's natural trust in his parents is betrayed. The parent does not protect the child but instead hurts the child. This is deep betrayal.

On top of that the infant is helpless and knows it. She can’t fix burning from wet diapers or pain from gas. She knows she is helpless and needs others to help her. That desperate cry that pierces our ears says she is in serious distress. This is very different from loud or angry crying, which says "I need help and I have a right to it." That is the sign of a healthy child.

The piercing cry says “I am in a panic and fear abandonment and death. I need help. NOW!”  If help does not come for a long time the infant may become silent. This may mean the pain is so great he dissociates or leaves his body. This is a natural way to avoid pain. This pain can come from not having loving contact it needs. Babies died in the Second World War when they were well fed but not emotionally nourished.

A dear friend of mine I’ll call Sue, told me that she remembered looking at her mother’s eyes when she was an infant, and no one was in there! Sue said, “My whole being shattered.” Her mother had a lot of trauma in her life and was “seriously spaced out.” Sue eventually did get the help she needed in her 60's and then blossomed wonderfully. 

When an infant repeatedly experiences abandonment or betrayal such as from being molested it learns not to trust. Without trust there cannot be intimacy. How can you be close to someone you cannot trust? We are born with the ability to trust. That does not have to be learned. Notice the loving flow between child and parent when children trust their parents. The children are totally natural and obviously feel safe. That is natural.

But we can learn not to trust. This can happen when an over wrought mother yells at a baby for crying, or worse hits and yells at her, “You are bad! Stop crying!” It happens from incest when the infant is overloaded with sensations it cannot handle. And it happens when parents do not protect their child from being molested by relatives and strangers, especially of that child fears telling her parents of the abuse.

The message the infant gets is “I am bad. I am not worth being cared for.” Sometimes an angry parent tells the baby just that! The impact of the parent's rage tells the child it can’t be itself or it may lose whatever caring the parent does give; food, shelter, clothing. The stakes are very high: Physical and emotional survival.  A rageful parent does not provide desperately needed nurturing nor is he or she likely to help a baby who hurts. The baby learns that it is bad in its being, otherwise why would the parent be angry? This is called shame.

Shame is feeling bad, no good, unworthy in the core of one’s being. A child who is shamed learns it cannot ask for help. It grows up learning not to let anyone know that it needs anything because to ask is likely to be further abused and rejected. He has learned he has no value.

 If you were such a child you would have learned to be independent, keeping your pain secretly deep inside. Eventually you became so used to this it became normal and you dis-associated from it.

But in a healthy relationship people feel pleasure in responding to each other’s needs. If you have dissociated from your needs how friends can help you? This is again the result of shame. You feel you are not worth receiving anything, that you have no needs and so you remain lonely.

Many clients have told me that their spouses or lovers should know what they want and what they are thinking. This is a residue from growing up shamed. “Love,” was only obtained if you could guess what your parents wanted and provided it for them. You have value only to serve your parents. If you don't you are shamed and may receive other forms of abuse. You need to be psychic in such a family just to survive! And you cannot need anything!

There is no parenting for a child in such a family. Needing to read people's minds seems normal for those brought up in such a family. But to anyone else this is obviously absurd and unhealthy.

In such a family it is shameful to ask for help or even to need help. If you are raised this way and meet someone who wants to help you then you may be so full of shame you cannot even admit you even have a need. That includes even the need to have a friend and not be lonely.

My friend Sue, after she healed, told me of one day when she was out with friends who were trying to decide where they wanted to eat for lunch. She spontaneously said, “I want to eat at such and such a place.” She shocked herself when she said this for she had never said such a thing before. She had never even known what she wanted before and suddenly she simply said it in a natural healthy way! Her trauma had been healed. And they all ate where she suggested!

Here is the dilemma in a nutshell: If you don’t ask, you are left empty, feeling abandoned as you were when you were a shamed child. You may not actually get rejected if you don’t ask, but you will feel abandoned and isolated. You can make yourself like a rock, but that is lonely and no fun. On the other hand if you acknowledge that you need love you feel like you are admitting you are worth-less, shame-full and without value. After all, that is what you were taught as a child. If people really loved you they should know you want their love and save you the humiliation of letting them know.

This painful knot can be resolved in therapy. Of course you may not trust your therapist very much at first either. Being able to trust is the root of the problem you may be seeking help for.  You simply need someone who can be with you as you struggle to overcome the shame that was laid on you in your childhood, WITHOUT FURTHER SHAMING YOU. Certain methods such as EMDR (Eye Movement Desensitization Reprocessing) or EFT (Emotional Freedom Technique) may make this faster and easier. 

Essentially you need a therapist whom you can trust enough to begin this adventure of discovering who you really are and shed the shame you have felt all your life. Such a therapist needs to help you feel safe and show you acceptance and understanding so that you will not be re-shamed. Then your journey to wholeness can begin.

Gil Shepard MFT has been a licensed Marriage and Family Therapist for over 35 years and has an office in Walnut Creek, California. He has helped many people who have been traumatized, shamed, molested and violated by parents and even groups of perpetrators. He is specially trained in treating people suffering from Trauma, PTSD and Dissociation, and is skilled in the use of both EMDR and EFT. You can reach him at 925-937-3337 or gilshep@pacbell.net.

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