From where I’m sitting: reflecting on the pressures of being a mental health professional

I decided to become a psychologist when I was a freshman in college. I chose psychology as my undergraduate major, initially, as a non-traditional course of study before applying to law school. After the first semester, however, I was hooked. The subject matter was fascinating, and helping others work through challenging mental health conditions seemed like a good fit for my personality: I like to problem solve, I am intuitive, and I’m not afraid of a challenge. I dove into research projects, I wrote an honors thesis, and I applied to graduate school. Becoming a clinical psychologist involved an academic obstacle course of demanding classes, comprehensive exams, a dissertation, extensive clinical training, a one year internship, and a one year post doctoral fellowship. Passing a comprehensive national exam and meeting state licensure requirements rounded off the journey, and I was finally a psychologist.

I’ve never second-guessed my decision to become a psychologist. I have heard many people say they wish they had done something differently with their career, and I feel very fortunate to be satisfied and dedicated to my choice. I love seeing the healing process unfold as people discover how to face their past or develop skills to become mentally healthier and live more meaningful lives.

There are some challenges, however, about being a mental health professional. They might be different than what most people imagine, and it seems like a good time to mention them, after an extremely stressful year. The difficulties of being a mental health professional certainly did not start with the pandemic, but they have been exacerbated by it. There are a few truths about those of us working in mental health that everyone should know.

Sometimes, we have personal stressors or hard circumstances. 

Mental health professionals typically don’t disclose much about our personal lives. Sometimes it’s necessary, if we have a family emergency, to reveal a bit of information. But we are not encouraged to share because our role is to help our clients navigate their problems, rather than burdening them with ours. I generally agree with this philosophy, but I think it’s worth mentioning that because we are also human and carry our own share of personal stressors, not every day of helping others is our best day. Sometimes, we have personal matters weighing heavily on our minds. It doesn’t take away our desire to listen or to be helpful. My mother died suddenly last April, and I had to contend with the grief while providing care to others during a scary time in our world. Having the opportunity to care for others was actually good for me because it gave me breaks from the persistent grief. Still, I struggled under the pressure to be fully present with my clients. 

We make mistakes.

This is a hard statement to make, not only because I tend to be a perfectionist, but also because as a mental health professional, we feel pressure to always be right. People are paying us for services and they expect us to always have the right answers. Of course, it’s more complicated than that because our answers depend on the information we are given at the time. Some client matters are more complex than others, and they take longer to resolve. Giving us permission to change our minds, and giving us the benefit of the doubt may help us to serve clients better.       

We can’t always be available to our clients. 

I can’t speak for other mental health professionals, but I often feel pressure, from myself, to be constantly available when clients have a question or need to talk. Generally, this pressure doesn’t come from the clients, but rather from a combination of my anxiety about making sure I am serving them well, coupled with some societal expectations about mental health professionals. Technology has definitely increased this pressure, given that we can constantly check our email and text messages. I have developed good boundaries around not checking email after work, defining what a client emergency entails and the steps in responding to it, and helping clients understand the importance of boundaries. But I still occasionally hear my own voice reminding me to respond promptly. 

Overall, 15 years of experience in private practice has allowed me to cope effectively with most of the pressures clinicians may feel.  However, I think it’s important to be reminded that we aren’t made of steel, we aren’t always right, and we aren’t always available. Remembering that we, too, are human, in addition to our knowledge and training, will increase the emotional connection and empathy in between mental health professionals and our clients.

Photo by Eduard Militaru on Unsplash

The New “Virtual” Reality of Therapy: Is it the future of psychotherapy?

Almost one year ago, mental health practices throughout the United States faced a difficult reality. They would have to transition their practice to a telehealth platform or close down. Most mental health professionals, myself included, had not widely practiced telehealth before. Occasionally, I would have clients out of town on business who would want to do a video session, or college students who would want to do check-in’s. But it was certainly not the norm, and it wasn’t something that most of us planned on doing regularly. So, when governors began announcing widespread, 14 day quarantines to “flatten the curve“ as the coronavirus began to infect more people, we had to think on our feet and respond quickly so the continuity of our patients' care would not be disrupted. 

Clinicians like myself, who work with younger children and teens as well as adults, scrambled to find creative ways to engage clients over the virtual platform for the first time. Some clients connected with it right away, willingly cooperating and adjusting quickly. Others were reluctant, but gave it a chance with some coaching from me. I had to adjust my own expectations of what it would entail, and modified my home environment accordingly to have proper boundaries and to successfully focus on the screen. This is not to say there weren’t any distractions. Sometimes my cat visited unexpectedly, demanding attention, or a child client wandered away from the screen to get a toy they wanted to show me. Overall, though, it was a surprisingly successful endeavor which most people assimilated to easily.

We are now approaching the first year anniversary of this experiment in psychotherapy. Our practice receives daily calls from new clients who insist on being seen in person. We also continue to receive a number of calls requesting that therapy be conducted virtually for the foreseeable future. As a clinician, I believe that I bear some responsibility for setting a good example. When it became clear that COVID-19 was going to be a pandemic and there were major safety risks with meeting in person, it was my responsibility to take the lead when clients were resistant to trying virtual therapy. But now, as we have the opportunity to get vaccinated, we know more about how the illness is spread, and we are capable of taking extensive precautions to keep people safe, it’s also my responsibility to lead those for whom it is most appropriate back into a more traditional clinical setting. At the moment, we are allowing clients to choose which format they prefer. My associates and I have gotten vaccinated, and we continue to take extensive precautions to keep everyone safe for those who choose to come in person.

But let’s be honest, there are definite perks to working virtually. It can be tempting to remain at home, for convenience, or to continue to reap the benefits of virtual therapy: clients generally don’t run late; I’ve had fewer cancellations; and I’m more more physically comfortable. I can start dinner and let it cook while I am in a video session. So if there are reasons that I am hesitant to return to in-person therapy, I must ask myself what they are and how I should deal with them.

It seems clear that there are some clients who should be seen in person so long as it is safe to do so. In particular, clients with severe social anxiety who may avoid in person contact, persons struggling with agoraphobia (fear of going out into public places), or clients who struggle with nonverbal, social interactions that makes therapy less productive. Continuing to see these clients virtually may hinder their progress because it doesn’t give them exposure to the source of their anxieties or opportunities to practice in-person social interactions.  

I’m certainly not suggesting that this is an all or nothing situation. The ability to conduct virtual therapy has indeed broadened the access to mental health, and there are certain individuals who should be able to continue to use the platform. Some of my clients with chronic physical illnesses and disabilities come to mind, for whom attending regular visits in the office can become an obstacle to the continuity of their care. Individuals who live in rural areas, children and teens whose parents are juggling work and cannot commute to bring them consistently are other examples for whom the prospect of ongoing virtual work is worth considering. It also provides continuity to clients such as college students who have gone back to campus.

My message to clinicians and clients alike is that we must be thoughtful about this decision. We cannot allow modern conveniences to take precedence over the client’s best interest, nor can we allow virtual therapy to enable patterns that will hinder clients from making progress in areas for which they are seeking our therapeutic support. Clinicians may have to become more assertive in guiding clients back to the therapy office by educating them about the risks of continuing virtual therapy. An honest discussion should be held with each client to determine what is best for them and for your therapeutic relationship. This could be a positive experience for therapists and their clients because the clients will know that you genuinely care about their progress, and therapists can explore their own potential anxieties about going back into the office. No matter what is decided, the conversation is a win-win for both parties.                   

As we move out of the pandemic, we will have to consider whether teletherapy should be a standard fixture of mental health care or if it should be a solution we turn to only in contexts where in-person therapy is not a valid option.    

Photo by visuals on Unsplash

THE REALITY OF ADULT ADHD

You’re sitting in front of your computer, browsing the Internet, and engaging with your favorite social media platform. You have a pile of work to do, but no motivation. You decide to go for a walk to clear your head, get a cup of coffee, and come back to your computer. You realize that two hours have passed, and little work has gotten accomplished. We all have days like this. We can’t focus. We feel exhausted even in the beginning of the day. We can’t do our work, but we can spend unlimited time on Facebook or Instagram. If this sounds like a typical day to you, however, there might be a bigger problem than just a tough day at work.

I hear similar scenarios frequently. People tell me they are struggling with motivation, and they’ve gotten feedback from employers, coworkers, and even spouses that they need to be getting things done. They know they are struggling beyond what most of us occasionally do, but it’s hard for them to believe they have attention deficit disorder. “I was a good student,“ they say. Or, “I have a professional career.“ “If I have ADHD, wouldn’t my parents have known that when I was a kid?“  These are statements commonly made by adults who have ADHD but have not yet been diagnosed. They have been academically and professionally successful, at least enough to graduate and launch a career. They are high functioning, but the struggles begin to catch up with them. This blog discusses why ADHD symptoms might be overlooked, and why adults should consider diagnosis and treatment. 

How can someone have ADHD and go through school without knowing it?

Many children begin to show signs of ADHD prior to the age of seven years. They may be hyper active, impulsive, have trouble following directions, and have trouble staying on task. While this description fits thousands of people who are eventually diagnosed, not everyone displays these challenges earlier in life. In addition, some people have trouble focusing, keeping schoolwork organized, and accomplishing things, but they don’t outwardly appear to be struggling. A sub-group of individuals who would meet criteria for ADHD are smart, resilient, and high functioning. They develop compensatory strategies that allow them to get through life, even though internally it may be incredibly stressful and painful. For instance, some students wait until the last minute to do their work, but they work well under pressure. So they pull an all nighter and receive a good grade on a research paper. Or they have excellent long-term memory capacity, so they don’t need to study for tests. They acquire a great deal of basic knowledge and retain it without having to review it. But as the workload becomes more demanding, or more work is required of them on the job, they begin to struggle. They miss deadlines, they are disorganized, and they procrastinate work that doesn’t interest them or that is more administrative in nature. Thus, they function, but it becomes more difficult to perform over time, and these difficulties begin to affect their quality of life and their relationships.

Why do adults get evaluated for ADHD?

You don’t have to be a student to get an ADHD evaluation. There are reasons to pursue testing for ADHD as an adult. Even if you have no plans to go back to school, knowing and understanding your diagnosis can be extremely helpful as you plan your professional development and other aspects of your life as welL. Clients tell me that it is a huge relief to know that ADHD is behind their challenges with initiating, planning, and executing work and other daily activities. Knowing that there is a specific problem that can be treated feels freeing to them. Identifying the problem alleviates negative thinking such as feeling lazy or stupid, or wondering why they can’t get things done as easily as others. 

In addition to the insight and the freedom that the diagnosis offers, there are effective treatment approaches for adults that will allow them to be much higher functioning and achieve their personal and professional goals. Additionally, ADHD can affect emotion regulation, social interactions, and communication and relationships. Thus, understanding the bigger picture of how it impacts adult life and finding strategies to manage is also valuable. 

What do I do once I know that I have ADHD?

There are several ways to learn about how to manage ADHD as an adult when it hasn’t previously been addressed. Here are some suggestions that clinicians recommend

1. Seek a consultation from a psychiatrist who has expertise in treating adult ADHD. Medication is definitely worth considering, especially if symptoms are intruding in multiple aspects of your life, such as work and personal life. Research does show efficacy for using medication as part of a comprehensive treatment plan.

2. Read about adult ADHD from reliable sources. The list of resources at the end of this blog are a helpful start to better understanding.

3. Find a therapist who practices cognitive behavior therapy. Cognitive Behavior Therapy (CBT) can be extremely helpful in managing symptoms by learning strategies for time management, organization, and planning. Additionally, CBT can teach coping skills to manage intense emotions impulsivity, and other behavioral symptoms.

If my descriptions of adult ADHD resonate with you, I encourage you to pursue evaluation and treatment because it can make a significant difference in your life. 

Resources

Driven to distraction: recognizing and coping with attention deficit disorder by Edward Hollowell, MD

You Mean I’m Not Lazy, Stupid or Crazy? by Kate Kelly

Smart but Stuck: Emotions in Teens and Adults with ADHD by Thomas E. Brown, Ph. D.

Photo by Maxim Ilyahov on Unsplash

Getting Real About Depression

It goes without saying that 2020 has been a year like no other. The pandemic has emerged not only as a threat to physical health, but it has also negatively impacted mental health for millions of people. Depression, suicide risk, and substance abuse have all become more significant problems since the pandemic started. Factors such as unemployment and social isolation contribute to feelings of depression and hopelessness. Perhaps something good that can come from all that has transpired will be greater awareness of mental health challenges and the importance of seeking effective interventions and support for those who suffer.

Depression, however, has always been a chronic struggle for millions of people: long before the stresses of the pandemic, depression has impacted people’s ability to go to school, work, and have healthy relationships. Misunderstandings about depression and inaccurate information about its causes and treatments have also been around for a while. The purpose of this article is to dispel some of the myths about depression by providing information is based on research studying depression and its effective treatment. An additional goal is to increase empathy from those who do not experience depression, so they can better understand the struggles of their loved ones and be available to support them.

Below, I list some common misconceptions about depression and explain the realities of the condition: 

1. Depression is a state of mind: We all have bad days, bad moods, and find ourselves in stressful circumstances. But this is not depression. Depression is a persistent set of symptoms that affect a person’s ability to sleep, eat, concentrate, handle stress, regulate their emotions, and interact in healthy relationships. People experience episodes of depression that last up to two weeks, and they may have chronic episodes lasting six months or longer that may meet criteria for major depressive disorder. Thus, depression involves much more than just feeling down or having a bad day.

2. Smiling will make it better: some people say, “smile and the world smiles with you.” Perhaps it is true that seeing someone smile can spread a temporary moment of cheer. For those with depression, however, it’s important to remember that it’s more complicated. Simple behaviors such as smiling do not result in happiness or remove the complexity of problems that the person is experiencing. It is true, though, that expressing gratitude for things one has to be grateful for can be helpful as part of a larger picture. Gratitude helps us focus on the present, which is one strategy that mental health professionals use in mindfulness and cognitive behavior therapy. That said, leave it to professionals to help depressed persons change their focus. Depressed individuals feel very misunderstood when those who do not share their experience give this kind of advice.

3. Depressed people are selfish: those who have family members or friends who struggle with depression can certainly feel left out and ignored. It can often be hard to be with them because they focus on how they are feeling, and it feels selfish. While it is true that persons with depression focus quite a bit on their internal thoughts and feelings, this isn’t intentional. It’s not selfishness in the way that we typically think. In contrast, they feel insecure, they lack self-confidence, and they often feel like they have nothing of significance to contribute.

4. They could talk themselves out of feeling depressed if they tried: depression isn’t only about emotions. Thought processes become challenged as well, including difficulty focusing and making even the smallest of decisions. Their brains often repeat negative thought patterns, making it difficult for people with depression to change what they are thinking. It is possible to change the thought patterns over time, with the right kind of professional help. But it’s not as simple as making the decision to feel better. This is especially true when the depression goes untreated for an extended period of time. The longer that negative thought patterns continue to cycle, the harder it is for people to change them.

The experience of depression is different for everyone who struggles with it. The research is clear that millions of people have been effectively treated with a combination of medication and therapy, and sometimes with psychotherapy alone. Social support is also critical, and those without friends and family to provide emotional support can have a bigger battle to fight. Some people struggle with depression throughout their lives, and stress can definitely trigger depression in those who are at risk. Some individuals do not experience relief from depression from traditional treatment approaches; therefore, it’s important to remember that because someone has sought treatment doesn’t mean that their depression can be cured. Rather than giving advice without knowing their complete circumstances, it’s best to just ask those you know who struggle with depression how you can best support them. If they aren’t sure, then reassure them that you will be there for them as best you can. Letting them know that you care about them and that you don’t pretend to know their struggles can be more helpful than trying to solve their problems. Empathy and active listening are the best ways to support those who are struggling with any mental health challenge.  

Photo by Kristina Tripkovic on Unsplash

MASTERING SELF-CONTROL IN A CHAOTIC WORLD

The day started with sunshine, a bright blue sky, and a chill in the air. The perfect autumn day. I was excited to select a sweater, which was appropriate for the crispness of the fall season. Pumpkins and chrysanthemums lined our sidewalk, and I was looking forward to a fire pit and s’more‘s with friends that weekend. Then, my husband came home from work feeling poorly. Within hours, my strong, healthy husband was curled up shaking and in terrible pain. Three trips to the emergency room later, we began to understand his symptoms, and things started to calm down. 

This drama happened in the midst of a pandemic, during a contentious election season, during the same year in which my mother died suddenly. It was hard not to lose control of my emotions. I was furious about everything and with everyone. When was my family going to get a break from the suffering? Combined with all of society‘s problems, I wasn’t sure if it was possible to stay strong, to keep calm and carry on. I alternated between experiencing fits of anger and episodes of frantically crying in sadness and fear. However, I knew that I could not continue on this path; that it was not good for my physical and mental health. I managed to compose myself long enough to take a step back and engage rational thought again. I have learned over time there are things that I can do to regain my self-control when I feel emotionally overwhelmed. These strategies are drawn from my professional training, but even professionals struggle at times to implement them amidst tremendous personal stress. 

1. BREATHE: I know it seems simple and cliché. Many people have told me to “take a deep breath.“ I didn’t believe that this would be helpful until I actually started to do it. Deep, slow breathing when we are upset is like clicking the “restart“ option on our computer when we can’t figure out how to correct its problems. When the brain is overloaded, it needs to be reset; to clear its cache before it can think clearly.

2. TAKE A STEP BACK FROM YOUR THOUGHTS: When I am angry, sad, fearful, or experiencing a mixture of these emotions, it’s easy for the negative spiral to begin. I think to myself “nothing is ever easy“ or “ why do so many bad things happen to me and my family?” It’s certainly understandable that I would think these things when multiple stressful and scary events take place within a short period of time. But I have learned that rather than judging the thoughts, it’s more helpful if I observe them. After all, they are merely thoughts. They do not predict the future. They are often untrue. When we are in the midst of a crisis, they seem like they are true. So, I make these observations. I call them distorted thoughts. In reality, bad things do not always happen to my family. Everyone’s family goes through trials. Stressful times are temporary. Thus, we don’t need to respond to our negative and catastrophic thoughts. We sit with them, having the understanding that they, too, shall pass.

3. CHOOSE THE COMPANY WHO CAN BEST SUPPORT YOU: when I am feeling intense emotions, I need to be around people who are calm, uplifting, and “realistically“ positive. I become equally triggered by those who go down a negative road and by those who offer superficial reassurance. People who empathetically listen without judgment, offering advice, or too much commiserating are the best choice of companionship during hard times. It’s important to be heard and supported; however, people who dwell in the negative and easily go to a negative place may not be the best people to have around during a crisis.

4. FIND HUMOR WHEN POSSIBLE: there are some situations in life that are not funny. While we don’t want to make light of hard times, there may be certain aspects of our circumstances that need levity. We don’t have to make jokes at the expense of another’s pain to find appropriate laughter and a break from the intensity. Perhaps it’s in the form of a funny TV show, a funny quote that we remember, or laughing about good times with friends. Sometimes, humor gives our brain a much needed break from mulling over our problems. After this break, we can often think more clearly and have a fresh perspective.

5. STAY AWAY FROM SHAME: When we are experiencing big feelings and losing control, we often blame ourselves later. We feel guilty for having a meltdown. We may tell ourselves that we are weak because we lost control. Most people lose control of their feelings once in a while. Replaying our emotional reactions does not erase them or change anything. Shame is a very powerful emotion that can undermine our self compassion and lower our self-esteem. When you notice that you are feeling ashamed of losing control over your emotions, remember that you are human. There are times when you will reach the bandwidth of what you can handle. You can proactively plan how to recognize when you are approaching your limits and possibly prevent future meltdowns. Learn from the experience and move forward.

A lot of people are going through a hard time during this tough year, and I can definitely relate to feeling like I could lose at any minute some days. But how you respond to these feelings will affect your ability to bounce back from being overwhelmed and move forward with the things you need to do. Practicing the strategies above will equip and empower you to persevere even when you feel like your emotions are out of control.

OVERCOMING LONELINESS DURING AN ERA OF SOCIAL ISOLATION

Even before the COVID-19 pandemic swept the nation and millions of people were ordered to stay at home as much as possible, many were suffering from loneliness and social isolation. At least in the United States, loneliness had already become its own epidemic. If you google “scholarly articles on loneliness and social isolation,” dozens of articles written within the past five years immediately surface. An article published in the APA monitor in 2018 outlines some of the health risks associated with chronic social isolation and loneliness, including a risk of harm to physical and mental health that is twice as high as obesity. Studies have shown that individuals who struggle with loneliness over an extended period of time are more likely to suffer from depression, develop medical conditions, and die younger than their peers. According to recent studies, loneliness has become a concerning public health issue. 

While a great deal of attention has been given to the negative outcomes associated with loneliness, not many solutions have been proposed. The purpose of this post is to have a candid conversation around how those who are suffering can seek support to fight their battle with loneliness and social isolation. But there is also a call to action for the rest of the community. We must all work together to fight this battle, and to support those who are struggling and to help them overcome it and build resilience.

Is loneliness the battle you’re fighting? First, we must distinguish between “loneliness“ and being alone. Not everyone who spends a lot of time by themselves considers themselves to be lonely. Loneliness is an emotion people experience when they are longing for connection with others, both physically and emotionally. We can live alone and be content, we can live alone and feel incredibly lonely, or we can live amongst others in the same household and feel lonely and isolated. We know from the research that people living in close proximity to each other can be just as lonely as those who live in rural areas. In fact, we know it can feel even lonelier to be surrounded by people but to not feel connected.

Is loneliness a problem we can solve? The increase of loneliness in the United States in the past decade is a result of societal changes that make it more difficult to make social connections. People who report feeling lonely regularly say that it’s harder to make friends and takes more energy to meet new people. 

A lot more people live by themselves, and it has become more common to move far away from traditional support networks like families and childhood friends. We spend more time on electronic devices for work and recreation, but interacting over social media and the internet does not create the same sense of connection. Thus, solutions to fight loneliness must involve ways for people to more easily connect.  

Identifying loneliness as a major public health concern and a condition that leads to physical and mental health problems is the first step to finding solutions. But it’s more complicated than just getting people together, though, that is of course important. Here are some steps that individuals can take to fight their battle with loneliness:

1. Get involved in your community. Volunteer in areas that interest you. Nowadays, volunteering does not have to be a huge time commitment, but it can make one feel purposeful, and it often leads to feeling connected to those who are also volunteering and those you are helping.

2. Get outdoors. Going for walks in your neighborhood, visiting a local garden or natural habitat, or exercising outside can also increase connection to the community, even if you aren’t always talking to others around you. 

3. Seek professional support, especially if you were struggling with severe anxiety, depression, or other mental health conditions that may affect your willingness to be proactive in fighting loneliness. Often, people say that a cycle develops, where they are lonely, but they are also anxious about reaching out to others or getting involved in the community. If anxiety or depression results in avoidance, it will be hard to take steps to find connection. During COVID-19, there are more opportunities than ever to find affordable support groups, therapists, and other resources to help reduce anxiety and improve self-confidence.

What can the community do to fight loneliness? Those who are struggling with loneliness should not have to fight this battle by themselves. Communities have the responsibility of supporting others who are struggling and making it easier for people to connect. Say hello to your neighbors when you see them outside. You never know who needs a positive word of encouragement. Call friends and family members who live alone, or who you know may be struggling with feelings of loneliness. Sometimes a text, phone call, or FaceTime can brighten someone’s day just because they know someone cares enough to stay in touch. It doesn’t take a grand gesture to make someone feel supported. 

Fighting the epidemic of loneliness is going to require more than recognizing that it exists. Whether you are lonely, know someone who is, or cannot relate to either, we all must take part in finding solutions.    

Photo by Priscilla Du Preez on Unsplash

A LOOK AT TELEHEALTH: Therapists Must Keep it Real

Over the past three months, we have all made adjustments to every aspect of our lives, especially the work environment. Mental health professionals are no exception. Since March 13th, I have been working from home and using video platforms to connect with my clients. I’ve gotten used to it, and I am making the best of the situation. But I have concerns about continuing to do so, and I think they are important to discuss. If teletherapy is going to become more common, we need a reality check regarding the risks so that we can engage in it without compromising the safety and trust of the client-therapist relationship. This requires explicit dialogue between the client and therapist about how the teletherapy sessions will take place. Here are some questions therapist and client can discuss to make sure that teletherapy is as private and productive as possible. 

1. How private is the client’s teletherapy environment? Therapists must not assume that because the client is alone in a room or a closet that they can talk freely. Clients should not have increased anxiety that what they are sharing will be overheard by members of their household. Having an intentional discussion about this issue could affect how therapy sessions will be conducted. Perhaps there are certain topics that can’t be addressed over telehealth. Or perhaps the client needs to think about words or phrases that can be used to communicate during session as a sort of “code“ for discussing sensitive topics. Therapists can ask clients to take the lead in opening up the discussions, so they don’t accidentally ask questions that clients wish not to discuss over virtual therapy. There are ways to minimize the risks of violating privacy, but they must be addressed in advance.

2. Are there distractions on either side of the call that need to be minimized? Unlike an office, where distraction can be more easily problem solved by altering the environment, home life is a much different scenario. Many therapists who work from home have spouses, children, or pets that may unexpectedly appear. While, in the abstract, watching videos of babies interrupting meetings can be cute, this may not be the case during a difficult or emotional conversation that a client is having with their therapist. For mental health professionals, doing our utmost to ensure that the client’s 50 minute session is protected is extremely important. Perhaps it means we go to our office to do telehealth. If we don’t have that option, it may mean that we schedule clients when children are sleeping or when there is someone else to watch them. It may mean that pets are confined to a room during working hours with food and water. It’s unfair for a therapist to expect their clients to focus if they are not also motivated to do so. Clients also need to think carefully about scheduling. If possible, sessions should be at a time when there are likely to be fewer interruptions and when the client has the energy to participate fully in the session. In addition, although it can be tempting, do not multi-task or pause your camera. To the best of your ability, give these 50 minutes the same attention you would if you were in the therapist’s office. The therapist and the client should acknowledge these potential pitfalls of teletherapy and have an intentional conversation about how they can work to make the most out of sessions.  

3. How do we stay professional? Even if you’ve maximized privacy and minimized distractions, the fact that you’re in your personal space changes the nature of the sessions. While having a window into those personal paces might be intriguing, noticing each other’s environment doesn’t need to become part of the therapy session. Instead you should be continuing to focus on the client’s therapeutic goals. Therapists can let the client take the lead and refrain from mentioning details that the client doesn’t address first. Clients in turn should avoid commenting on their therapist’s space. Together you can set explicit goals at the beginning of each session to help you stay focused. You might even consider setting up a Zoom background. 

We now have the option to do therapy remotely, thanks to modern technology. But just because we can, doesn’t mean that we should. Conducting teletherapy is very helpful in keeping therapy consistent during a crisis. But it is certainly not a model that I would advocate maintaining instead of meeting in person, when that is possible and safe. When we must do it, however, being cautious and thoughtful about how it is conducted is essential. Maintaining a standard of privacy and sensitivity can make the difference between preserving or alienating the therapeutic relationship.

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EXPERIENCING GRIEF AND LOSS DURING THE COVID-19 PANDEMIC

Life hasn’t been the same, for anyone, since the COVID-19 pandemic took over our lives about six weeks ago. Schools and businesses closed, and we all went home for the foreseeable future. Many daily activities and simple pleasures, such as going to the coffee shop, have been put aside for now. As if life wasn’t hard enough with all of the suddenly imposed change, you lose a loved one. Then not only are you grieving the loss of life as you knew it, but you are grieving the loss of someone’s life. 

The statement that life will never be the same again takes on a special meaning for those of us who have lost a loved one during COVID-19. My mother was 80 years old, and she had chronic and long-term medical conditions that were always of great concern to my family. She had cancer, COPD, a stroke, and a heart condition, but she had survived it all with incredible strength and courage. So we did not expect her to pass away following a long infection for which she was being treated. We were certainly not expecting her to pass away during a pandemic, when we were unable to hold a proper memorial service. Extended family and close friends could not travel to pay their respects, nor could anyone easily send flowers, bring food, or do the other things people normally do to support those who are grieving. Of all the ways I thought my life would be altered by COVID-19, losing my mother and being unable to properly show respect for and celebrate her life was not what I had envisioned as one of the challenges.

How can mourners cope with the deeply felt loss during a time when others can only show limited forms of support? How can we access resources to help us grieve, when so many options are limited? I’ve asked this question both as a clinician and as someone grieving, and these are some strategies I have created.

1. Fully acknowledge the magnitude of your loss: For me, it would be easy to include the loss of my mother as an additional source of stress during an already stressful time. But losing a loved one, especially a parent, is devastating. It’s important to acknowledge how deep the loss is, rather than combining it with other stressful events happening concurrently. 

2. Make time for grief: As the days and weeks seem to run together during this time when we are almost always at home, be sure to carve out time for the emotional pain. Leave time for tears, reflection of fond memories, and processing emotions such as shock, sadness, and anger. The journey of grief is different for everyone, but it’s important to take the journey.

3. Give self-compassion: I’ve heard many people say they feel pressured to be more productive and creative right now because they have more time. I felt this way prior to my mom passing away. I am fighting against feeling it now. Self comparison is never a good idea, but when you are grieving, it is worse. Grieving the loss of loved ones demands emotional energy. We should not place expectations on ourselves or criticize ourselves for doing less and being less motivated. There is no way to anticipate how we will feel from one day to the next, so pressuring ourselves to accomplish certain things or feel certain ways can be harmful to our emotional adjustment.

4. Engage in simple pleasures: Let yourself find ways to experience temporary relief from your grief. Such as stepping outside for fresh air and sunlight, eating a favorite meal, taking a hot shower or bath, reading a good book, or doing whatever brings you some moments of joy. There are no “rules“ of grief that say you have to constantly feel pain. It’s okay to take time away from grieving.

5. Access good support: Identify trusted sources of support and encouragement, whether it’s personal friends and family members, mental health professionals, clergy, or all of these. We cannot be together right now in the ways that would be ideal during times of mourning. But we can reach out through phone calls, video chats, and group chats. If you aren’t feeling up to talking, let those closest to you know how they can best support you. It’s very easy and very tempting right now to isolate. But social distancing doesn’t mean emotional distancing. We still need connection with others, especially at times when we’ve lost someone so important to us. 

There’s no formula for grieving. Nor is there a time frame for getting over the loss. However, there are some things we can do to take good care of ourselves as we mourn. This is especially important during this time of great uncertainty. 

Photo by Sam Schooler on Unsplash

HOW TO BUILD RESILIENCE DURING THE CORONAVIRUS PANDEMIC

Three weeks ago we were all doing life as usual. We were following our daily routines of work and school; going out to dinner with friends; planning vacations over spring break; and looking forward to the change in season. After all, the groundhog promised us an early spring.

Then, the news coverage began. Each day, there are new positive test results for COVID-19. Life as we know it quickly changed, and the prognosis for the near future became scary. Schools have closed, people are strongly encouraged to telework, and now restaurants and bars are rapidly changing their business hours or closing all together. It’s a lot of change to accommodate within a short period of time. 

While adjusting the way that we work and learn is doable with today’s technology, adjusting to the social isolation and the complete halt of our typical activities can feel overwhelming. This is especially true given that we don’t know how long this will last. Initially, activities were getting canceled and things were closing for the next 2 to 3 weeks. But recent press releases in the last few days have indicated that it could be up to eight weeks, or longer, before life returns to normal. Adding in the risk of contracting a virus that we still don’t know much about, and we have the recipe for fear, anxiety, and hopelessness

Though it may not seem possible to maintain a positive attitude right now, we must not lose hope. We must focus on what we can control and do our best to modify our environment in ways that are not only tolerable, but enjoyable. Hopefully, this blog can suggest some ways to make the best of life and continue to build resilience during what may be an extremely tough few months. 

1. READ AND LISTEN TO RELIABLE SOURCES OF INFORMATION: to manage anxiety around the spread of the virus, as well as its impact on the world around us, visit credible websites with up-to-date data. These include the CDC, WHO, and your county government website for local data. Select the quality and quantity of your news coverage carefully: be cautious about reading many different sources of information that aren’t directly related to facts and recommended behaviors. Sometimes, you really can have too much information. 

2. KEEP AS MUCH STRUCTURE IN YOUR DAY AS POSSIBLE: if you are working from home, taking classes, or simply hanging out at home much more than usual, it’s important to maintain structure. Start your day with some physical activity or mindfulness meditation, schedule times to speak with others, and set a timer to do work if necessary. This will prevent the days and weeks from running together and will increase your sense of accomplishment.   

3. STAY CONNECTED VIRTUALLY TO FRIENDS AND FAMILY: regardless of your work or living situation, schedule times to talk with friends and family. Be intentional about making connections and engaging with your support network.    

4. GET CREATIVE, LITERALLY: Explore your creative brain in whatever fashion peaks your interest. Cooking, drawing, painting, writing stories or poetry, playing a musical instrument, writing songs, or simply rearranging your furniture. Find your inner creativity and explore a side of yourself that you don’t usually give time to.

5. EXPRESS GRATITUDE: This might be hard right now with so many things put on hold and so many typical pleasures lost temporarily. But it’s not as hard as you may think to find reasons to be thankful. Each day, think of at least a couple of items that you can be grateful for, whether it’s physical health, stabile finances, the ability to work online, the opportunity for simpler living for a time, or the relationships that you cherish. Being grateful allows us to remember that life is not as grim as it may seem.

6. EMBRACE NATURE: even those who are not athletes can embrace nature with a simple walk in the neighborhood. It’s now spring, and there’s plenty to enjoy, whether it’s cherry blossoms, flowers in your garden, or a bright sunny sky. Enjoying nature can be emotionally rewarding and physically restorative. 

These are challenging times for us all. But using these strategies can help make the best of a difficult situation. Right now try not to worry about or predict the future. We really have to just take life one day at a time.                           

Photo by Jason Leung on Unsplash

Should You Fire Your Therapist?

In my October blog post, “Good Therapy Is an Art and a Science,” I explained what quality therapy looks like. The post below offers additional insights into therapy by providing tips to help you determine whether or not your therapist is a good fit.

You’ve been going to therapy for two months. You have to leave work early to get there on time. You’re paying out of pocket because you couldn’t find anyone who takes your insurance. You’re thinking about stopping therapy because you should feel better by now, right? I mean, after all, you’re paying good money for therapy. That means that it should work right away, and two months is long enough to wait. 

If you’ve ever felt this way, let’s talk about therapy. There are indeed legitimate reasons to stop going or to find a new therapist. Your feelings about wanting to benefit from therapy and understand how you are benefiting are valid. Of course you need to feel like you are improving. Therapy is a commitment, so it is true that you want to make sure it’s worth your time and money. Caring and competent therapists agree, wholeheartedly, that clients should feel their time and money are valuable, and that they will get a return on their investment.

Here is the harder truth to reconcile, though: Your expectations of therapy will affect the outcome. So, before you decide to fire your therapist, here are some factors to consider: 

1. How many times have you gone to therapy? If you have gone a handful of times, now is the perfect opportunity for you to tell your therapist you don’t feel that it’s helpful. This will allow them to work with you on goal setting and troubleshoot why you feel like you’re not benefiting. Don’t drop out of treatment until you have had this conversation.

2. Do you know what your goals are in therapy? If your goal is to increase your self-awareness, you need a therapist who can help you identify behavioral patterns that you’ve developed over time. If your goal is to overcome your fear of spiders, you need a therapist who can teach you specific strategies to manage that anxiety. Being specific about what you want to accomplish or overcome in therapy will help you choose your therapist. It will also help you decide whether your therapist is a good fit.

3. Have you done work on your therapy goals outside of your session? If not, this could be an important part of the reason that you aren’t making progress or are feeling dissatisfied with therapy. Therapy is not a one hour a week experience. It requires reflection, self analysis, and intentional action during the rest of the week. If your therapist hasn’t clearly communicated this to you, talk with them about it. Issues discussed and strategies learned during the sessions are the food for thought that you act on, and chew on, in between appointments.

4. Have you communicated with your therapist about your lack of progress and dissatisfaction with their work? Some therapists will be direct, and they will ask you how things are going. Other therapists will wait for you to tell them. It’s a matter of personal style and theoretical orientation. But you can always choose to tell your therapist that you don’t think you’re making progress. Most good therapists will receive this and can adjust or adapt their approach. 

5. Do you believe that your therapist cares about your progress? If you have gone to therapy more than a handful of times, and you do not believe that your therapist is invested in helping you, it may be time to find someone new. However, if your therapist asks you how you think things are going, expresses an interest in setting goals with you, and tells you that they care about you, they probably do. An uncaring therapist is likely not the reason that you aren’t making progress.

The key in deciding whether to persist with your current therapist or find a replacement is honesty. Be honest with yourself about how much effort you are making in the process. Be honest with your therapist in sharing information, identifying goals, and giving them feedback. Don’t decide to leave therapy or your therapist without first communicating your concerns and giving the therapist, and the process of therapy, a genuine opportunity to work.

Photo by Mr TT on Unsplash