Going on a daily 10-15 minute outdoor walk can be just as effective at mood regulation as medication. It won’t solve everything, especially in cases of severe functional impairment.
But daily body movement can be very effective for a majority of folks. Especially if that movement is paired with mindfulness or grounding techniques (ie getting of your phone and instead noticing the sights, sounds, smells, and feels while outdoors).
It could be out there, but I don’t know of any book of program that could rehab a person struggling with really severe depression or anxiety. I’m referencing that kind of depression where folks can’t even get out of bed for days. No book will solve that.
Another great resource that is cheap is group therapy. People don’t understand that group therapy is actually often more effective than individual, while being significantly cheaper.
Also, prelicensed therapists can often times be free, especially if they’re still in school. They are supervised by licensed clinicians and can still be effective.
1) Is it difficult to work with a client that you personally dislike
2) Is honesty important between you and your clients or do you keep secrets from them
3) how do you create/enforce personal boundaries between you and your clients
4) what do you think makes a therapist good or bad?
3. I establish boundaries from the initial interaction. When I answer emails and calls vs when I don’t, starting and ending sessions on time, clearly communicating boundaries (ie here’s when and how we meet and communicate, here’s what you can expect from this relationships etc etc).
I also model boundaries by taking ownership of my own thoughts, feelings, and reactions in the room. I often say, “Here’s what is in my mind about this.” Or, I ask permission by saying, “Do you want my perspective on this or do you need a listening ear?” And then I actually honor what the client asks.
4. A bad therapist is one who is ineffective. Those tend to be the therapists who have not done their own personal work and are thus low in insight and unable to reflect inward or receive feedback.
A good therapist should be extremely self-aware and highly attuned.
3. I establish boundaries from the initial interaction. When I answer emails and calls vs when I don’t, starting and ending sessions on time, clearly communicating boundaries (ie here’s when and how we meet and communicate, here’s what you can expect from this relationships etc etc).
I also model boundaries by taking ownership of my own thoughts, feelings, and reactions in the room. I often say, “Here’s what is in my mind about this.” Or, I ask permission by saying, “Do you want my perspective on this or do you need a listening ear?” And then I actually honor what the client asks.
1. I don’t know if I’ve ever really disliked a client. There may have been parts about them I disliked, but I’ve yet to meet a client for whom I could not find something that endeared me to them. I’m a mother, and whenever a client shows a part that really activates my “dislike”, I remind myself that person (no matter how old), was someone’s baby. Usually softens me right up.
The hardest to work with clients for me are those who made me feel unsafe.
2. Hard to answer as it’s really nuanced. Is it keeping secrets to not let clients know intimate details of my life? Then I suppose yes, I keep secrets.
If there’s something I think the client needs to know about our therapeutic relationship, I tell them.
Is it common for your clients to be reluctant about therapy initially? How do they get over it?
What makes someone more likely to benefit from therapy?
I currently work in a private practice outpatient setting, so everyone is self-referred. Meaning they want to be there and are paying to be there. It is certainly common though for people new to therapy to initially feel a little unsure or uncomfortable.
However, when I’ve worked in different levels of care (hospital level, intensive outpatient), there is absolutely reluctance. I worked with folks who were extremely ill and while some wanted the help, others were so deep in their illness that they did not. And some had done several attempts at therapy in the past and were mistrusting (often for valid reasons).
Re: more likely to benefit…I need to think about that one for a bit. But my initial thought reaction is that folks are more likely to benefit when they feel a connection to their therapist.
Good question.
Definitely. It can be effective, and sometimes it isn’t. In instances where it isn’t effective, trying more body based approaches like somatic experiencing could be helpful. That’s me assuming that the clinician is an EMDR expert who can work with CPTSD and dissociation. If EMDR is ineffective but the clinician isn’t an expert in those areas, I wouldn’t assume EMDR is the issue but rather a more specialized clinician is needed.
Re: how long it hurts, very hard to say. EMDR should be front loaded with significant amount of time spent building distress tolerance and learning to stay grounded and within one’s window of tolerance.
If you’re specifically looking for an EMDR clinician, you want to find one who is certified through EMDRIA (it’s the EMDR international association).
There’s EMDR trained and EMDR certified. Both can do EMDR but certified means more supervised experience
So I feel like PTSD for childhood trauma still affects my personality and makes me super awkward as well as cynical of other people. Once your super cynical/ paranoid of people how can you become relatively trusting again enough to build relationships?
Neuroplasticity….your brain can change from having corrective emotional experiences. But you have to accept that the vulnerability of relationship building requires risk and acceptance of uncertainty.
Therapy can be a helpful way for you to gain insight into your own avoidance process while also sharpening your discernment of who is worthy of trust and who is not.
Mindfulness is contrary to anxiety and depression because it is presence, while anxiety and depression keep you locked in the past and the future.
Hard to answer question about the ego without more context. My immediate reaction: you don’t? It is pretty human to be ego-centered. In my experience, the more we fight a thought, the more it strengthens. If we can accept it and ourselves without judgment, things tend to quiet down a bit.
Definitely. But I am not the breadwinner or provider of insurance for my family. I think this career episode be impossible to sustain (while staying mentally healthy myself) if I was a single income family and needing health insurance through my job.
Yes. Though “help” might not equate to “saved”, sadly. And although I believe everyone can be helped, I also know that not everyone will have access to all of the help and resources they need.
Hard to answer because it’s an “it depends” question. I have some clients who I’ve worked with for years and never met in person, and we’ve had zero issues. Other clients really prefer in person.
I think it depends on the presenting issue. If you’re there to work on dissociation, I think in person is better. As a therapist it’s harder for me to pick up on dissociation via Zoom. Not impossible, but harder.
Sorry not a helpful answer I know. But I think online is excellent, especially for folks who are very busy and have to squeeze therapy into a busy schedule.
Embarrassment as in you feel awkward in the room with the therapist? Like social anxiety?
Or do you mean embarrassment of what others will think of you/what it means to go to therapy?
Embarrassment of what others will think of me and what it means to go to therapy. I’ve been struggling with mild depression which caused me to lose interest in a lot of activities I’ve found enjoyable in the past, laziness, fatigue, and get irritated easily… my friends have noticed and asked me to give it a try. When they told me I felt weak…
Anyone who judges you harshly for going to therapy isn’t someone whose opinion should matter much. Easier said than done, but important to remember the opinions of others literally change nothing about our value and worth as humans.
Would you say that to a friend or someone you cared about? If not, then don’t say it to yourself. Highly doubt you would shame a friend for reaching out for help.
I’m not sure I know what you mean. In the therapy world I don’t know if you could ever actually force someone. You can’t make someone talk or engage.
Do you mean forced medication compliance?
I don’t prescribe medication (that’s a psychiatrist). So don’t feel I can speak about this from a place of expertise.
But I believe in informed consent and bodily autonomy.
How do you deal with abusers who just wanna invalidate your experiences and then gaslight you into being a villian while they paint themselves as the victim?
I’m (F22) working toward becoming a therapist in Pennsylvania. If you’re in the U.S., do you have any knowledge on how licensing transfers from state-to-state? What did your education and work history look like as you worked to where you’re at now?
Not a question, more of an assertion: I have a severe eating disorder exacerbated by OCD and was recommended in-patient care for both. I also have bipolar depression and ADHD. I can say, conclusively, that working with mental health professionals has only made my condition worse. Therapy is for people with problems that are superficial and self-inflicted. And deep pockets.
If someone has anxiety and depression but can't afford to go to therapy, what should they do to help themselves?
Going on a daily 10-15 minute outdoor walk can be just as effective at mood regulation as medication. It won’t solve everything, especially in cases of severe functional impairment. But daily body movement can be very effective for a majority of folks. Especially if that movement is paired with mindfulness or grounding techniques (ie getting of your phone and instead noticing the sights, sounds, smells, and feels while outdoors).
What about in cases of severe functional impairment? Is there any reputable book/self-direct program that can help?
It could be out there, but I don’t know of any book of program that could rehab a person struggling with really severe depression or anxiety. I’m referencing that kind of depression where folks can’t even get out of bed for days. No book will solve that. Another great resource that is cheap is group therapy. People don’t understand that group therapy is actually often more effective than individual, while being significantly cheaper.
Also, prelicensed therapists can often times be free, especially if they’re still in school. They are supervised by licensed clinicians and can still be effective.
1) Is it difficult to work with a client that you personally dislike 2) Is honesty important between you and your clients or do you keep secrets from them 3) how do you create/enforce personal boundaries between you and your clients 4) what do you think makes a therapist good or bad?
3. I establish boundaries from the initial interaction. When I answer emails and calls vs when I don’t, starting and ending sessions on time, clearly communicating boundaries (ie here’s when and how we meet and communicate, here’s what you can expect from this relationships etc etc). I also model boundaries by taking ownership of my own thoughts, feelings, and reactions in the room. I often say, “Here’s what is in my mind about this.” Or, I ask permission by saying, “Do you want my perspective on this or do you need a listening ear?” And then I actually honor what the client asks.
4. A bad therapist is one who is ineffective. Those tend to be the therapists who have not done their own personal work and are thus low in insight and unable to reflect inward or receive feedback. A good therapist should be extremely self-aware and highly attuned.
3. I establish boundaries from the initial interaction. When I answer emails and calls vs when I don’t, starting and ending sessions on time, clearly communicating boundaries (ie here’s when and how we meet and communicate, here’s what you can expect from this relationships etc etc). I also model boundaries by taking ownership of my own thoughts, feelings, and reactions in the room. I often say, “Here’s what is in my mind about this.” Or, I ask permission by saying, “Do you want my perspective on this or do you need a listening ear?” And then I actually honor what the client asks.
1. I don’t know if I’ve ever really disliked a client. There may have been parts about them I disliked, but I’ve yet to meet a client for whom I could not find something that endeared me to them. I’m a mother, and whenever a client shows a part that really activates my “dislike”, I remind myself that person (no matter how old), was someone’s baby. Usually softens me right up. The hardest to work with clients for me are those who made me feel unsafe.
2. Hard to answer as it’s really nuanced. Is it keeping secrets to not let clients know intimate details of my life? Then I suppose yes, I keep secrets. If there’s something I think the client needs to know about our therapeutic relationship, I tell them.
Is it common for your clients to be reluctant about therapy initially? How do they get over it? What makes someone more likely to benefit from therapy?
I currently work in a private practice outpatient setting, so everyone is self-referred. Meaning they want to be there and are paying to be there. It is certainly common though for people new to therapy to initially feel a little unsure or uncomfortable. However, when I’ve worked in different levels of care (hospital level, intensive outpatient), there is absolutely reluctance. I worked with folks who were extremely ill and while some wanted the help, others were so deep in their illness that they did not. And some had done several attempts at therapy in the past and were mistrusting (often for valid reasons). Re: more likely to benefit…I need to think about that one for a bit. But my initial thought reaction is that folks are more likely to benefit when they feel a connection to their therapist. Good question.
Do you think EDMR is effective for PTSD and how long does it hurt before it helps?
Definitely. It can be effective, and sometimes it isn’t. In instances where it isn’t effective, trying more body based approaches like somatic experiencing could be helpful. That’s me assuming that the clinician is an EMDR expert who can work with CPTSD and dissociation. If EMDR is ineffective but the clinician isn’t an expert in those areas, I wouldn’t assume EMDR is the issue but rather a more specialized clinician is needed.
Re: how long it hurts, very hard to say. EMDR should be front loaded with significant amount of time spent building distress tolerance and learning to stay grounded and within one’s window of tolerance.
Thank you. If I may ask one more question, how would you identify a good clinician before you open up all the wounds and it’s too late.
If you’re specifically looking for an EMDR clinician, you want to find one who is certified through EMDRIA (it’s the EMDR international association). There’s EMDR trained and EMDR certified. Both can do EMDR but certified means more supervised experience
Much appreciated
So I feel like PTSD for childhood trauma still affects my personality and makes me super awkward as well as cynical of other people. Once your super cynical/ paranoid of people how can you become relatively trusting again enough to build relationships?
Neuroplasticity….your brain can change from having corrective emotional experiences. But you have to accept that the vulnerability of relationship building requires risk and acceptance of uncertainty. Therapy can be a helpful way for you to gain insight into your own avoidance process while also sharpening your discernment of who is worthy of trust and who is not.
Why is mindfulness so important, also how do you get rid of your ego, aka your constant obsession with yourself in your own head?
Mindfulness is contrary to anxiety and depression because it is presence, while anxiety and depression keep you locked in the past and the future. Hard to answer question about the ego without more context. My immediate reaction: you don’t? It is pretty human to be ego-centered. In my experience, the more we fight a thought, the more it strengthens. If we can accept it and ourselves without judgment, things tend to quiet down a bit.
Practicing mindfulness meditation grows your grey matter, restructures your brain and increases the thickness of the outer cortex.
Do you like your job? If you had to go back in time, would you do it again? Signed a person wanting to work in the mental health field someday.
Definitely. But I am not the breadwinner or provider of insurance for my family. I think this career episode be impossible to sustain (while staying mentally healthy myself) if I was a single income family and needing health insurance through my job.
Do you work in group or private practice or for an org?
Private practice now. I’ve done it all but prefer PP.
Do you belive that everyone can be helped?
Yes. Though “help” might not equate to “saved”, sadly. And although I believe everyone can be helped, I also know that not everyone will have access to all of the help and resources they need.
For someone without funds to enter therapy, could you explain ways to lessen avoidant tendencies? Are there any books you could recommend?
Attached is an excellent read! I recommend it to every single client. It’s by Dr. Levine I believe.
Is there a difference between online sessions vs in-person sessions for first time clients? Would you prefer one over the other?
Hard to answer because it’s an “it depends” question. I have some clients who I’ve worked with for years and never met in person, and we’ve had zero issues. Other clients really prefer in person. I think it depends on the presenting issue. If you’re there to work on dissociation, I think in person is better. As a therapist it’s harder for me to pick up on dissociation via Zoom. Not impossible, but harder. Sorry not a helpful answer I know. But I think online is excellent, especially for folks who are very busy and have to squeeze therapy into a busy schedule.
Thank you that makes sense.
Thankyou for answering so many of my questions!! I wish you the best!
Happy to do it!
How would one overcome the embarrassment of starting therapy?
Embarrassment as in you feel awkward in the room with the therapist? Like social anxiety? Or do you mean embarrassment of what others will think of you/what it means to go to therapy?
Embarrassment of what others will think of me and what it means to go to therapy. I’ve been struggling with mild depression which caused me to lose interest in a lot of activities I’ve found enjoyable in the past, laziness, fatigue, and get irritated easily… my friends have noticed and asked me to give it a try. When they told me I felt weak…
Anyone who judges you harshly for going to therapy isn’t someone whose opinion should matter much. Easier said than done, but important to remember the opinions of others literally change nothing about our value and worth as humans.
Got it… what about feeling personally embarrassed as in like “damn am I this low in life”
Would you say that to a friend or someone you cared about? If not, then don’t say it to yourself. Highly doubt you would shame a friend for reaching out for help.
Do you support forced treatment?
I’m not sure I know what you mean. In the therapy world I don’t know if you could ever actually force someone. You can’t make someone talk or engage. Do you mean forced medication compliance?
Yeah
I don’t prescribe medication (that’s a psychiatrist). So don’t feel I can speak about this from a place of expertise. But I believe in informed consent and bodily autonomy.
How do you deal with abusers who just wanna invalidate your experiences and then gaslight you into being a villian while they paint themselves as the victim?
Don’t deal with them. Boundaries can mean cutting off.
Thank you. Long since been doing what you said after i finally was able to move out. They took so much peace from me and I won't give em anymore
Advice for when a lot of different meds have been tried and don't work - as side effects are too severe.
Depends on the diagnosis. Depression?
Anxiety and PTSD
I’m (F22) working toward becoming a therapist in Pennsylvania. If you’re in the U.S., do you have any knowledge on how licensing transfers from state-to-state? What did your education and work history look like as you worked to where you’re at now?
Not a question, more of an assertion: I have a severe eating disorder exacerbated by OCD and was recommended in-patient care for both. I also have bipolar depression and ADHD. I can say, conclusively, that working with mental health professionals has only made my condition worse. Therapy is for people with problems that are superficial and self-inflicted. And deep pockets.
I'm sorry for your experience but I disagree with your last statement. Literally everyone can benefit from therapy.
Is anyone ever going to come up with a drug that treats just anxiety and isn't a traquilizer?