Online Counseling Services

We do everything online. Shop, pay bills, talk to our medical doctors, and talk to mental health professionals. Online therapy has had a lot of tomatoes flung its way, but the research speaks to its effectiveness in multiple situations.

Regardless of therapeutic platform, the relationship that therapist and client build together is the most important factor in successful therapeutic outcomes. Other factors that contribute are the client’s belief that therapy will help, the clinician’s ability to build rapport, and finally, presenting problem, and method of approach.

As early as 2012 research had indicated that online therapeutic relationships aren’t any less deep or rewarding as those formed in the in-person setting (Sucala et. al., 2012). This particular concern about online therapy isn’t something I’ve had an issue with. Not every counselor is right for every client; it is essential to get that “click” between counselor and client. Sometimes I’m not the right person for the work ahead. This happens in my online practice just as rarely as it happens in person.

The research questions we need to ask are, “What are effective online therapists doing? What skills do they have?

Not every mental health counselor belongs in the online environment. It requires a bit of tech savvy, the ability to communicate well in text and email, and to troubleshoot on the fly. That isn’t a set of skills that some therapists have or even want. Not all modalities translate well into the online environment either. Some have specific research support in the online environment like cognitive behavior therapy, and some just translate the mediums better.

Clinician flexibility is a must! Our ability to adapt is important in the in-person setting as well. Far too many times I encounter tales from clients and other clinicians alike that reveal the hazards of ill-equipped therapists in the online environment.

Thankfully, I grew up a product of the email and chat room generation. I mastered text as that technology became more common. Some of these skills have come in very handy in communicating across different tech platforms with my clients. Its not that my old “yahoo chat” skills made my clinician game strong – its that my ability to read between the lines of text on a screen, and to deliver text on a screen is a bit finer tuned than someone else’s who didn’t have that experience.

You know that person who always thinks you’re angry in text? I’m not usually that guy. I’m also not the guy who sends texts that come off as forceful. A therapist’s ability to be genuine, admit mistakes, seek feedback, and monitor therapy progress help determine outcomes too. Any ethical therapist is going to do these things in order to work with the client, regardless of medium.

Not all clients are suitable for online therapy. Crisis situations, recent suicide attempts or plans, and other considerations may mean that in-person help is the place to address particular issues. An ethical therapist will refer someone not suitable for online therapy to local resources.

Any ethically practicing therapist will utilize research proven means of intervention regardless of the platform through which they’re delivered. Research about what interventions are most helpful in the online environment are developing and its important for clinicians to stay up to date on this information.

“E-therapy” has been shown to be effective for a variety of issues (Barak et. al, 2008). Anxiety, depression, and the variations thereof have research support. In my practice I have case study support for a variety of more detailed issues. As an ethical and licensed therapist, I’m not willing or able to practice outside the realm of my expertise. If a problem doesn’t fit well in the online environment, I refer it out. Most counseling interventions used during counseling can be successfully transferred to online chat according to Barak et. al, (2008).

There are some clear benefits to online therapy:

  • Access in rural areas is increased
  • Access to qualified clinicians at a broader range of hours
  • Enhanced privacy for clients (no car to park in a therapist’s lot)
  • Fees for online services may be lower than for in-person sessions as overhead costs are reduced
  • Lower fees increase accessibility to services
  • No travel of any distance to a counselor’s office
  • Appointments can occur outside normal business hours which enhances convenience and accessibility

The factor that rates highest in the research as the most important factor in successful therapy outcomes is that of the therapeutic relationship or alliance. This alliance occurs and is part of the healing process and work that takes place in therapy. The ability to get online and fish from a much larger pond of professionals increases the likelihood that someone will find their ideal match. That match may just make the difference.

Finding a good online therapist is the same as finding a good one in person:

Examine credentials and education
Research the clinician through their state licensing board
Find out what professional organizations the therapist belongs to and review their ethics code (For example, I’m a member of the American Counseling Association and the National Board for Certified Counselors – both have ethics codes and so does my state. I adhere to all three.)
Ask questions about expertise and experience
Speak up and change counselors when in doubt

For more info check out this blog on finding a good counselor and this one on the differences in mental health professions.


Sucala, M., Schnur, J. B., Constantino, M. J., Miller, S. J., Brackman, E. H., & Montgomery, G. H. (2012). The Therapeutic Relationship in E-Therapy for Mental Health: A Systematic Review. Journal of Medical Internet Research14(4), e110.

Azy Barak, Liat Hen, Meyran Boniel-Nissim & Na’ama Shapira (2008) A Comprehensive Review and a Meta-Analysis of the Effectiveness of Internet-Based Psychotherapeutic Interventions, Journal of Technology in Human Services, 26:2-4, 109-160, DOI: 10.1080/15228830802094429



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Do You Self-Sabotage?

I hear about self-sabotage from my clients pretty frequently. Its true that we self-sabotage at times; we all do things that make little sense in retrospect or bring about the exact opposite of what we were hoping for. Sometimes we do things in direct contradiction to the goals we’ve got our sights on.

Before diving into working on self-sabotage, I invite you to consider that it isn’t so much “sabotage” as it is self-protection. Everyone has a survival instinct built into their brains, and it gets activated by fear. It kicks into action to try to protect us from getting hurt or experiencing pain. This survival and protective fear response is really helpful if we’re being threatened and need to fight, flee, or faint to protect ourselves.

Throughout our lives we have various experiences that can teach us to re-program that response. It stops kicking in only when we’re physically in danger and can start to activate when we’re threatened with emotional hurt too. Sometimes we internalize (after painful experiences) the ideas that certain emotions are bad, unbearable, or can’t be handled. Emotional injuries do hurt, after all.

Over time we may find ourselves operating from those ideas, which means that our protective stress response comes in and promotes thinking and behaviors as if there is a physical threat, when in reality our fear of emotional pain has caused us to switch into survival mode. This mode draws us into behaviors that we sometimes label as “self-sabotage”.

Areas You Self-Sabotage

Relationship based self-sabotage is common. We naturally don’t want to be hurt by those we love and care about. Finding the beliefs you internalize that may have you acting in ways that aren’t helpful or supportive to your relationship goals is a first step toward addressing self-sabotage.

Below are some beliefs that might trigger fear or resistance to taking action that supports you, your relationships, or your goals:

• I’m not lovable.
• Once someone knows me, they’ll leave me. I always get left.
• I’m not relationship material.
• I will lose my freedom. I have to give myself up to keep the relationship.
• Being rejected is too painful to handle. I don’t want to take the chance of being hurt.

For a lot of people, fear of rejection is a primary motivator for self-sabotage.
Work related self-sabotage is also linked to fear of rejection. Below are some beliefs that may trigger self-sabotage when it comes to work:

• If I fail, it means I’m stupid and worthless. Everyone will think I’m stupid.
• Everyone tells me to work and succeed at work. If I don’t I will let them down, so I better stay small and stay in my “lane” or risk failure.
• I deserve to start at the top and won’t take anything less.

There are many thinking patterns and beliefs that can stop us from taking the right action or keep us stuck. Spend some time thinking about your thought processes in relationships and work. Identify thinking that may not be helpful to you. You can also check out this list of cognitive distortions to dig into this issue further.

Some other fear based beliefs that may keep you stuck:

• Success or failure defines my worth as a person.
• I’m an inadequate person.
• I can’t handle rejection.
• I have to give myself up to be loved.

How You Self-Sabotage

Self-sabotage can look different for each of us but some common patterns may be:

• Keeping yourself isolated.
• Rushing into relationships.
• Giving yourself up to the point of resentment in relationships; becoming angry due to feeling like you’ve lost yourself, and then ending the relationship intentionally or overtime with angry outbursts.
• Not sharing yourself enough to create real connection.
• Putting off looking for work you really want.
• Staying in a job you hate. (Resentment builds, anger starts, you begin to lose yourself, and may quit or become ill from the stress associated, leading to issues at work.)
• Giving yourself up at work, allowing yourself to be used, not setting clear times for work and home or fun.
• Keeping yourself uneducated or refusing opportunities for learning, promotion, and growth, which stops you from doing what you really want to do.

Getting Unstuck

• Pay attention to self-judgements. Self-judging is a big factor in self-sabotage. When you notice self-judgement and ask your logical, rational, Spock-like self what the higher truth really is.
• Examine whether your definition of self-worth comes from “success” or effort. Decide and commit to defining your worth by the loving acts you put into the universe and toward yourself, rather than the outcome of “success”.
• When experiencing failure, note what you feel you’ve “failed” at and be intentional about looking for successes. Maybe your sales pitch didn’t get a lot of products sold, but it did provide practice for your craft, new contacts, etc. Look for opportunities to learn more, for areas you may want to grow in.
• Learn to be as compassionate to yourself as you are to your friends and loved ones. When you are able to allow feelings of pain to come and be met with kindness toward yourself rather than self-blame and self-judgment for them you will start to embrace a higher truth. You’ll show yourself you’re willing to take loving action toward yourself.

Doing the work of introspection, thought monitoring and challenging, and building tolerance to the distress of your fears, is difficult – yet empowering. It is a high form of self-love, and will help you on you way to loving relationships and happier work experiences.


Green Time

Spring is here and summer is on the way. Every store in town has plants for sale along with all the plant food and gardening tools we could possibly need. The weather is finally pleasant enough that most of us are able to get outside and enjoy it. The bright colors of flowers and leaves and the warmer weather aren’t just pleasant to our senses – they have some pretty impressive health benefits too.  

Countless studies have shown that spending time in nature and outdoors is good for us generally. Some studies have looked specifically at the healing powers of nature and “green time” like gardening and found that views of nature from hospital rooms and even paintings or pictures of nature in hospital rooms can speed recovery time following surgery. Its true that nature is great medicine!

With the season for all things plant and garden at hand, here are some awesome reasons to get outside to play, plant, read, or walk.

1.       Gardening increases life satisfaction, vigor, psychological wellbeing, sense of community, and cognitive function. Plant some things at home or find a community garden run by a local group or church where you can spend some time!

2.       Gardening decreases stress, anger, fatigue, and symptoms of depression and anxiety.

3.       Gardening can also help reduce Body Mass Index or BMI for those concerned with health related to weight and BMI.

4.       Just walking in nature can lead to lower risk of depression. Most people live in city and urban areas and as such more and more of us are away from nature and sources for quality green time. City dwellers are at a 20% higher risk for anxiety, and 40% higher risk of mood disorders compared to people in rural settings. People born and raised in cities are twice as likely to develop schizophrenia. Living in a more urban setting doesn’t have to get you down – having house plants, planting trees where you’re allowed to, and visiting community parks and gardens can do the trick.

5.       Spending time outdoors is grounding. The earth is a pretty solid thing. When we experience overwhelm or feel lost, digging in the dirt, hiking through hills, and spending time outdoors can reconnect us to things that don’t change.

I’d love to see pictures of your gardening projects, hiking trips, and hear how “green time” has impacted your life!

Some Resources:

Soga, Gaston & Yamaura (2016). Gardening is beneficial for health: A meta-analysis. doi:  10.1016/j.pmedr.2016.11.007

Gigliotti C.M., Jarrott S.E. Effects of horticulture therapy on engagement and affect. Can. J. Aging. 2005;24:367–377.

Gonzalez M.T., Hartig T., Patil G.G., Martinsen E.W., Kirkevold M. Therapeutic horticulture in clinical depression: a prospective study of active components. J. Adv. Nurs. 2010;66:2002–2013.


7 Ways to Help Heal Emotional Overwhelm

Life is full of seasons that often leave us feeling overwhelmed or out of balance. During these times even regular “little” daily things can become too much to cope with if we’re not mindful and self-aware about what is going on with us. When life throws a curveball and you need a recharge to get some of that balance back or come back to a less intense emotional point, it helps to have a plan for coping. Here are some strategies to help get you back to zero during chaos, stress, and overwhelm : )

  1. Get grounded. There are lots of grounding exercises on the internet, but my favorite by far is to spend time in my gardening. In nature things have a predictable pattern and a feeling of being solid, which is comforting during times of upheaval. Gardening also invokes so many of our senses that it helps me stay focused on what I’m doing in the here and now, which brings peace. *Bonus: When it rains (or when I water the yard or plants) and I’m wanting to really get grounded or just have fun, I’ll make a muddy spot to walk. Feeling the mud on my feet and making a little mess (we don’t let ourselves make messes very often as adults!), can really be great.
  2. Slow down. If there’s some major decision to be made or some pressing problem to sort through we tend to tell ourselves that we can’t take a break or relax until the situation is resolved. Not true! Decisions are best made when we’re at an even keel; problems are sometimes more easily or creatively addressed when we take time to get fresh perspective. Give yourself time. If its really hard, make yourself do it. Set a timer and get gardening, take a hot bath, put in a comfort movie and force yourself to take the time away from being stuck in problem-focus or decision-making mode.
  3. Examine your thoughts. Take some time to check your thinking out. Are your thoughts contributing to the feelings you’re having that aren’t helpful? Check out this list of cognitive distortions and the worksheets included for help with this!
  4. Eat well. If you’re facing major upheaval in environment or emotions, your body will tire itself out more quickly. Make sure that you’re giving your body the fuel it needs to support you through this time period.
  5. Get rest. Finding the motivation to keep up with your sleep routine or even having the ability to get the sleep you need can be hard during stressful times. Shut your electronics off at least 30 minutes before bed (ALL OF THEM!), avoid caffeine after lunch, and try a sleep-aiding meditation like Andrew Johnson’s Deep Sleep (available on the app stores!).
  6. Exercise. Walk for 30 minutes, do yoga for 20-30 minutes – basically any physical activity will help you sleep better, reduce stress, and increase your feel-good chemical endorphins.
  7. Find a pro. Some times its harder than others to get things back on track after a life change or upheaval or even just a bigger than average dose of stress or worry. Taking time to work through things with a pro can be really helpful too!


The Ways We Think – Cognitive Distortions

We humans tend to trust what goes on between our ears. After all, its us, its our brain. If we can’t trust our own brains, whom can we trust?

We’re wired so that our brains can alert us to danger, find solutions to problems, and so much more. Yet sometimes the brain leaps to conclusions that aren’t super helpful. The brain doesn’t lie to us, but because the brain is predisposed to making connections between ideas, actions, thoughts, and consequences, it will sometimes make connections between things that aren’t absolutely accurate.

This is where therapists get the term “cognitive distortion”. Cognitive distortions are exactly what the name implies; distortions in our thinking patterns. They are biased views or perspectives that we develop through environment and experience. Cognitive distortions aren’t our thoughts but are our way of having thoughts. These patterns are deeply ingrained and are so much a part of us that sometimes we don’t really even know they’re there.

Cognitive distortions come in different basic types, which we’ll go into in the list below, but there are three commonalities. All cognitive distortions are:

  • Patterns of thinking or believing
  • Which are false or inaccurate
  • Have potential to cause damage to the person and their relationships

A lot of people are hesitant to look at their own thinking patterns to determine where their cognitive distortions may lie. Its scary to admit we may not be aware of how we think, and sometimes scary to admit that how we’re thinking may be to blame (at least in part) for problems we have. The statistics are simple on this, and they can be comforting – if you’re human you’ve likely had numerous cognitive distortions at some points in life. Everyone does!

Cognitive distortions are in play around depression, anxiety, and numerous other mental health issues. Understanding them and seeing how they may affect your emotional state, and how they may affect your interactions with others gives you power to challenge and even change them so that your thinking is helpful at promoting the feelings, interactions, and relationships you want to have.

Common Cognitive Distortions

Overgeneralization. This distortion takes one example and generalizes it as an overall pattern. For example, someone searching for work may be interviewed and passed over by a potential employer to come away thinking that he is stupid, undeserving, or a failure. Overgeneralization leads to negative thinking about ourselves and our environment on the whole, all on the basis of just a few examples or experiences.

All or Nothing Thinking. This type of thinking, also called black and white thinking, is an inability to see shades of gray where they may exist. Instead of seeing that something is just “ok” a person might think things are wonderful or terrible, or view themselves as either perfect or a complete failure.

Mental Filter. This distortion focuses on a single happening and excludes all other information. For example, a single comment by a romantic partner that is negative may become the focus even though that same partner has made thousands of positive comments; this perception may have the offended party as viewing the relationship mostly negatively while ignoring all of the positive experiences in the relationship.

Downplaying the Positive. When we downplay the positive we automatically believe that positive comments or positive treatment are a fluke rather than deserved or earned. For example, someone who gets a very good grade on a speech in class may decide this grade was because everyone else was so awful comparatively, or because the professor feels sorry for them, rather than that the grade is earned or that they are deserving.

Mind Reading. This distortion is very common and it assumes that we know what another person is thinking, feeling, and even what motivates them. Its entirely possible to have an idea what others may be thinking and feeling, but with mind reading we immediately jump to negative interpretations of the information we have. For example, seeing someone staring at you in public and assuming that they are thinking poorly of you is mind reading.

Fortune Telling. This is similar to mind reading but about our future as opposed to people or events in present. Someone who is unmarried and wanting to marry and have a family may think that it will never happen for them because it hasn’t happened yet. There isn’t anyway to know if this person will remain single forever; but the fortune-teller sees this prediction as fact rather than one of many potential outcomes.

Personalization. Like its name implies personalization occurs when someone takes everything personally and assigns blame to themselves with no factual information to support that blame. For example, attending a dinner party with friends who seem to be irritated and upset and believing that you are the reason your friends were irritated. In some cases where personalization is very ingrained it can lead people to believe that they’re responsible for all the moods and irritations of those around them.

Heaven’s Reward. This distortion is the belief that our struggles, suffering, or hard work will result in an equal reward for our troubles. There are lots of times in life where we and those we know will work hard or suffer through much without an apparent reward. The idea that there’s an amount that we can work or sacrifice to achieve a reward can be damaging as it often results in anger, disappointment, and even depression if the reward doesn’t happen.

Shoulds. We tend to make “should” statements. They’re statements that we make to ourselves about what we should do, and we even apply them to others. We decide what others should do and set expectations that have no guarantee of being met. When we won’t budge on these we frequently end up feeling guilty when we don’t meet our “should” expectations and when others don’t live up to them we are disappointed and can become resentful.

Fact Feelings. When we reason from an emotional place we accept our feelings as fact. We think if we feel something it must be true. Accepting our emotional reactions and states as facts can cause misunderstanding, poor communication, a hotbed for poor decision making, and resentment in relationships. Emotions are temporary and are based in our thoughts.

Fairness Fallacy. Operating in a world that is completely fair is something most of us would enjoy, but it isn’t based in reality. Frequently we’ll encounter life’s unfairness and judging experiences and actions of others in a way that compares them to what our personal idea of “fair” is will often result in hopelessness and anger when we’re forced to deal with a situation that isn’t fair.

These are just a few examples of commonly experienced thinking patterns that can harm us and our relationships or interactions with others. As most people read through lists of these there are a few that jump out as being relatable – so now that you have an idea that some of your brain’s patterns for thinking aren’t helpful, what do you do?

Working Through Distortions

  1. Identify distortions that you believe are most commonly occurring for you. Journal them down and jot down a few times that the ones you’ve recognized you can relate to have intruded on your emotions, interactions, or decision making.
  2. Use this awesome worksheet I made called a Thought Record. In it you’ll describe the situation in which a negative thought arose (very likely due to a cognitive distortion), then you can identify context information about what you were doing and where you were. Next you’ll rate the strength of the emotion that the situation brought on, and then you’ll identify the negative thought and feelings that came with it. Next you’ll examine the evidence that supports the thought or doesn’t. You’ll create an alternative thought that can be used to argue against the negative thought. As a last step you’ll reevaluate the situation with the new thought in place and record the intensity of the emotion after this process. The goal is that the intensity goes down a bit after this process!
  3. Practice differentiating between facts and opinions with this handy worksheet I made.
  4. Journal frequently using the format from the Thought Record and make a habit of asking yourself if you’re viewing your thoughts and or feelings as facts.
  5. Recognize that this is challenging work. Undoing thinking patterns that have been with you for years (and years and years!) isn’t easy. It can really help to have a professional keep you motivated and on track. Be compassionate with yourself as you do the work.
  6. Locate a licensed counselor in your area to work with you on your distortions. Therapists that say they do “CBT” or cognitive behavior therapy will be the bees knees for this type of work; and if you’re in Texas, give me a shout! I provide counseling online via video and also via phone!

BONUS! Check out this list of questions designed to help you challenge your thinking patterns!

Happy Thinking!


4 Ways to Boost Your Self-Esteem

At least once a week I encounter a client who states a desire to improve their self-esteem. Self-esteem is pretty important to us; it is about how we see ourselves, how much value we believe we have, and for those reasons it impacts every area of our lives. Our interactions, relationships, thinking patterns, and so much more are impacted by the way we feel about ourselves. Here are some exercises to help you improve your self-esteem:

1.       Cultivate self-awareness. Notice when you’re feeling down about yourself and take a moment to flip back to the moments just before that feeling started. Note your negative thoughts or words spoken to yourself prior to the onset of the feelings. Make a mental note of the impact of those thoughts and words. Use a CBT Thought Record or similar journal entry if you can find time to write. Ask a friend to help you stay self-aware and discuss these thoughts with you.

2.       Practice self-compassion. The negative thoughts you’re having that lower self-esteem are hurtful, but we tend not to think of them that way. Imagine saying the same sorts of things to someone you love. Would you? Most likely not! You’re a kind person! So, reword things and say them to yourself as you would to a friend.

3.       Create an “I Love Me” board or file. Get some poster board and draw pictures, cut and paste images, and write words of your personal highlights. Times that you said or did something or noticed something great within yourself. You can use pictures, magazine clippings, and doodle little memories with artful letters (or plain ones!). Add to this board or journal or file as often as you want to. Fill it up!

4.       Create a “Kindness Journal”. Keep this journal by your bed and each night before you go to bed, write in three things you did that day that were a display of kindness or compassion to others. Did you hold a door for someone? Help someone carry a package? Smile at a stranger? Do laundry for your spouse? Pick up a child’s friend from school as a favor? All sorts of things count. If you can think of more than 3, keep that list going! Add to it daily just before you hit the hay. This puts you in a kind mindset about yourself before you go to sleep and helps you wake up the same way!

Check out this graphic that sums it up: