Emotional Garbage: Taking on other people’s trash

Years ago, when I was still under clinical supervision for licensing, my supervisor taught me an extremely valuable lesson about making things both three dimensional and palatable for my clients. His trick? Making things physical for them and using stories and euphemism to paint pictures. His method was like that of Milton Erickson, but with a much more brisk, rough-around-the-edges approach.

Here, I present one of these tales, as it was delivered to me to help me grasp the concept of emotional boundaries, and where they come from – within us rather than extrinsically.

I was struggling to help a client set boundaries for themselves. We’d done all the preparation. Identifying areas of unease that needed to be protected, discussed methods of communicating the boundaries, practiced in the office. Yet, they weren’t getting it in the way I thought they would – there was a lot of emotional upset from people’s responses to my client’s setting of boundaries. These angry emotions expressed to the client left them feeling hurt, and as if the boundary setting was hurting rather than helping their level of peace in life.

I’d made a mistake by focusing on the behavioral aspects of boundaries: not engaging with unwanted or harmful behaviors of others, being selective with information shared with those who offered unsolicited opinion, etc. I’d failed to give enough attention to the emotional aspects of how boundaries function and one of the largest boundary issues of all: the sharing of emotion.

People who flagrantly violate boundaries do it because they can get away with it, and they get away with it because the person they’re violating either won’t say ‘no’, is unable to do so due to an authoritative issue, and/or because they know that person feels responsible for whether or not they’re upset.

When you feel responsible for someone else’s emotions and behaviors, you’re likely to do all you can to keep their emotions and behaviors from being unpleasant ones – up to and including allowing them to tromp right over a boundary you may have set or be working to set. This is what had happened to my client. They had put some behavioral boundaries in place, but when they were exposed to the emotional reactions of the person they’d set boundaries with, it was a terrible feeling. Guilt, shame, and blame.

How to help this person draw that mental and emotional boundary?

As I discussed this with my supervisor he munched on the tiny snickers candies his wife kept stashed in the bowl on his desk for him. Little wrappers began to pile up on the desk next to him. I babbled endlessly trying to put into words what I felt needed to be done as he scooped those wrappers off his desk and into his hand.

“Put out your hand, mi hija.”

I dutifully put my hand out, palm up. He responded by putting all of his many wrappers into my hand. They started to fall out of my hand and onto the floor. I reached down, scooped them up and clenched them tightly. I sat there holding them. I was eyeballing the trashcan next to his desk.

What in hell is going on here? Was he really thinking I was going to just hold his trash for him? 

My eyes must’ve been darting from my hand to the trashcan in a noticeable way at this point. Finally, he put his hands up in a “What do you expect?” kind of way and shrugged.

“You just going to hold that?”

I felt really….stupid for a split second. Then I realized that I’d been had in a brilliant way. He held his trashcan out to me and I dropped the wrappers into it and dusted my hands against my dress.

If we keep holding our hands out, open to taking responsibility for what anyone may just hand us, then we can’t ever be free of those things. We’re quite literally holding onto them, and willingly.

This is how emotional boundaries work. What someone does won’t ever stop bothering us as long as we hang on to it emotionally. If we aren’t able to understand that what other people do and feel are their responsibility, then this part of boundary setting will never click.

This requires letting go of the emotions that people hand to you, and accepting that you can’t “fix” them or control them. It demands understanding and accepting that nothing anyone else does is because of you, but is because of them, their experiences, their own inner world, values, and beliefs – which you have no control over. It means you have to repeat this to yourself over and over (and over) again while you’re learning it and trying to let go.

The true difficulty with that is that when we accept that we must also accept by default, that our emotions and responses are our own responsibility. We embrace fully, that we are responsible for what we take on and how we feel about others’ expressed emotions when we accept that we aren’t responsible for what others feel. Others can’t be responsible for their own emotions and reactions if we can’t agree that we’re responsible for our own.

Maybe this is why this part of boundary setting is the hardest to get. It’s far easier to say ‘no’, to limit contact with someone, or to change what you communicate with them verbally than it is to embrace responsibility for just yourself and how you choose to hang on to someone else’s feelings and trying to fix them, or letting them go and stepping into your own calm and peace.

Here’s your invitation to let go, drop the emotional refuse that keeps you working so hard to make others happy that you can’t find energy to manage your own reactions.

Namaste!

5 Times Star Trek Got Mental Health Right

Where are all my Trekky fans at? Over the last year my husband and I watched Star Trek spinoffs The Next Generation, Voyager, and Deep Space Nine. Obviously, we’ve liked it, or we would’ve stopped before our trek through DS9. We’re about halfway through DS9 and we came across episode 19 of season four titled Hard Time.

Our post-episode discussion had us talking about it and during that it occurred to me that these shows have done a really good job in working to increase mental health awareness and de-stigmatizing getting treatment and help when it’s needed. Here’s my list of times that a Star Trek series nailed mental health.

  1. Deep Space Nine | Season 4, Episode 19 “Hard Time”

The episode stars everyone’s favorite Chief Petty Officer, Miles O’Brien, who is arrested and spends time in a prison for espionage. It details his time in prison and his release. To the rest of the world, O’Brien is held for a number of hours for punishment for his crime, but to O’Brien he was imprisoned for 20 years. Thanks to the scientific advances of the planet administering the punishment they have no brick and mortar prison or punishment; they simply hook people up and install memories of imprisonment, and then release people.

Miles wakes up with 20 years of memories of starvation, beatings, torture of all kinds, and even sadly, killing his cellmate (who doesn’t really exist and is just an implanted memory) over some food during a time the prison staff was withholding food. He returns home with extreme emotional trauma, hypervigilance, and portrays complex trauma in a realistic way, including his initial resistance to treatment and withdrawal from friends and family.

Ultimately, Miles’ friends support him through his experience, and he happily accepts both medication and counseling in order to heal. Good job, Deep Space Nine, and actor Colm Meaney.

  1. Star Trek Next Generation | Season 7, Episode 7 “Dark Page”

This episode stars the flamboyant mother of ship’s counselor Deanna Troi, Lwaxana Troi. Because of the Troi family Betazed heritage, they enjoy the ability to communicate telepathically. This brings Lwaxana to her daughter’s ship, the Enterprise, in order to help a new Federation member planet whose population communicates only telepathically learn to speak verbally.

During that process Mrs. Troi overexerts herself and becomes very stressed, and very emotionally attached to a young girl she’s teaching to speak verbally. With her internal defenses down, memories of the tragic loss of Mrs. Troi’s eldest daughter (Deanna Troi’s older sister) come flooding back. This loss and even her first daughter’s existence are things Mrs. Troi held deep in her mind away from everyone, including her daughter, Deanna.

Eventually, Mrs. Troi suffers a total collapse and both the ship’s counselor (her daughter) and another telepath help Mrs. Troi process that old hurt and her grief, which enables her to heal and move forward. It also helps Deanna better understand her mother and some of her mother’s past behavior. An entire family is healed!

  1. Star Trek Next Generation | Season 6, Episodes 10 & 11 “Chain of Command”

In this episode, Federation enemy species, the Cardassians bring the Federation to the brink of war. Star Fleet Command sends Enterprise Captain Jean Luc Picard on an undercover mission where he is ultimately captured and tortured for days. Picard valiantly clings to hope that he will be rescued, and that his crew is still alive and working to get him back.

The Cardassians release Picard after their political demands are met, and Picard returns to the Enterprise in poor health, and unsure of his own reality thanks to the psychological torture he endured. After taking command of the ship he leaves the bridge, enters his ready room, and sends for Counselor Troi. He begins talking with her about his experience immediately. What’s best – the whole bridge crew sees him reach out to Troi and take a break from his bridge duties when he needs it.

  1. Star Trek Next Generation | Season 3, Episode 5 “The Bonding”

Security Chief Worf takes an away team to investigate an uninhabited planet, only to walk into a minefield. One of the scientists on the away mission is killed during the exploration. She leaves behind a young son, whose father was killed in a conflict when he was a baby. The ship’s counselor works hard to help him adjust, as do several other crew members.

The alien species responsible for the mines that would kill the young boy’s mother witness all that is happening and in their guilt, they take the form of his mother and create an illusionary world for him – all in an effort to ease the boy’s pain. The crew, including the captain, learn what is going on, and work hard to help the boy, Jeremy, process his pain, and choose reality, over the illusion they’ve offered.

Worf invites the boy into a healing Klingon ritual that makes him a member of Worf’s family.

  1. Voyager | Season 5, Episode 3 “Extreme Risk”

In this episode, main engineer B’Elanna Torres loses interest in her and boyfriend Tom Paris’ project in developing the revolutionary shuttle craft, Delta Flyer. She becomes disconnected and withdrawn. She starts showing up late, and missing things. That just isn’t B’Elanna. Soon her friends and crewmates are concerned about her, and everyone is trying to figure out what is going on.

First Officer, Chakotay soon realizes that B’Elanna is spending time in the holodeck running programs with the safety settings off. She seems to have lost interest in protecting her health and to be taking joy in hurting herself. Finally, Chakotay finds B’Elanna running a simulation of the day her friends and fellow resistance fighters in the Maquis die – an event her tour through the Delta Quadrant caused her to miss.

B’Elanna, it seems, is dealing with both survivor’s guilt and depression in trying to cope with the loss of her Maquis friends. Chakotay is able to help B’Elanna discuss her feelings, the loss of her friends, and the issues at hands. A bit of peer counseling and support from friends help her heal.

There are a lot of episodes I likely missed. And how many TV shows outside of Bob Newhart ever made counseling and therapy a main idea (and yet in a respectful, helpful, realistic way)? Star Trek Next Generation brought on the idea of counseling as a healthy part of operating on a daily basis. Counseling was so important that space stations like Deep Space Nine and even the flagship of the Federation staffed counselors to support and assist people on board.

Star Trek for the win again!

Any episodes I missed? Or other TV shows you feel have demonstrated the helpfulness of counseling and helped to norm mental health treatment? Let me know in the comments!

Enmeshment: Why it may feel like someone else is pulling your strings

 

Why can’t I just deal with my family’s disapproval? Why does my mom get so angry when I keep talking to my sister when they’re arguing with each other? Why can’t I make a single decision without feeling like I have to explain it to my dad? How do I usually end up feeling like it’s my fault when it was my sister’s words that were so hurtful and I only confronted her about her behavior?

If you’ve ever thought along these lines in regard to your relationships, or even just one relationship you have, then its likely that you’ve dealt with enmeshment. Enmeshment is a term used to describe the blurring of boundaries between people. Although enmeshment most frequently occurs in families, it can happen in any relationship. Enmeshment eventually leads to a feeling of loss of personal freedom and can cause problems in relationships and in families.

Families often value closeness, but enmeshment goes beyond the normal family closeness we might desire or aim for. When there is enmeshment a parent may center their action or emotion on his or her children and their mistakes, choices, and even successes. The enmeshed parent may try to know and direct their child’s thoughts and feelings, and they’ll usually rely on the child for emotional support.

The issue with enmeshment is that it causes those involved difficulty in developing a sense of self, engaging in relationships with healthy boundaries, and sometimes regulating emotions. Another common side effect of enmeshment is an inability to be assertive later in life when it may be necessary.

Signs of Enmeshment

  • Lack of appropriate privacy between parties
  • Being “best friends” with a parent
  • A parent telling secrets or adult problems to a child
  • A parent giving special privileges to a particular child
  • Overinvolvement in decisions, other friendships, activities

These signs can be present in relationships outside the parent-child relationship, however. For example, a friend that insists you must be angry with a mutual friend just because she is, is enmeshed with you. Someone who insists you consult them about decisions you make, or insists you explain decisions you make (outside the bonds of marriage and joint decision making, of course) is likely enmeshed with you. Someone who dictates (or tries to) how you spend your time and who you spend it with is likely enmeshed with you.

Effects

If you grew up in an enmeshed family, the impacts can be harmful. In enmeshed families, members can fail to develop full individual senses of identity and self. Members of these families may avoid trying new things, and this is a vital part of building self-identity during youth. You may also feel responsible for the emotions of members of the family, extreme guilt when acknowledging your own needs or feelings, and a sense of being controlled by family.

Enmeshment can impact future relationships as it can affect what is viewed as healthy or normal in relationships. It can cause difficulty in trusting people outside the enmeshed relationship or relationships. Research has also shown that people who are in enmeshed relationships or grew up in them have difficulty regulating their own emotions or tolerating distress in life.

Therapy + Treatment

If an entire family wants to address and understand how it may be enmeshed and how this is affecting their members, a family therapist is the way to go. In family therapy members can learn to set boundaries and express thoughts and feelings with one another in a healthy way. However, enmeshed families are often locked in a pattern of behavior and when there’s a pattern, it means something is working – it may not be working for everyone involved in a fair or healthy way, but it’s working. This means that many times it’s difficult to get an entire family to come in and address issues of enmeshment.

Individual therapy is very helpful for people who want to understand their family’s enmeshment and how it may have affected them. People from enmeshed families or in enmeshed relationships may feel controlled or trapped between expectations of self, other relationships, and the enmeshed relationship. Individual therapy can help that person understand the enmeshment and create healthy boundaries that are more in line with what their own needs and wishes are.

If you’re dealing with enmeshment in your relationships, it’s a good idea to learn about boundaries, and to practice setting some. A therapist can be really helpful as a supportive party and someone to provide feedback while you do so.

Sensory Sensitivity + Anxiety

If you’ve been reading my blog for any length of time, you know that anxiety and its many facets are something I work with and write about often. An issue I’ve never touched on here in the blog is an important one – sensory sensitivity.

Most of us are familiar with the concept of sensory processing difficulties associated with numerous other conditions, and there are some diagnoses that refer directly to a person’s ability level to integrate and process sensory data. What we’re less familiar with is how anxiety may make someone a bit more sensitive to external sensory input.

I hear the word “overwhelmed” as a descriptor from my clientele about certain situations they encounter that create anxiety or just inflame it. What they’re usually trying to communicate to me is the feeling of being inundated with external stimuli like lights, sounds, physical sensations, and smells during a state of anxiety or panic.

What it is + Why it happens

During periods of anxiety, the body’s fight, flight, faint, or freeze response kicks in (or the flight/fight response). The fight/flight response is a brilliant system in the human body that integrates multiple body systems with the use of both hormones and neurotransmitters. The hormones travel throughout the bloodstream causing certain responses, and the neurotransmitters act within the brain to trigger other responses. These work together to create a group of battle or flight-ready responses in the body to prepare us to either kick some butt, run, faint for protection, or freeze in place as a means of survival.

This response isn’t just triggered by life or death danger. It can also be set off by the threat of danger or perceived danger; the perceived or real danger that starts the fight/flight response can be either emotional or physical in nature. For those of us with histories of trauma, adverse childhood experiences, and similar – we may be running in “crisis mode” to an extent with some level of the fight/flight response sort of kicked in at any point in time.

The fight/flight response causes the body to do some interesting things:

Heart rate and blood pressure increase so that more blood is moving through your system more rapidly, which makes it easier to run or fight.

The pupils dilate so that its easier to see whatever the danger is.

Veins constrict in order to get more blood into muscles to aid in fighting or fleeing.

Muscles tense, which helps get more blood into some muscles for fighting or running, and the smooth muscles relax, which increases oxygen flow.

Non-essential body systems shut down, which frees up energy for the potential need to fight or run.

It becomes hard to focus on small tasks because your attention is diverted to the bigger picture, which is staying alive.

This all happens very quickly and it can happen whether there is any “real” danger or not. Notice how part of the process is the dilation of the pupils in the eyes. Our pupils expand or contract depending on the level of light we’re exposed to in most situations. During times of intense anxiety or panic, they dilate as a means of keeping you safe. You’re on high alert for danger and this includes your pupils working to take in more light. The sensory result can be feelings of overwhelm and confusion in bright or very low lighting during times of anxiety.

Other senses may become heightened as a result of the fight/flight response in the body as well. Your brain thinks its about to have to defend you and make sure you survive, so it makes sense that sensitivity to noise in the environment as well as smell and physical touch may occur. In moments of anxiety you and your brain are on the look out for anything threatening, which means that all your senses become more “sensy” – they’re trying to detect any danger around.

This process is what creates the feeling of overwhelm that many people with anxiety experience when they’re in the wrong (or right) situation. This is why for some people a trip to the store is no big deal, and for some with anxiety, its an event requiring deep breathing exercises before and during.

This isn’t the case with all sensory sensitivity experienced by people or even by people with anxiety. It’s always important to talk with your doctor or mental health professional about any sensitivity that interferes with your daily life to be sure there isn’t something more going on.

To cope with sensory sensitivity related to anxiety, try some of these tips:

  1. If being in the store or other brightly lit places slows you down, spaces you out, or makes you want to hide, try wearing your sunglasses. This cuts the brightness back, and sometimes there’s a cozy feeling to having the eyes protected.
  2. If noise is an issue, try wearing earbuds with your favorite tunes or some relaxing music playing. You could even kill off a few chapters of an audiobook or podcast. This helps drown out the miscellaneous noise and lets you focus on just one bit of noise. Of course, this isn’t an option if you’re driving, or in an otherwise unsafe-for-earbuds-situation. Use good judgment!
  3. Before entering into a sensory-rich environment take a few minutes to practice regulating your breath and calming your nervous system by breathing in a pattern that has been shown to do so. Inhale for 4 seconds through the nose, hold the breath for 7 seconds, and exhale for 8 seconds. Keep your lips parted, your tongue against the roof of your mouth, and count evenly. Do this several times. You can also try 4-square breathing: breathe in for 4 seconds, hold for 4, exhale for 4 seconds, hold for 4 seconds, and then back to inhaling for 4 seconds.
  4. Try some gentle progressive muscle relaxation so you enter the environment “loosey-goosey”. Slowly tense and then release each group of muscles in your body. Don’t over-tense! It shouldn’t be painful. When you fully relax the tension it should feel like a bit of relief.

While these tips will get you through a moment or two when things become overwhelming, working on your underlying anxiety is where the real gold is at. Check out my course on taming your anxiety or visit my work with me page to find out about working directly with me on your anxiety.

Whitney

Communicating Boundaries (to people who don’t care or listen)

Boundaries are the things that tell us where someone else ends and we begin. They tell us what is ok with us and in which relationships and what isn’t. Nearly every person on the planet has at some point had a boundary problem.

Clear signs you’re in need of a boundary tune-up are dreading social interactions with a particular person or people, getting easily dragged into other people’s ‘drama’, having a hard time telling people ‘no’, having trouble making decisions or assertions for fear of judgment, having your feelings hurt or feeling disrespected, and feeling like you need to explain yourself (to people who aren’t signing your paychecks).

If any of that sounds familiar, this post may be helpful for you. To narrow things down, these tips are best for those resistant to boundaries and for relationships that simply aren’t healthy. They’re for people who really don’t or won’t hear you. These aren’t tips for initial attempts at boundaries in healthy relationships.

In a perfect world, you would be able to easily decide what is ok with you, communicate that to others, and everyone would respond, “Okie dokie,” and abide by what you’ve stated is ok or not. The trouble with that is that when we enter relationships or even entire families, we take on roles that others want us to, sometimes without knowing. Others get used to having us in a particular role and therefore ok with whatever things they assume we’ll do, tolerate, or participate in. When we tell someone, “No,” for the first time it isn’t easy for us to say and it isn’t easy for them to hear and act on.

Setting boundaries is often an equal issue of pattern-breaking. We’re making a new pattern for us and we’re trying to get others to go along with that, which is often entirely up to our willingness to set a boundary and reinforce it like a sentry standing guard at a gate. This takes effort on our part in a major way.

Communication plays a large part in that sort of pattern breaking and it isn’t the seemingly simple matter of explaining our positions and then everyone jumping on board with them. If people are really very used to your responses in a situation or you playing a particular part with them or within a family group, standing guard for your boundaries will involve some communication changes.

In many (MANY) situations it will take a total make-over of how you engage with others to both set and reinforce boundaries.

Opinions, judgment, and input from others often flood when people are used to us allowing that to happen. You can’t control what someone will say or do in response to a decision, but we can control how we present information, what information is presented, and how we respond to unsolicited input. Check out these tips for starting to lay and protect boundaries where opinion, judgment, unsolicited advice, or ‘drama’ are the issues:

  1. Limit the information you share with people who offer judgment/opinion/advice that you don’t want. While you’re building and reinforcing boundaries keep conversation to non-controversial topics. Now isn’t the time to share with boundary-hating Aunt Edna that you’re thinking of quitting your job to return to school. Keep information you share non-personal to the extent possible. When you need to let people know about a decision you’ve made (and spend some time thinking about whether they really need to know!) just deliver the information that you’re doing such and so and leave out the details as to the hows, whys, and wherefores.
  2. Retreat from drama. When your friend who is big into drama calls to do their daily drama-dump, be unavailable if you want to. Don’t explain why. Be bored with what you’re hearing and don’t offer solutions or fixes for the person’s drama. Be polite, but don’t get involved. The goal here is to avoid emotional entanglement that really isn’t yours to begin with. You can avoid feeling angry, jealous, or upset about things that this person brings to you if you don’t engage past listening in a very flat and bored way. If someone succeeds in roping you in, the drama for them and for you will only escalate. Try shutting things down with:
  • That’s too bad.
  • You really should talk to (someone the situation actually concerns) about this.
  • I can’t help with this.
  1. Make like a cheese-puff. I like this one because I like cheese puffs. They’re light and fluffy, just like you need to be with people who have historically upset you, roped you into drama, or pushed too many of your other buttons. Be full of fluff, light, and airy as a general rule.
  2. Don’t answer intrusive questions. When someone asks you a question that isn’t ok try not engaging with it. In some relationship its easy to take on the idea you owe an explanation to someone, or in your eagerness to feel understood you may answer a question that steps over the boundaries you want to create. Instead, shut things down with:
  • What a great question! Why do you ask?
  • That’s already taken care of.
  • I’m not really into talking about that.
  • Oh, that’s too bad. I already decided.
  • I’d like to hear how/what you’re doing.
  1. Make your tone flat. Tone of voice communicates a lot, and if someone’s goal is to upset you in some way, your tone can be the first indicator of that. Try to keep an even tone, a non-emotional tone, avoid raising your voice. Keep your tone flat if possible and depending on who and what situation you’re dealing with.
  2. Its always ok to take space. Remember that if someone is emotionally or verbally abusive, or you are feeling uncomfortable, it is ok for you to walk away, take a break, or leave the situation altogether. Listen to your gut and do what is best for you.

Using these communication tactics should help you to disengage emotionally and mentally from people and patterns that have upset you in the past. The goal is to make yourself a bit boring to people who tend to suck you in for their personal joy or gain or people who tend to feel entitled to explanations and details when they aren’t really. Over time, people will begin to see that you aren’t playing into situations in the way that you may have in past, they may get bored trying to get you to respond in a particular way and stop trying their usual things with you – or they may never give up. Utilizing these methods for keeping your business yours, theirs theirs, and your emotions where you’d like them will help in either case.

Be light and airy!

Whitney

Name it to Tame it!

One of the most common things I hear from clients coming into therapy with me is that they have a pile of intense emotions that they want to decrease or even make go away entirely. There’s a basket of emotions that a lot of us find uncomfortable. No one would see all the emotions we can experience laid out on a buffet table and walk up and choose a heaping slice of anger or a bowl of sadness – so in that sense we’re talking more comfortable versus less comfortable emotions.

To preach the therapist’s cliché – there really aren’t any “bad” or “good” emotions. There are just emotions, and depending on the person, some are more comfortable than others.

Emotions are an advanced form of internal communication that can inform our beliefs, our wants, and our behaviors. I like to use this as an example of emotion as communication: If you’re angry and your spouse isn’t quite getting it, and you’re not great at expressing what you’re feeling, that is communication that doesn’t get heard. For some of us that means it’ll seep out in some other way like a slammed door or overzealously chopping vegetables for dinner. It will find its way out.

So, again with another therapist’s cliché, when approaching emotions in an effort to decrease their intensity and influence overall, communicating them is key. This doesn’t necessarily mean you have to sit your spouse down and enumerate in detail all the things you feel about them having lost your house keys. It means that in the way you label and describe emotional experiences even just to yourself, you have the ability to change the intensity of what you’re feeling. It also means by being able to accurately describe what you’re experiencing to said hypothetical spouse, they may better understand what you’ve got going on and be able to respond in a more helpful way.

Emotional granularity is the term used to describe a person’s ability to specify and differentiate between different emotions. Researchers are learning that higher emotional granularity indicates the potential for better mental health, may serve as a prevention tool for some mental health problems, and is associated with less reactivity to negative emotions. Less reactivity to negative emotions is what many people are aiming for when entering therapy (translation: being angry about being cut off in traffic will be less likely to take over the day).

Increasing emotional granularity can be a fun exercise. You can start out by researching different words that describe emotions in your own language and culture and you can expand on that by researching terms and words for emotions in other cultures. Its amazing how much variety there is in relating different types of emotions.

Having and building this vocabulary can help you go from, “I’m angry,” to, “I’m sensory-overload-angry.” Sensory overload angry is the term we use in our house when there is too much going on. We might have company, dogs barking, a TV blaring, the lights on, and music going somewhere else. It can get to be too much. Instead of stalking around and shutting things off, yelling for people to be quiet, or hiding in a closet with all of the anger this particular situation can generate, we can label it so we know what’s going on, so others know what’s going on, and so we can take the right action. Maybe most importantly with this particular descriptor we know that the anger is situational and temporary. By identifying it that way it helps it not take over the day.

In our house we’ve worked to identify some common sources of more uncomfortable feelings, determine the degree to which they’re temporary, (all emotions are temporary and will change eventually, and having a label that helps categorize them that way is powerful – it stops you from lining up the whole day to stew on things).  We work at being able to think in these more specific terms and discuss emotions in more specific terms with each other. It can also be fun to sit down and discuss with the family the different types of each emotion you all notice personally and sort of craft a family emotion dictionary in that sense.

The cool part is that if you do this work and you learn to specify emotions past their more basic labels, you create a positive change in yourself that helps you tackle what the day may throw at you, you set yourself up for continued expression in this way that your children, spouse, and others will pick up on – it will help them out too. By naming emotions in a very specific way we tame them and feel them less intensely, we communicate them, which takes away some of their heaviness and power in our daily living.

Just like in Harry Potter, fear of a name only increases fear of the thing itself – name it to tame it!

Happy granulating!

Whitney

 

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.

References

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. http://doi.org/10.2196/jmir.2084

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