Psych Central Professional For mental health, psychiatric and psychological professionals. 2017-01-16T10:54:17Z Marie Hartwell-Walker, EdD <![CDATA[Personal Therapy for the Student Therapist]]> 2017-01-15T23:54:49Z 2017-01-16T10:54:17Z Group TherapyMany graduate programs in counseling and psychology at least recommend, if not provide, personal therapy for their students. Even when the program doesn’t promote it, many students voluntarily get involved with at least some personal therapeutic work. In 1994, a survey of psychologists by Kenneth Pope and Barbara Tabachnick (published in Professional Psychology: Research and Practice) found that 84% had participated in therapy for their own healing and/or growth even though only 13% had graduated from programs that required it. 86% of their participants reported that they found the therapy to be helpful. More recent studies confirm their conclusions. Participants in a 2013 dissertation study by Eric Everson, M.A. (Marquette University), for example, reported that therapy while in graduate training had a beneficial influence on their functioning personally, academically and clinically.

Why do your own therapy? Here are some of the important reasons to include personal therapy in your training:

Self-knowledge is crucial to the art of therapy: Academic theory and mastery of interventions can only go so far. Often enough, gaining the trust necessary for helping a client requires connecting in a deeply personal way. That means drawing on ourself to use the sensitivities and instincts that have come from our own experiences to relate, to empathize and to move the therapy forward. In order to do that, it’s crucial to know as much about our “self” as we can. That means embracing our own strengths and confronting our own imperfections, wounds and fears.

It increases our empathy for clients: It’s important to understand what it feels like, up close and personal, to be a client. When we have done our own work seriously and thoughtfully, we better understand from the inside what it feels like to strip away defenses, to disclose the both the admirable and less than admirable parts of ourself and to be known in the way a therapist can know us. By participating in treatment, we can develop more empathy for our clients’ anxieties about it. We may also be more sensitive to client non-verbal cues as they talk about their distress and consider our responses to it.

It sensitizes us to counter-transference: It’s important to identify and work on resolving our own pain so it is less likely to get in the way when treating clients who have similar issues. Psychoanalytic therapists are trained to recognize and manage what they call “counter-transference”, i.e., a therapist’s vulnerability to getting emotionally tangled up with the client’s story and reactions.

Other trainings aren’t as specific but, whatever it is called, the issue is still a real one. Our client’s problems and experiences can be so similar to ours that it can be difficult to differentiate the client’s responses and conclusions from our own. Every therapist needs to have strategies for maintaining objectivity even while recognizing the similarities. A 2001 study by Andrew Grimmer Rachel Tribe published in the Counselling Psychology Quarterly found that students who did their own therapy improved their ability to sort their own issues out from those of the clients and felt more validated as professionals.

It legitimizes therapy as a tool for personal growth: Therapy can be an invaluable medium for personal growth as well as for healing. Students who haven’t been challenged by serious life obstacles may not have had the opportunity to develop sufficient coping skills or confidence in their own strengths. Therapy can encourage such students to take some emotional risks and to work on their own skills of resilience. Even students who feel emotionally centered and strong can benefit from further personal growth.

It may reduce vulnerability to depression:  About 20% of the participants in the Pope/Tabachnick study reported that unhappiness or depression had been the focus on their therapy. Further, 61% reported that even when it wasn’t the main focus of treatment, they had experienced at least one episode of clinical depression. It may be that the very sensitivities that lead people to become therapists make them vulnerable to becoming burdened, saddened or even depressed by the distress of our clients and the general state of the world. Therapy may therefore have a protective function. It can help us develop the coping tools we need to journey with so many others who are in pain.

It provides personal application to theory: Doing our own therapeutic work provides another route to expertise. Even if a student has had years of therapy prior to graduate study it’s helpful to do another round with a therapist who both offers some new insights for personal issues and then is willing to discuss the therapeutic decisions and process. Such discussions enhance theoretical learning by making it deeply personal.

It’s a matter of integrity: Therapists believe that therapy is a route to self-understanding and healing. Our integrity requires that we have successful experience with being a client if we are to do the work with the confidence that it is a valuable way for people to manage the challenges of life.


Related Article of Interest

While working on this, I came across this article by Maria Malikiosi-Loizos: The Position of Different Theoretical Approaches on the Issue of Personal Therapy During Training.  She discusses why various schools of psychology (Psychoanalytic, Humanistic, Cognitive-Behavioral, etc.) support the inclusion of personal therapy in their students’ training. (






Bret Moore, Psy.D. <![CDATA[It Will Take More Than VA to Solve Veteran PTSD]]> 2017-01-14T09:31:35Z 2017-01-14T11:31:14Z As president-elect Trump continues to fill his cabinet and inner circle of advisersbigstock--135338915, it’s not surprising that perhaps the most difficult job – that of Secretary of the Veterans Administration- will be the last to be filled. The next Secretary will inherit myriad challenges; managing an overwhelming staff, bureaucracy, claims backlogs and a negative public perception.  And most importantly, the psychological wounds of combat such as PTSD.

The VA rightly states that there is a national shortage of mental health workers.  Not only are there not enough, but according to Rand, many of these mental health professionals are not trained to deal with and understand the types of trauma that our veterans experience.  This situation is compounded by the fact that for many veterans, seeking “therapy” is inconsistent and counter-culture to the way military veterans are trained.  A concept that veterans do understand is one of “mental health training” especially when the training is provided by a veteran peer who speaks the same language and has lived within the military culture.

The next VA Secretary will not only have to understand the nature of psychological wounds and the magnitude of the problem, but lead an organization that many consider resistant to change to use new and innovative approaches to mental wellness.  The VA estimates that about 700,000 (almost 30 percent) of post 9/11 veterans who deployed to Iraq or Afghanistan are struggling with psychological wounds such at PTSD.

Based upon a VA study, we know that on average, 20 veterans take their own lives every day.  At the same time, there are fears that the current approach of talk therapy and medication attacks symptoms, not core issues of PTSD.  In August of 2015, the Journal of the American Medical Association called for a “new and innovative approach to PTSD among veterans.” Often what is seen as “war trauma” begins at an early age through parental abuse, domestic violence, drug and alcohol abuse or sexual trauma.  Recognizing that those serving in the military have a higher rate of these types of childhood trauma creates a need for health professionals to dig deeper beyond “tell me about the IED attack.”

Posttraumatic Growth

Most importantly, we need to change how we think about and discuss mental health issues such as PTSD.  Retired Navy Captain, Charlie Plumb, was a prisoner of war in Vietnam for nearly six years between 1967-1973.  While Captain Plumb spent years being tortured and held in an 8’ by 8’ cell, an experience that anyone would find traumatic, Charlie will tell you that these were the best growth years of his life.  Charlie came back many pounds lighter, but immeasurably stronger.  He was not suffering from Post-Traumatic Stress Disorder, but benefiting from Posttraumatic Growth (PTG).

While extensive writings of growing stronger from your struggles (PTG) are found in ancient literature and religion, the concept seems to have been forgotten or at least not talked about regarding veterans.  Dr. Rich Tedeschi, a psychologist at the University of North Carolina, Charlotte, has spent the past 30 years researching and documenting PTG and creating a body of evidence that demonstrates the power of times of struggle.

The VA can’t care for our veterans alone. Likewise, no new Secretary, changes in bureaucracy, privatization of services or bags of money will completely heal our veterans of their invisible wounds and reintegrate them into communities.  We need a national dialogue and innovative approaches to reframe the “burden of PTSD” to the “opportunity of PTG.” Through increased understanding of Posttraumatic Growth and the use of military-style training, we can help remove at least one of the issues for the new Secretary of the VA.

* This article is a collaboration between Dr. Moore and Ken Falke.  Mr. Falke is a retired Navy EOD Master Chief Petty Officer, Founder of Boulder Crest Retreat in Bluemont VA and the co-author of the Warrior PATHH Posttraumatic Growth Curriculum.


Jennifer Rollin, MSW, LCSW-C <![CDATA[Facing Fears of Taking the Leap to Private Practice-Featuring Sarah Berger, Ph.D]]> 2017-01-12T18:37:50Z 2017-01-13T11:37:25Z Concept Of Optimism And PositivityMany clinicians feel scared when it comes to the decision to take the leap into private practice. It’s important to note that any time we step outside of our comfort zone, it is normal to feel some level of anxiety and fear. In this instance, your fear and anxiety is a sign that you are taking risks and headed towards growth.

Often we think “I’ll wait until I feel less afraid.” However, the paradox of this is that often the “doing it” comes before the fear goes away. It is my hope that this conversation and series on facing fears of entering private practice, helps you to realize that you are not alone in experiencing anxiety and that your dreams can become a reality.

A Conversation with Sarah Berger, Ph.D.

 I had the opportunity to interview Sarah Berger, Ph.D., a licensed clinical psychologist in private practice in Washington D.C. Sarah shared some of her insight and experiences from years of experience in the field.

1.     If you could go back and tell yourself something when you were first starting out in private practice, what would you say?

 Have more confidence in yourself; at the same time recognize that the anxiety is normal and will hang around for a while.  I also wish I could tell myself to continue just being myself.  Being authentic helps me attract the clients that are truly a best fit for me and my practice; however in the beginning of the transition, the fear of not succeeding can lead to a desire to take on any client – not just ones that are truly a good fit. I wish I could remind myself to have faith that the clients will come.   

 2.  What is one thing that was very helpful to you in starting your practice?

 I had a clear sense of what works best for me. I knew I was someone who had a low risk tolerance so I made a slow transition. Thankfully, this was an option for me. I realize it’s not an option for everyone.  I took on one day a week at first, subletted space before signing a lease, joined a group first then started my own private practice.  

 With each step, I gained confidence to take the next step.  This also worked best for my young family, both logistically and financially.  I am also someone who benefits from a strong support network.  I attended workshops on how to make the leap to private practice and I have two fantastic peer consultation groups that were able to provide logistical and emotional support.  

3. What is your advice for those who are feeling scared to make leap from agency work to venturing out on their own?

 Recognize that you will probably always fear “the leap” – the fear alone is not enough of a reason to stay at an agency.  Ask yourself what your fears are, is there a way to get help with it – whether that is getting support, breaking it into smaller steps, etc.  How can you take the fear with you?

Face Your Fears

 Ultimately, it’s important to “practice what we preach” to clients in terms of taking risks and stepping out of our comfort zones. If you are passionate about starting a private practice, I would encourage you to begin taking small steps towards that goal.

 I am so grateful to Sarah for taking the time out to talk with me and share her helpful and sound advice. Stay tuned for future articles to come featuring more interviews on this topic with experts in the field.



Kelly Higdon, LMFT <![CDATA[Can you do a lower fee?]]> http://4.907 2017-01-13T09:41:28Z 2017-01-13T09:41:28Z Can you do a lower fee?

Can you do a lower fee?

Can you do a lower fee?


The exchange of money for your services is not simply a financial transaction in business. There is often an unconscious exchange happening as well, an acknowledgment of roles and of value.


This exchange is powerful when brought into the room between a client and therapist. It opens the door to discuss what therapy means to them, if it is “effective” or meeting unspoken expectations.


Discussing your fee is the first container provided to the client prior to them coming to their first session. How you handle this, hold responsibility and boundaries with it, impacts the client and is your first cornerstone of trust.


There are some common reactions that therapists have when discussing fees that we feel is worth exploration.


1.     They don’t discuss it until after the first session. In some states it is required that the fee be set prior to the appointment. This means the client knows what they are getting into before the relationship is formed. Imagine forming a bond with someone and then being told of an expectation you can’t meet in order to maintain that bond. Discuss the fee from the outset. Get comfortable with saying “My fee is $xxx.” Look in the mirror and repeat it until you are able to say it with clarity and assuredness.

2.     They wait for the client to bring it up. No matter your clinical orientation, if there is an important issue that you see in the session, do you wait til the client sees it or do you bring it up with them? As a therapist your role is to manage your business and to provide the boundaries for the work and the fee is part of that. Putting it on the client is unnecessary. Bringing forth your fee, up front is you saying, I have taken care of these aspects of my business for us to do our work.

3.     They get defensive. The reason that people call expecting to negotiate the fee is because our community has taught them to do that. It does not happen when they go to a restaurant or their doctor because those communities are quite clear that their fee is set and not negotiable. The person asking for a lower fee or a packaged fee is doing so because that is what they know to do. It is not a personal attack and it isn’t about you at all. Respond with kindness, be factual but not defensive. “Thank you for asking about that. I keep a flat fee for all of my clients. Does this fee not work for you? Tell me more about your situation so I can help.” The discussion about the fee is another opportunity to discuss if this is a good fit for you and the client. You can give them referrals out if it isn’t and that will be more helpful for the client in the long run.

4.     They take a lower fee than they want. Getting clients through the door just so you can fill slots is a recipe for resentment and frustration down the line. It also is harder to come back from and make changes to when you realize that you cannot sustain the fee you agreed to. If you agree to a fee, it is your decision. Take responsibility for these decisions in your business and understand the clinical impact it may have on the relationship. Having a confident therapists makes for a more trusting relationship with the client.


Sliding scale fees can be part of your practice but you want to have a process by which you determine if someone is eligible for the lower fee. If all your clients sat in a room together to discuss what they pay you and how that was determined, would you be confident that it was clear amongst all of them?


To get help with setting your fee and talking about it with clients, join our upcoming private practice challenge. Click here to join!

Christine Hammond, MS, LMHC <![CDATA[The Aging Narcissist: Adding Dementia to the Mix]]> http://5.1174 2017-01-12T16:46:06Z 2017-01-12T16:46:06Z dementiaDespite what a narcissist will pontificate, even they are subject to the effects of getting older. Becoming elderly is a normal part of the developmental stage of life for most people, but not for the narcissistic. They view aging as an ultimate evil. Some will engage in ridiculous plastic surgery in an effort to look as young as they feel. Others will begin a new career while their peers are retiring. And still others will take on far younger partners.

But what the narcissist can’t do is dodge the effects of dementia. As a progressive indiscriminate disorder which sometimes transforms into Alzheimer’s or other disorders, dementia effects every area of the brain in a random order. What seemed natural and habitual now becomes foreign and difficult. Memory becomes scattered and unreliable. Familiar people become strangers or even enemies that are out to get them.

For the narcissist, this is completely unacceptable. Most narcissists rely heavily on their cognitive abilities as a way of constantly demonstrating superiority over others in performance, influence, power, beauty, or money. Any sign that is is deteriorating or diminishing is out of the question, something that cannot and will not be tolerated. This is when the narcissist is most at risk for suicidal behavior.

Make no mistake; narcissists don’t threaten suicide just to get attention, they actually follow-through on the action especially when they begin to view their superior identity as slightly inferior. They would rather die, than be revealed as fallible, vulnerable, or depending on someone else to do the basics of life. When a person has spent their entire life belittling and mocking those believed to be beneath them, they cannot in the end be revealed like them.

There are seven stages to the progression of dementia as listed below. However, how a narcissist responds to each stage is very different from other patients. This is because the narcissism is like a web inside their brain effecting more than one area.

  1. No Dementia: No Cognitive Decline. This first stage is what pre-dementia looks like where there is no memory loss and a person, including the narcissist, functions normally.
  2. No Dementia: Very Mild Cognitive Decline. As a person ages, forgetfulness becomes typical but it doesn’t impair normal functioning. For the narcissist, their forgetfulness is often blamed on others.
  3. No Dementia: Mild Cognitive Decline. Forgetfulness becomes more consistent and trouble concentrating for long periods of time increases as work performance declines. Narcissists begin to notice this stage but work very hard to hide it from others. It is typical for them to have increased aggravation over their perceived slowness which they frequently project onto others.
  4. Early Stage: Moderate Cognitive Decline. Despite the best efforts of the narcissist, their decreased cognitive abilities become apparent to others. They typically struggle to remember even recent events, accidentally send too much money to the electrical company, or getting lost easily when in new locations. Complex work tasks become too difficult but the narcissist won’t admit to it. Instead they will blame others and distract with elaborate stories of past successes. To avoid embarrassment (the Achilles heel of the narcissist), they withdraw from family and friends. When needed, the narcissist can function at a select event for a short period of time but as soon as it is done, so are they. The disengagement is extreme and may even appear catatonic.
  5. Mid-Stage: Moderately Severe Cognitive Decline. The memory deficiencies become significant as even common tasks such as cooking, dressing, or grooming require some sort of assistance. Some narcissists can weather this stage well if they have a caretaker who is willing to pamper them and tolerate their aggravation. But others slip rapidly into a depressive state which adds to the frustration. They may not remember major life events or people any longer. However, what the narcissist values is definitely revealed at this stage. If work over family was important, they won’t remember family vacations but can still remember a major deal they negotiated.
  6. Mid-Stage: Severe Cognitive Decline. This is when suicidality becomes a possibility if they are able to carry out the task. No longer able to care for themselves and having embarrassing problems such as eating or bowel control, narcissists shut down. For brief periods of time, the narcissism will disappear and what the person would be like without it appears. This becomes a hope that most family members cling to but the progression of the dementia is so advanced now that it becomes discouraging. It is also common for the narcissist to have delusional thinking such as watching something on TV and believing they are actually doing it. Anger outbursts are common as are paranoid delusions. The narcissist is so convincing even at this stage that they are able to draw in others into their delusional state.
  7. Late-Stage: Very Severe Cognitive Decline. At the last stage, there is little to no communication, psychomotor skills, or walking. Everything requires assistance and the narcissist is a shell of what they once were. No longer able to recognize themselves or others, all of the narcissistic symptoms have disappeared along with their personality.

Watching any person go through these stages is traumatic; however there is a glimmer of awareness that is unique to a narcissist who has dementia. The key lies in remembering the brief moments when the non-narcissistic side of them appeared. This is who they really were, instead of whom they became.

Christine Hammond is a Licensed Mental Health Counselor and a National Certified Couselor who lives in Orlando and is the award-winning author of The Exhausted Woman’s Handbook.

The Carlat Psychiatry Report <![CDATA[Medications for Agitated Kids When Nothing Else Works]]> 2017-01-12T18:39:26Z 2017-01-12T06:56:31Z Medication for agitated kid when nothing else worksHere is a hypothetical situation that most child psychiatrists have encountered: You’re an attending on a child psychiatric inpatient unit. An 11-year-old boy who was admitted for suicidal ideation just had a difficult meeting with his parents and the social worker.

He wants to go home, but is not yet ready for discharge, and he’s angry about it. He marches up and down the hallway menacingly. He goes into his room and pulls the mattress off his bed and throws it around. Both you and your staff have tried to reason with him in order to de-escalate the situation, but nothing works.

What do you do? Unfortunately, there are no clear answers, since we lack good research on the best ways to calm acutely agitated children. Your approach may likely be slightly different from a colleague’s. In this month’s interview, Ruth Gerson, MD, discusses a variety of verbal de-escalation strategies in child psychiatry emergencies, and we suggest you use these when you can. (See “Practical Tips for Handling Psychiatric Emergencies in Children and Adolescents” on p. 1.)

But, as with adults, children can lose behavioral control, putting themselves or others at risk, and in such cases it is our responsibility to figure out how to quickly ensure everybody’s safety—which may include the use of medications, whether voluntary or involuntary. In this article we provide you with some tips and pearls, derived from the literature and from discussions with various child psychiatrists on the front lines.

Typical Situations Requiring Sedation

Situations requiring sedation boil down to potential harm to self or to others, with agitation usually a part of the mix. Common diagnoses leading to these situations include autism spectrum disorders, conduct disorder, depression and other mood disorders, psychotic disorders, and substance abuse. The behaviors will vary depending on age and developmental level, and can include explosive temper tantrums, verbal threats, frank violence towards others or property, and agitation or restlessness.

Pre-Medication Management

We want to avoid medications if possible, and we certainly want to avoid using physical restraints. Why avoid restraints? According to one study, children, especially those with histories of abuse and neglect, perceive restraints to be aggressive and punitive, potentially leading to further mistrust of mental health providers (General Accounting Office, 1999,

Behavioral Interventions

If talking has not worked to calm your patient down, try behavioral or environmental changes. You can deploy these in a variety of settings, whether you are working in your office, in an emergency room, on an inpatient ward, or even if you are giving phone advice to panicking parents. (See “Some Guidelines for Working with Agitated Patients” on p. 3 for more tips.) Some tried and true methods include:

•    Separation from the trigger. Put some space between the patient and people who may be aggravating him, such as parents or siblings, specific teachers, hospital staff whom the patient has singled out as “the problem”, or security personnel who may have brought the child in for involuntary treatment.
•    Use media as a distractor. Watching a little TV, playing a video game, or listening to some music can be helpful in soothing the cycle of agitation.
•    Milk and cookies. Kids like treats, which can serve as a distraction, and the bonus is that they may like you better after you offer them.
•    Sports. If available, a game of foos- ball, ping pong, or basketball can help dissipate the negative energy.
•    Relax. Asking the patient to chill out by sitting or lying down in a quiet place can be helpful.

Pharmacologic Management

You’ve tried behavioral remedies, but your 11-year-old patient is still pacing and tearing up his room. Don’t go right to physical restraints. First, see if you can convince your patient to voluntarily take a medication to calm himself down. Getting agitated kids to agree to a sedative is often not difficult, but it requires skill in the art of convincing. Here are some techniques:

•    Normalize the situation by communicating an understanding of their reaction, and saying that you’ve seen it before. For instance, “I understand that being in a hospital can make you pretty stressed out. A lot of kids I’ve seen who get this stressed tell me they feel a lot better after taking a medicine.”
•    Give them a sense of control by framing the suggestion as a question. “What would you like to do to calm down? Can I give you something to help?”
•    Give them some choices—usually just two is enough. “I can see you’re pretty keyed up now. I have two suggestions—either take a seat on the couch and cool down, or take this medication. Which one do you choose?” Or, if the situation is more dire and teetering toward physical restraints, say, “Here’s the deal. You have two choices. You can either take this medication or we’re going to have to put you in restraints. You decide.

Medication Options

Although Risperdal and Abilify do have FDA indications for the management of irritability associated with autism spectrum disorders, this evidence is based on standing doses and not when used “prn” or as needed. In fact, there are no FDA-approved medications for managing acute agitation in children, so in the absence of good research you’ll probably settle on a few favorite go-to meds based mainly on your experience.

Susan Gonsalves <![CDATA[How Much Time Do I Need To Put Into Marketing My Private Practice?]]> 2017-01-11T22:04:28Z 2017-01-11T19:20:59Z goals and ambition way to success guarantee to reach your goal aFor many therapists and those in the helping professions, marketing is often one of the biggest hang-ups we have to building a successful business. However, it is an absolutely necessary part of any business. And, as with most things in life, you will get out of it what you put into it.

Marketing is how we let our community know that we exist and that we can help them with a problem they are having. Once we accept this necessary aspect of creating a thriving private practice, how much time do we need to realistically put into our marketing efforts?

There is no definitive answer to this question, as it will be different for each therapist. However,there are a few steps you can take to determine what the right amount for you might be.

The first thing you need to do in order to determine how much time you should be putting into your marketing efforts is to know what your vision is for your perfect private practice. I’ve created a free workbook, the “Perfect Practice Business Plan” workbook, and worksheet, “Defining Success and Your Perfect Practice,” that you can grab by clicking the link in my bio. These workbooks will help you define your vision and the foundation for your practice. Once you know your vision for your ideal practice, you’ll want to look at how many hours per week you want to be working.

From there, you need to look at how many hours you are currently working.

Once you have both of these numbers, the difference will give you a general idea of how many hours per week you should be putting into your marketing efforts. For example, let’s say in your vision you’ve determined that your perfect practice will include seeing a total of 20 clients per week, over the course of four days in the office and you currently have six clients. That means you should probably be putting in 14 hours per week into marketing your practice.

As your marketing efforts start to pay off and you see an increase in your caseload and referrals, you can start to back off the marketing efforts a little (unless you want to keep them up, then go for it). This formula is a great tool to have as you can always return it with the natural ebb and flow that any business will have, but especially private practice (um, hello summertime).

It is important to remember that you are running a business and you need to treat it as such. And, again, you will get out of that business what you put into it. It may be hard to imagine putting 14 hours per week into marketing, but there is always something you can be doing. If you need help with ideas, download the 20 Things You Can Do to Market Your Private Practice checklist, again, the link is in my bio.

How You Can Take Action

Ask yourself the following questions. And allow yourself to put real thought into your answers and write them down rather than just half-heartedly answering them in your head. You’re a therapist, don’t underestimate the power of writing things down!

  1. How much effort am I currently putting into my marketing efforts?
  2. Is my practice currently where I want it to be?
  3. What am I willing to commit to as far as time and effort until my practice gets to where I want it to be?
  4. What marketing activities am I willing to commit to?

Also, I encourage you to publicly commit to your goals by leaving a comment below and telling us what you’re willing to do to build your perfect private practice. And of course, if you have any questions, comments, or insights, please let us know in the comments section down below.

Dr. Jennifer Chrisman has been working in private practice and supervising and mentoring therapists for nearly 10 years and with that experience came the passion to help other therapists go from good to great in their own businesses. With that in mind, Jenn came up with simple, yet proven marketing steps to help therapy businesses boom. Her website offers lots of FREE resources and e-courses for therapists in private practice.



Tiffany McLain, LMFT <![CDATA[Prepare Yourself for The Best 2017 Your Practice Has Ever Seen: Week Four]]> http://8.434 2017-01-10T17:37:01Z 2017-01-10T17:37:01Z Over the past four weeks, you and I have traveled back in time to take good, hard look at the state of your private practice in 2016.

And boy, howdy! What a ride that has been.

In week one, you had a chance to review your finances and take an honest assessment of how much your 2016 Bling Dreams lined up with the reality of your 2016 income.

In the second week,you took stock of your schedule and answered the tough questions about whether your the way you structure your time in private practice is based on what you want or based on fear about not having enough.

Finally, in week three, you whipped out your practice policies to see if your financial and scheduling goals were actually built into your policies or whether you were secretly sabotaging your chances of success.

Kudos to you!

Most of us are happy to talk at length about the things we’re proud of, but it’s much harder to talk openly about the goals we don’t reach, the raisins in the sun – all wrinkled and shit. But, your willingness to be open about the hard stuff, despite shame and disappointment, is the difference between success and failure. The mere act of reviewing your wins and losses over the past year is something that most certainly warrants a pat on the back.

So now what do we do?!

I’m going to share a little secret with you. Lean in. Closer….closer. Okay – woah. Totally close enough. The secret is this: the only way to attain your goal for 2017 is to do this process of honest review, every single week. And – if you really want to make it happen, grab an equally (or more) motivated buddy!

Then, do the following.

Recipe for Weekly Strategy Sessions:

The “secret” to consistent growth in your private practice.


  1. Choose a 30-minute chunk of time each week that will not change.
  2. During that time write out the concrete & measurable steps you will take that day that will bring you to your 2018 goals.
  3. Write out your “wins” – those tasks you successfully completed that you set out to do the week before.
  4. Write out your “Fails” – those tasks you didn’t successfully complete + what got in your way!
  5. Write out the experiments you will try in the coming week that will allow you to achieve with more precision than you did the week before.

You’ve already done the work to determine what worked and what didn’t over the course of the entirety of 2017. By doing so, you came to learn a lot about what you’d like to do differently. This exercise allows you to do that – not after you’ve spent an entire year mired in confusion and ennui – but every single week. This goes a long way to cut down on the regret and disappointment that often comes with an annual review.

If you do this, you literally cannot fail in terms of building a thriving private practice that helps you achieve your yearly goal. This is a practice that will allow you to understand your self better, and thereby create systems that allow you to move forward consistently in ways that work with your unique quirks.

photo credits: Ion Chiosea ,T. Al Nakib

Christine Hammond, MS, LMHC <![CDATA[Can a Narcissist Be Remorseful, Empathetic, or Forgiving?]]> http://5.1169 2017-01-10T17:36:22Z 2017-01-10T17:36:22Z forgiving narcissistTry to point out a narcissist’s mistakes and the attack is likely to be returned with force. Expect a narcissist to show understanding during a difficult time and the conversation will quickly be turned back towards the narcissist. Ask a narcissist to forgive an error in judgement and a detailed accounting of all blunders will be recounted.

Within the definition of narcissism is a lack of remorse, empathy or forgiveness. Narcissists have a fantasy view of themselves where they are all powerful, knowing, beautiful, and influential. Even when reality might prove otherwise, their distorted perception of self greatly contributes to egocentric behavior. So if everything is about them, then why does a person need to admit to wrongdoing, show compassion for others, or release the wrongs of others?

In the eyes of a narcissist, they don’t. However, when it is to their advantage, a narcissist can demonstrate limited amounts of remorse, empathy or forgiveness. Here is what that looks like:

Remorse. For a narcissist to demonstrate regret, the benefit must outweigh the cost. For example, a narcissistic boss might value the financial contribution a client brings so much that they are willing to show sorrow for over a forgotten commitment. Or a narcissistic parent might want the approval of a favorite child that they are willing to acknowledge their mistakes with the other children. Or a narcissistic spouse might make a joke out of their indiscretion in front of another couple to head off any negative comments made by the spouse.

Basically the show of remorse is part of a calculated formula where the expense of admitting to a mistake is small in comparison to the potential positive return. For the non-narcissist, this equation can be utilized as well. It is far easier to get a narcissist to admit to an error when the benefit is obviously pointed out in a discussion. However, real remorse is not likely since that would require awareness that the narcissist is not immune from error.

Empathy. Many narcissists are skilled at faking compassion for brief periods of time. They can learn from movies, videos, and empathetic people who demonstrate a caring response in times of trouble. But a show of understanding over a long time frame is nearly impossible. In order to demonstrate empathy, a person must see things from another’s point of view and be willing to allow that perspective to dominate. As hard as a narcissist might try, their distorted perception of reality won’t allow them to see things differently. It is like asking a color blind person to see yellow or blue.

However, when the narcissist can look like the hero to a person who is less fortunate, they will take on the challenge. From an outsider’s point of view, this could look empathetic, but it is not from the narcissist’s vantage point. For the narcissist, rescuing someone else is further demonstration of their superiority.

Forgiveness. Granting pardons to those who make mistakes feeds the narcissistic ego. Again, it is another opportunity to show how much better they are then others. But there is a very high price to pay when asking for forgiveness from a narcissist. First, they might say they forgive but they won’t forget even to the point of reminding the person of the mistake many years later. Second, there is some type of restitution that is likely to be requested in exchange for the clemency which usually far exceeds the crime. And last, narcissists reserve the right to withdraw the forgiveness without notice if it serves their interest.

It is commonly believed that forgiveness is for the mental well-being of the victim, not the offender. But when the wounded person is a narcissist, there are two things they do with the pain. One, it is added to the list of deep rooted insecurities of which no person is privy and which is covered by bravado. Two, it is discarded as inconsequential to their self-worth and therefore not worthy of their attention. Either way, the offender will not know the difference.

It can be frustrating to see remorse, empathy or forgiveness from the narcissistic perspective. But it is even more damaging to expect them to act and think like everyone else when they don’t.

Christine Hammond is a Licensed Mental Health Counselor and a National Certified Couselor who lives in Orlando and is the award-winning author of The Exhausted Woman’s Handbook.

Jennifer Rollin, MSW, LCSW-C <![CDATA[3 Tips for Using Social Media to Market Your Psychotherapy Practice]]> 2017-01-10T14:22:44Z 2017-01-10T14:45:25Z bigstock--131184203The advent of social media brought about some unique challenges as well as opportunities for clinicians in private practice. It appears that more clinicians are starting to utilize social media platforms as a way to market their private practices. While social media is often not ideal as a primary marketing strategy, it can be an incredibly helpful tool in regards to building your personal brand and generating buzz about your services.

As a psychotherapist and individual who enjoys using social media for professional purposes, the following are three quick tips for using social media to market your psychotherapy practice.

1.     Determine the platforms that your ideal client is using.

 It is simply not necessary to be active on every social media platform. Additionally, as psychotherapists, we often have limited time and energy for social media engagement. Thus, it can be helpful to be strategic in regards to the social media platforms that you use professionally.

After you have clearly defined your ideal client, it can be helpful to look at where they likely are spending their time online. For instance, if your ideal clients are teens then you might decide to utilize Instagram. Additionally, if your ideal clients are adolescents, you might consider the platforms that their parents are more likely to use. Parents are more likely to be engaged on Facebook. Whereas, Twitter and Linkedin are great platforms in terms of networking with other professionals.

 I would recommend picking one or two platforms on which to focus your time and energy, rather than spending less time on a bunch of them.

2.     Share content, such as quotes, pictures, and articles, which are aligned with your specialty.

 I’ve spoken with some therapists who are unsure of what kind of content to share via social media. Sharing images and quotes that speak to your ideal client is one way to start to build traction via social media. Additionally, it can be helpful to add value by sharing articles that are pertinent to your areas of specialization.

It is important that the content that you share really resonates with your ideal clients. Many platforms now provide you with data showing your reach and engagement per post. This data can be useful in terms of deciding ideal times to post and the type of content that is gaining traction.

3.     Figure out a scheduling system that works for you.

 Most of us don’t have the time to be posting on social media during a busy day of seeing clients. Therefore, it can be helpful to find a system to schedule your social media content in advance. There are a variety of ways to go about scheduling your social media posts. Facebook even has a built in scheduling system and Hootsuite is a way to schedule your posts across multiple platforms.

 You might also consider searching for a marketing professional or social media guru to assist you in scheduling your social media content.

Tying It Together

 Social media marketing is not for everyone. However, these days it seems as though social media is becoming increasingly integrated into the lives of our clients and potential clients.

 I’ve had numerous professional opportunities come from social media and can personally attest to the value of spending time cultivating your social media presence and engagement.

Of course, it is important to maintain professional boundaries via social media and seek supervision and/or consultation if you are struggling with how to do so.

Utilizing social media to build your professional brand and market your services is a free strategy that you may find to be helpful in propelling your practice towards increased recognition and success.




Susan Gonsalves <![CDATA[It’s About Time]]> 2017-01-08T23:55:30Z 2017-01-09T11:55:10Z

In our fast-paced world, the pressure of time drives us through each day so that we are unaware that “half our life is spent trying to find something to do with the time we have rushed through life trying to save”1 (Will Rogers).

bigstock--139141391The New Year is generally the time for many people to pause and reflect on the past and future of their lives. But TIME is a four-letter word that rarely raises an eyebrow even though it fills our lives on a daily basis.

It is probably one of the most used words in the English language yet slips by us because we take it for granted. Since the beginning of time, theologians, philosophers and scientists have struggled with this concept. But few ever take the time to think about it other than through its measurement.

We use it to structure our lives as in daytime, night time, lunch, dinner or bedtime, time to go to work and time to go home.

Clocks can be found everywhere to keep us on schedule and we even wear time to ensure we are always on time. It seems our lives would be chaotic without it. Time is one of the most important gifts of life so why do we not value it more? The many clichés about time in our language only reflect its significance in our lives.

Mortality Clock

Several years ago, an enterprising entrepreneur and inventor created what was called a Mortality Clock. It was simply a wristwatch that could be set according to actuarial statistics of a life span. Each of us has a personal Mortality Clock that will inevitably end.

The World Health Organization (2016)2 published a list of life expectancies at birth for countries around the world.  It states the average life expectancy worldwide was 71.0 years (68 years and 6 months for males and 73 years and 6 months for females) over the period 2010-2013, with women on average living longer than men in all countries, except Tonga.

For the total U.S. population, the average was 79.3 years, with 79.6 for males and 81.6 for females. The factors reflect the quality of healthcare in the countries listed as well as other factors including ongoing wars, obesity and chronic infections.

Imagine time as a deposit made in your bank account at birth. These deposits vary from individual to individual. Some people will, unfortunately, be short-changed to varying degrees while others are given a bonus. For approximately 18 years of our lives, our parents manage our time bank accounts for us because we are still too immature. Time is in a ‘Trust Account.’

In order to grow into healthy, independent adults we need our parents to spend their time on us. They need to make a large deposit from their own accounts. Lay-away plans won’t work. You cannot buy, borrow or bank it. So parents may steal it from their children with a promise to pay it back later.

Paying it Back

But as singer-songwriter Harry Chapin, whose own time on earth was brief, sang in “The Cat’s in the Cradle,” we can never make up time. Without a large parental deposit, our children will have nothing in their parenting time bank inheritance to give when they are grown. Time is a valuable commodity, which moves in only one direction. So the best present a parent can give to a child is the Present. It will eventually become the Past on which the Future is built.

As a society, we also recognize the importance of time as a premise on which our penal system is based. It is used as a powerful punisher for those who transgress our laws. For example, we take out a portion of time allotted in their personal bank accounts, the amount of which will depend on the severity of the offense. Prisoners who do time become keenly aware of the importance of free time.

Similarly, terminal patients who have precious little time, realize its value. They face the harsh reality that time is not endless. Yet the only difference between the terminal patient and those not so designated, is the person knows Father Time is waiting right around the corner.

Sadly, too many people merely waste it, pass it, or kill it? It’s not that we have that much to spare. If time were really money, would you squander it foolishly? A study3 led by Wei-Ching Wang in Taiwan, found that retirees feel planning free time is more important than the amount of free time. He suggests governments and other support services for seniors, introduce educational programs to teach people how to schedule their free time to feel more contentment in their retirement years.

I would add that spending time with family and friends, participating in long-held dreams and creative goals are generally the important values held by many people. It is important to define what matters most to you and develop a strategy to reach those goals.

So when you make your last withdrawal, will you feel bitter regret or satisfied that your legacy of time has been deposited for future generations? You haven’t taken the time to think about it? Don’t you think it’s about time?







Sharie Stines, Psy.D <![CDATA[Holding Your Own With a Narcissist (or other Personality Disordered Person)]]> http://7.997 2017-01-08T05:33:27Z 2017-01-08T05:33:27Z empowermentIt may have come to your attention by now that the narcissist or other type of manipulator in your life defines the terms.  This is because he/she has two essential motives – to get his/her way, and to look good doing it.  Ordinary people do not bode well with these narcissistic types because they tend to play by a different set of rules – fair ones; ones that involve cooperation, collaboration, equality.

So, now that you know that you have a formidable opponent, how do you arm yourself for battle?  Here is some great advice from the book, In Sheep’s Clothing, written by George Simon, Jr., on character disordered people:

  1. Stop participating in losing battles. Your biggest losing battle is trying to get your disordered person to change. Your narcissist is uninterested in changing. He/she does not care about your feelings or your point of view, so lay your efforts down and put your energy where you do have a chance to win – into your own well-being.
  2. Do not deceive yourself. Stop pretending that the negative interaction you just had never occurred. Live in reality and learn to accept reality. As you interact with a narcissist be aware that you are dealing with a characterologically challenged individual and do yourself a favor – expect him/her to act accordingly.
  3. Independently own yourself. Do not let a narcissist manipulate you by causing you to react, respond, second guess yourself, or defend yourself. You must hold onto yourself, which means you are allowed to have, honor, and respect your own opinions and feelings, regardless of how much effort your manipulator puts into thwarting your sense of self. You never have to agree with him/her – particularly in matters involving your value or reality.
  4. Eliminate “easily-manipulate-able” traits from yourself. In particular, the following characteristics have no place in the same room with a narcissist: conscientiousness, self-doubt, emotional dependence, being the one who takes on responsibility for making things “right,” gullibility, or being understanding.  In any interaction with a narcissist, leave these characteristics about yourself elsewhere.  They will only be used against you.
  5. Arm yourself with Personal Empowerment Tools:
    • Don’t accept any excuses for poor behavior. Remember that if someone’s behavior is wrong, any rationale for the behavior is irrelevant. Confront inappropriate behavior directly and label it for what it is.
    • Don’t be manipulated by the other person’s “impression management” strategies. Don’t “mind-read.” Judge actions for what they are; don’t try to second-guess why someone does something. Remember, behavior patterns alone give you enough information about a person’s character. You don’t need to “buy in” to an explanation.
    • Establish your boundaries ahead of time. That means, decide what behaviors you will tolerate and then also decide what actions you will take for behaviors you want to disengage from. This will help you cope with problem behaviors when they arise.
    • Be direct and accept only direct responses. If you can’t get the other person to provide a direct response to your direct request or question, understand that the other person is trying to control and/or manipulate you. Refer back to item 1 above – you can’t change anyone but yourself; therefore, figure out what you need to change in order to be healthy and at peace.
    • Stay in the here and now. Don’t let your narcissist try to drag you off on a rabbit trail. The only change that matters is that which takes place in the moment. Stick to the present issue and do not allow the other person to sway you away from it.
    • Keep the focus of the responsibility on the manipulator. Narcissists are masters at projecting their problems onto the other person and are particularly adept at blame. Do not take responsibility for his/her behavior for any reason. Ask how he/she will correct his/her behavior. Do not listen to rationalizations.
    • Remain calm and fair when confronting a narcissist. Realize that he/she will use any perceived hostility on your part as an invitation to respond with denial, selective inattention, and blame.
    • Do not threaten a narcissist; just take action. The best strategies to use with a narcissist are actions. Even if the narcissist does not change his/her behavior, at least you can take action to take care of yourself. This always benefits you.
    • Do not allow yourself to be in the “one-down” position. This is going to be hard because narcissists are unwilling to be anything other than the “winner.” They do not know how to be on a level ground position. You will have to be mindful of this reality and keep yourself on top.
    • Speak for yourself. Use “I” statements. Don’t let the other person define you or tell you what you mean. Also, don’t speak for the other person either.

Suffice it to say that your relationship with a narcissist will never be an easy one.  Do whatever you can to build self-empowerment and remain focused on trusting yourself.

If you would like to join my free monthly newsletter on The Psychology of Abuse, please send me your email address ( and I will add you to my list.

Marie Hartwell-Walker, EdD <![CDATA[Science and Art: You Can’t Have One Without the Other]]> 2017-01-07T16:41:06Z 2017-01-07T16:41:06Z bigstock--131652731Obviously, it takes more than desire or a talent for listening to successfully help others heal and grow. It requires formal schooling in the science of counseling, i.e., theory and practice. But what is often missed is that it also requires purposeful work in mastering the “art part” (some would call it the “heart” part) of this work.

Science and art: One without the other simply doesn’t work.  Someone can be a straight A student in academics but not be able to connect with those in pain. Someone can have enormous intuition and empathy but not know where to go with it. As you ponder whether to become a therapist, take into account your willingness to commit to developing both skill sets.

The Science Part

The “science part” requires the study of human development, human nature and ethics, theory and interventions, research and studies.  It doesn’t really matter which theory you embrace – as long as you have one.

Knowing a specific theory well provides the scaffolding for all that we hear and intuit from a client so we can make a kind of sense of it. Knowing the interventions that go with that theory moves therapy along in a way that has consistency and flow. Whenever we are “stuck” (and, believe me, being “stuck” happens regularly when working with complicated human beings), having a solid background in a particular theoretical point of view provides a systematic way to analyze the situation and to move forward.

There are many well-documented ways to think about and do therapeutic work. Choose the therapeutic theory and method that best resonates with you and that matches the needs of the population you wish to serve. As you develop your career, you will layer additional information and skills onto that base. Becoming eclectic is fine when it is done purposefully. See the related articles listed below.

The Heart Part

The “heart part” requires the development of the instincts and skills to be unafraid and supportive as you go on a healing journey with someone in pain. The curriculum of the heart part includes confronting our innermost self with integrity and developing our talents for making positive connections with other human beings. Why? Because research shows that it is the connection between the therapist and the client, not the therapeutic orientation of the therapist, that is the most important determiner of a successful outcome. When the chips are down in treatment, when we have done everything we know how to do within our theoretical framework, what we have left is what’s within our own hearts to connect, to delve ever more deeply into the client’s pain and to determine what might be most helpful.

In my experience, developing the “heart part” requires systematically turning these personal qualities into professional skills:

Self-knowledge: In order to draw on yourself, it’s crucial to know as much about your “self” as you can. That means embracing our own strengths and confronting our own imperfections, wounds and fears. Listening to other people’s pain hour after hour, day after day can be exhausting, even traumatizing. Self-awareness provides both tools and protections as we venture into another person’s experience and distress.

Compassion: In Latin, compassion means “co-suffering.” Successful therapists are not afraid to touch the suffering of a client. Doing this work well doesn’t mean maintaining a professional distance at all times. Sometimes, it means truly feeling the client’s pain in order to understand its depth and its outlines. To do that safely means developing skills to then pull back from the suffering in order to re-enter the conversation in a way that is helpful.

Curiosity: Curiosity is your very best friend. We are often confronted with the unusual, the different and sometimes the outright bizarre but our job is to do our best to understand it. When we partner with a client in being curious instead of distressed, we open the path to understanding.

Patience: A plant’s growth can’t be hurried by tugging at it. It requires nurturing and the willingness to wait for results – even when we wish it would hurry up already. People are no different. We can only facilitate. We can’t force growth. Sometimes that means we are frustrated, bored or even annoyed by the client’s persistent pain. Our job is to contain our own impatience and continue working, having faith in the client, ourselves and the process.

Pacing: Each client has their own pace. Go too fast with suggestions, interpretations or responses and we will lose them. Go too slow and they will get impatient and quit. Our job is to steadily match the client’s pace with just enough push or restraint to gently keep therapy therapeutic.

Non-judgmentalism: Clients often fear they will be judged if they disclose beliefs or behaviors that are unpopular, illegal or politically incorrect. Lynn Hoffman, one of the founding mothers of family therapy, once told me that there is an important difference between therapy and politics. People don’t come to therapy for an education about racism, feminism, religion or any political point of view. They come to alleviate their pain. Yes, that may mean eventually considering the impact of gender, race, sexuality, class or political or religious beliefs but the starting point for healing is working within the client’s vocabulary and values – even if they are far afield from our own. If the client’s values are a part of what is creating their suffering, it is then our job to carefully challenge them without imposing our point of view.

Tact: Exquisite tact is the key to successfully challenging ideas and behaviors that are causing distress or dysfunction for the client or those around them. That means knowing how to say difficult things without causing the client to recoil in defensiveness, dislike or disgust.

Courage: Being a therapist is not for the faint-hearted. What if we mess up? What if our efforts increase rather than decrease a person’s pain? But unless we have the courage to take some educated chances, we are in danger of enabling the very issues the client has looked to us to help remedy. Part of our job is to model the courage to be imperfect, even to fail, without feeling like a failure. Having the courage to apologize and try again shows our clients how to move forward in spite of the misunderstandings, criticisms (by self and others) or missteps that are inherent in being human.

Science and Heart: Good therapy weaves a web of safety and clarity for therapist and client alike through the strategic use of both. Developing the two skill sets to the best of our ability is a lifelong commitment – to ourselves and to our clients.

Related Articles:

On Becoming Eclectic Part I: Assessment

On Becoming Eclectic Part 2: Interventions

On Becoming Eclectic: Adding Skills in Child Therapy

Christine Hammond, MS, LMHC <![CDATA[How Flattery Can Be Abusive]]> http://5.1163 2017-01-07T16:18:10Z 2017-01-07T16:18:10Z flatteryIt’s easy to identify bullying, intimidation, physical restraint, or molestation as abusive. But what about other, more subtle forms of abuse that seem on the surface to be kind and generous, then are not. Think of it as a mask of deception used to control, manipulate, and eventually abuse. To the outside world the mask may appear to be attractive, but to the person on the receiving end it feels like a hidden form of torture.

To be clear, this is not about a compliment, it is about flattery. The difference is quite significant. A compliment is an unconditional gift of praise, whereas flattery is excessive and insincere praise given to win favor. On the surface the praise could look innocent, but in time the deception of flattery is revealed.

What does this type of flattery look like? Here are a couple of examples:

  • Flattery on the rocks – “As a wise person, you can see the wisdom in my idea.” This implies that a person is only wise as long as they see the idea as good.
  • Flattery straight-up – “You look marvelous.” This is a flat statement with no obvious deception initially. However, later the statement might be more like, “You looked marvelous before.” The implication is that the person no longer looks good now and should change.
  • Flattery with a twist – “You whole face lights up when you see them, it’s not like you.” The implication is that a person is not normally happy. This is a passive-aggressive insult added to the flattery.
  • Mixed flattery – “You would be smart not to piss me off.” This statement incorporates flattery with a threat. The key to the level of threat is which word has the most emphasis: smart or piss.
  • Watered-down flattery – “I can’t remember your birthday because you look younger every year.” Basically this statement incorporates flattery with an excuse by blaming the other person.
  • Double shot of flattery – “You are so beautiful and smart. I can’t believe how amazing you are.” This is excessive flattery signals the other person that something hurtful is on the horizon.
  • Hot toddy flattery – “You look angelic when you are angry.” This is flattery mixed with an anger inducing comment. It is designed to be directly hurtful and provoking.
  • Flattery chased with a mixer– “You are so kind. Let’s have sex.” This flattering statement is quickly followed with a selfish request.


The difficult part of these statements is that on the surface they can be rather innocent or even enticing. But in the case of abuse, these comments are usually followed by verbal assaults, physical violence or manipulation. Done often enough, it generates a conditioned response where it only takes a small flattering statement to bring on intense anxiety or even a panic attack. The flattery becomes a warning of sorts that the abuse is imminent.

The key to knowing if this is happening in a relationship is to observe the person receiving the flattering remark. Do they immediately stiffen up, take a deep breath, or look downward? If so, they might be secretly abused. Usually a person in this situation responds well to demonstrations of care and concern that are void of any type of flattering remarks.  It is hard for them to trust anyone who engages in flattery when abuse has been the outcome. Be kind to them, they are hurting and in need of support.

Christine Hammond is a Licensed Mental Health Counselor and a National Certified Couselor who lives in Orlando and is the award-winning author of The Exhausted Woman’s Handbook.

Dorlee Michaeli, MBA, LMSW <![CDATA[The Mood-Food Link: 7 Tips to Greater Mental Health]]> 2017-01-06T18:40:51Z 2017-01-06T18:40:51Z Mood Food Link Title imageAre you looking for some ideas to improve your overall health for the new year? Or would you like some nutritional guidance to help steer your clients to improved mental health and general wellbeing?

As per the fascinating talk given by Dr. Leslie Korn at the 2016 Psychotherapy Networker Symposium, “Nutrition Essentials for Mental Health,” poor nutrition tends to be involved in mental illness or poor health.  Dr. Korn is both a mental health counselor and a certified nutritional therapy practitioner.

This post will provide you with key learnings from Korn’s presentation, as well as some simple steps that you may wish to consider taking to jumpstart your self-care routine for this coming year. Please see the graphic below for a quick summary!

To better understand the value of the food we give our bodies, Korn provides a car metaphor. Our bodies, like cars, need the right type of fuel in order to run properly. With the wrong fuel, our cars and bodies may work for several years but over time, they will wear down.

Before delving into some nutritional self-care principles, Korn raises four important considerations for those of you who are contemplating giving nutritional psychoeducation to your clients: ethics/scope of practice, drug and food interactions, the meaning of food and a food/mood diary:

Ethics/Scope of Practice – As mental health professionals, we want to make sure that we are practicing within our scope of practice. To do so, check out:

  • Your discipline’s scope of practice (for example: NASW’s scope of practice for clinical social work)
  • Your state’s laws governing nutritional practice:
  • The different levels of competency (primary, collaborative and referrals) – At the beginning, you may wish to collaborate and/or make referrals to nutritional experts, but over time, you may wish to build your own knowledge/expertise in this area.
  • Understanding the Role of Drug and Food Interactions. We want to know how various drugs and supplements interact with one another, and the food you eat.

Exploring the Meaning of Food

  • How is (and was) food eaten at home?
  • What are (and were) mealtimes like?
  • How is (and was) food prepared at home?
  • Consider eating as an act self-care and nourishment and become more mindful (putting your fork/spoon down between bites is a good first step)

Keeping a Mood/Food Diary for 3 Days

  • Note foods eaten at different times of day/night
  • Observe mood/energy level/fatigue felt when eating
  • Dr. Korn’s book provides a checklist of how to interpret/guide

As a result of our having individual needs and preferences, there is no one diet that is right for everyone. In addition, many people don’t see a connection between nutrition and mental health.

Start becoming more mindful about eating and getting in touch with how different foods make you feel. This process will help you figure out what’s the best diet for you.

Below are some of Korn’s guidelines that are likely to help you experience improvements in your overall mood, immune function and energy levels. (For a quick recap, please see the graphic at the end of post.)

7 Nutritional Tips to Greater Mental Health and Wellbeing

1. Drink More Water

Are you suffering from headaches and/or feeling tired? In all likelihood, you’re probably not drinking enough water.

Korn recommends that we drink 30 to 50% of our body weight in ounces of water. In other words, a 200 lb. individual would benefit from drinking 100 ounces of water.

2. Eat Your Basics

While there is no one diet that is right for everyone, most people would benefit eating from the following foods/categories:

  • Proteins – With regard to dairy, Korn recommends eating goat/sheep vs. cow products. She states that unless your ancestors came from Northern Europe, you are unlikely to be able to genetically digest cow’s dairy milk.

In addition, contrary to eggs being bad for your heart/cholesterol (as was believed in the past), they are excellent food for your brain, memory and mood stabilization. She advises eating between 1-3 eggs per day.

  • Fats – Saturated fats as in nuts are important for cognitive function and managing chronic pain.


  • Root Vegetables – These provide important support to the brain and are a helpful transition food from starchy and/or sweet foods.


  • Fresh Greens – Try to have a mixture of fresh and raw vegetables in all colors of the rainbow to ensure that you are getting all the nutrients that you need.

Note that eating kale, cauliflower or broccoli in excess may depress thyroid function and cause depression.

  • Fruit – Try substituting your sweets with fruit.
  • Grains –Some people do fine with these; some do not. For example, 50% of people with schizophrenia are allergic to gluten, and individuals with arthritis or RA will experience a lot of stiffness that further disrupts the natural function of organs.

3. Avoid Inflammatory Foods

Where there is depression, there is inflammation. We begin with the experience of high stress. This condition often leads to the use of medication and the eating of high inflammatory foods (a diet high in sugar/refined carbohydrates) which cause further inflammation and may ultimately lead to depression.

Interrupt the cycle wherever possible with alternatives and restoration. Try making a list of positive changes that are doable, such as drinking more water, and using more olive oil.

4. Eat Fermented Foods

Korn suggests thinking of our intestine and colon as a garden and our fiber (prebiotic) as preparation for our garden in which we plant our probiotics (good bacteria) to grow our brain transmitters and keep us feeling happy.

She recommends that anyone with anxiety go on probiotics daily in one form or another.  Probiotics help lower the stress response by regulating GABA, the relaxation neurotransmitter. You can get probiotics naturally from foods such as yogurt, sauerkraut, kimchi and miso. Every culture has its own probiotic.

Re soy, Korn points out that it is only a good food if it is fermented as it is in miso.

It is best to avoid soy milk or burgers. Unfermented soy protein in large amounts may depress thyroid function and pancreatic enzymes which are a risk factor for cancer and thyroid problems. Also stay clear of soy isolates in packaged foods because they cause chronic gas and digestive problems.

5. Use Healthier Substitutions

Identify and eliminate addictive foods one at a time (using healthy alternatives will make this easier).

A few substitutions worth considering:

  • Fruits and sweet potatoes for breads or sweets
  • Molasses, honey or maple syrup for cane sugar
  • Later, stevia for the above mentioned sugar substitutes
  • Smoothies with stevia instead of sugar or artificial sweeteners
  • Freshly made unsweetened cocoa with stevia instead of sweetened cocoa

Korn advises against aspartame, and other food additives because of research linking them with various neurological and behavioral disorders.

6. Try Easy Food Prep

Purchasing and using a crockpot can be a big time saver. This purchase enables you to easily throw vegetables and meat/chicken in the pot in the evening and have a meal cook overnight.

In general, Korn advises preparing your food over 1-2 days (probably over the weekend when you have the most time) and then you can split it up into containers to eat during the week.

Aside from the crockpot idea of cooking meat or chicken with veggies, she suggests preparing a dozen hard boiled eggs, roasting some sweet potatoes and preparing a salad as some easy food prep ahead ideas. Soaking dried fruits and nuts and making bone broths are some additional healthy ideas.

Work with your clients to find out what are their obstacles to preparing their own healthy meals. Motivational interviewing may be helpful in this regard.

7. Test Vitamin D Level

As per Korn, 90% of people residing in the United States are likely to be deficient in their vitamin D and this puts us at risk for cancer, depression, suicidality, poor immune function and pain.

Therefore, it pays to get your Vitamin D level tested. Most people would benefit from a supplement of 1000 or 2000 units of Vitamin D.

Lastly, Korn provided the below simple protocol that she believes everyone may follow, for which there are no contraindications.

Korn’s Rx for Overall Health

  • Eat every 2-3 hours proteins and fats with some complex carbohydrates

3 Supplements:*

  • Bioglycozyme forte
 (from Biotics Research)
  • Glucose Tolerance Factor – Chromium/B6/Fiber (Allergy Research)
  • Amino Acid Quik Sorb (Biotics Research)

Your food intake impacts your mood and mood swings follow swings in your blood sugar. By eating every 2 to 3 hours, you will be stabilizing your blood sugar and minimizing any mood swings induced by changes in your blood sugar.

The recommended supplements fill in important nutrient areas that we may all benefit from strengthening to obtain greater overall health.

To learn more about ways that you may further boost your brain and overall functioning, and help your clients, you may wish to check out Korn’s book: Nutrition Essentials for Mental Health: A Complete Guide to the Food-Mood Connection.

* Korn states that there are no contraindications; however, to be 100% safe, it is best to run these recommended supplements by your doctor, particularly if you are on any prescription medications.

Mood Food Link - 7 Tips for Greater Mental Health


Korn, L. (2016, March 18). Nutrition Essentials for Mental Health. 2016 Networker Symposium Session# 7160-227.



Jennifer Rollin, MSW, LCSW-C <![CDATA[3 Tips for Psychotherapists Looking to Start a Blog]]> 2017-01-04T20:11:37Z 2017-01-05T11:11:17Z bigstock--138804500Writing has become a popular pastime and marketing tool for psychotherapists. I’ve had many individuals reach out to me asking how they can go about starting their own blog and establishing themselves as writers.

I’ve enjoyed being able to provide professional coaching services to clinicians who are looking for assistance in blogging and establishing themselves as writers. The following are three simple tips if you are looking to start a blog and unsure of where to start.

1.   Think About Your Ideal Patient.

If one of your primary purposes in starting a blog is generating referrals for your practice, it is critical to first define your ideal patient. It can be helpful to get as specific about this factor as possible. Additionally, after you have defined your ideal patient, it is important to think about his/her specific interests and “pain points.” This way you can ensure that the topics that you plan to write about are tailored specifically to the clients that you hope to serve in your practice.

2.    Define Your Unique Niche.

Take some time to think about the things that set you apart from other clinicians. Maybe you are passionate about a unique treatment modality. Or, perhaps you enjoy working with a very specific population.

It’s critical not to fall into the trap of being too vague and general. It’s important to note that when you write for “everyone,” typically you end up writing for no one. Additionally, it’s a good idea to write about the topics about which you are truly passionate. Writing about specific topics or ideas that excite you will make your posts more engaging and authentic.

3.    Take the  Leap.

 I’ve spoken with people who have thought about branching into writing for a while, but allow their nagging inner critic to take over instead. Some people put it off because they believe that they “don’t have anything unique to say.” Whereas, others are waiting for the “perfect moment” where they will feel confident enough to put their work out there. Still others are caught up in perfectionism and unable to feel a sense of contentment with their creation.

 I frequently talk with clients about the importance of “feeling the fear and taking action anyway.” Often we want to wait for “the fear to go away” before taking action. However, the reality is that every experience of true growth and vulnerability will naturally stir up some fear and anxiety.

Therefore, it is important to stop procrastinating on putting your work out into the world. Think about the lives that could be impacted as a result of your writing. In holding back your gifts, you are doing a disservice to the many people who could benefit.

The Bottom Line

 Writing is not everyone’s cup of tea. You don’t have to start a blog just because other clinicians are doing so. What’s important is that you work to discover the marketing tools and creative outlets that highlight your unique strengths.

 For instance, if speaking is your jam, you could create Youtube videos or your own podcast. If you enjoy the arts, you could try your hand at graphic design. The options for marketing and finding a fun outlet are endless.

 If you do decide to start your own blog, it’s also helpful to practice some self-compassion. It takes time and practice to build any skill and it’s okay if you make some mistakes in the process.

Ultimately, you deserve to be able to share your thoughts and highlight your unique voice and perspective.


Christine Hammond, MS, LMHC <![CDATA[Five Ways a Narcissist Comes Unglued]]> http://5.1158 2017-01-05T00:25:42Z 2017-01-05T00:25:42Z angry narcissistThe angry outburst of a narcissist is like a two-year old temper tantrum. It appears out of no where, creates an unnecessary scene, and shocks others into inaction. It is the ultimate in selfish behavior as everything immediately becomes about them and what they want. Just like a child, a narcissist cannot tell the difference between what they need and what they want. The two things are exactly the same and as such an angry rant is sparked by both.

There are five main reasons for a narcissistic temper tantrum:

  1. Shattering their fantasy – Two year olds think imaginary, not logically. Narcissists also have a distorted perception of reality where they are all powerful, beautiful, knowing, authoritative, and right. Any shattering of that fantasy is met with immediate anger.
  2. Revealing their insecurity – At the heart of every narcissist, is a deep rooted insecurity that causes shame or doubt such as abuse. Most of the displayed grandiosity is an effort to cover up that insecurity. But the second it is revealed, the narcissist becomes angry in order to deflect the shameful image.
  3. Challenging their superiority – All narcissists view themselves as being superior to others in appearance, intelligence, and/or influence. Any challenge to that image is met with swift retaliation and competitive reactions. They must win at all costs even if the damage is a lost relationship.
  4. Seeking attention – Just like a two year old, some narcissists have learned that if they can’t get positive attention, negative will do just fine. Narcissists crave daily doses of attention, affirmation, affection, and admiration. When they don’t get it, they react aggressively.
  5. Embarrassing moments – Narcissists take pleasure in embarrassing and humiliating others. They are famous for saying, “I was only joking,” and expecting others to be OK with the derogatory comments. But when others do the same thing back, the response is a severe backlash.

There are four ways a narcissist expresses anger:

  1. Aggressive – This can be instantaneously in the form of verbal lashings, throwing objects, threats of harm, yelling, being argumentative, unyielding in opinions, repetitive speech, twisting the truth, and intimidation.
  2. Suppressive – This type of anger is expressed as giving the silent treatment, ignoring problems or people, playing the victim, complaining about physical aches, being resentful without ever saying it, alienation of family members, and hiding money. Sometimes this anger later expressed in an explosive manner.
  3. Passive-aggressive – This is a more sneaky from of expression though sulking, gossiping, sarcasm, back-stabbing, agreeing to a person’s face but then refusing later, charming those they hate, setting others up for failure, procrastinating, gaslighting, and guilt-tripping.
  4. Violent – When other forms of anger fail to get the point across, some narcissists will escalate to carrying out threats of violence on self or others or being intentionally abusive.

Instead of becoming defensive or attacking back at a narcissist during the next temper tantrum, try using the opportunity to study their methods. Narcissists like to do the same thing over and over especially when it has already proven to be effective. Being able to anticipate a blow-up is the first step in learning how to counteract the attack.

Christine Hammond is a Licensed Mental Health Counselor and a National Certified Couselor who lives in Orlando and is the award-winning author of The Exhausted Woman’s Handbook.

Bret Moore, Psy.D. <![CDATA[6 Steps to Cutting Caffeine from Your Day]]> 2017-01-04T20:10:58Z 2017-01-04T20:10:58Z bigstock--147070274In my previous article I talked about the effects of caffeine on people who suffer from various types of anxiety.  Letting go of the hold this popular stimulant has on the body and psyche is no easy feat.  Some argue that quitting caffeine is as hard to kicking cigarettes or losing weight. If you have a patient who believes he or she needs to stop, or that you feel would benefit with stopping or cutting back, below is a detailed plan for helping them be successful.

STEP 1: Identify why quitting is important to you.  Ask your patient to write down at least three reasons why he or she wants to quit using caffeine.  If they tend to be anxious, one obvious reason is to help them get control of their anxiety.  However, there are many other benefits to quitting such as reducing high blood pressure, improving sleep and saving money.   Ask your patient to keep these reasons with them at all times.  They can jot them down on a 3 x 5 index card, business card or restaurant napkin.  It doesn’t really matter.  The important thing is for them to keep the reasons handy so they can pull them out and remind themselves while they are standing outside of Starbucks or about to order a large glass of iced tea at their favorite restaurant.

STEP 2: Educate yourself about withdrawal symptoms. Yes, your clients can have withdrawal symptoms from caffeine.  Fortunately, they tend to be mild in most people and only reach the level of being a nuisance.  The most typical withdrawal effects are:

▪ headache

▪ fatigue

▪ sleepiness/drowsiness

▪ insomnia

▪ concentration problems

▪ irritability/agitation

▪ flu-like symptoms

If your client is able to understand that these effects are short-lived and cause no lasting negative effects, it will be much easier to tolerate them.

STEP 3: Choose a start date. This tip may seem like a no-brainer, but you would be surprised how many people never put a plan into action because they have not decided on when to start.  Ask your clients seeking to give up caffeine to choose a start date that is realistic.  It may be next week or next month.  If the next couple of weeks are going to be unusually stressful, then they should start after things settle down.  And they should not try to quit too many things at one time.  If they are already quitting smoking, cutting back on carbs or kicking gluten out of their dietary routine, encourage them to conquer those things first.

STEP 4: Track your caffeine intake.  Your client will need to track how much caffeine he or she takes in each day.  They can make up a simple chart or download one of the several caffeine trackers available for smart phones (Coffee Addict or myIntake).  Ask them to estimate their daily caffeine intake over a period of one week.  Once they know how much caffeine they take in, they can proceed to step 5.

STEP 5: Cut back gradually. Your clients should avoid quitting “cold turkey.”  Reducing their caffeine intake gradually helps prevent withdrawal symptoms.  A general rule of thumb is to reduce caffeine intake by 50% each week.  So, if your patient normally drinks 8 cups (600-800 milligrams of caffeine) of coffee a day, he or she would cut back to 4 cups a day  the first week, 2 cups the second week, 1 cup the third week and ½ cup (or stop altogether) the fourth week.

STEP 6: Increase your fluid intake. As your patient reduces liquid, even if it is coffee or soda, it is important to replace it with non-caffeinated beverages to avoid dehydration and headaches.  An ideal replacement is water.  Water will help the kidneys flush toxins out of your client’s system. It also keeps him or her hydrated.

*This article is based on a chapter in Dr. Moore’s book “Taking Control of Anxiety: Getting the Best of Worry, Stress, and Fear.

Sharie Stines, Psy.D <![CDATA[Overcoming Perfectionism]]> http://7.986 2017-01-04T02:24:30Z 2017-01-02T19:20:29Z walkingfreePerfectionism affects many people in our society, for many reasons. Some have been raised to believe that the way to win approval from others is to “succeed” by doing everything perfectly; this is a “performance based” view of relationships. Others have placed perfection upon themselves in order to avoid feelings such as inadequacy, shame, and fear.

Perfectionism leads to two common problems: anxiety and procrastination. 

If you believe that you have to do everything perfectly then you live a life of constant “hustle.”  You don’t allow yourself sufficient relaxation, which contributes to stress. Too much stress causes too much cortisol to flow through your blood stream.  Too much cortisol leads to a shorter lifespan.

When chronically elevated, cortisol can have deleterious effects on weight and immune function, increasing the risk of chronic disease.

Why not give yourself the gifts of freedom and self-acceptance this year?  Make a decision to have a paradigm shift in your philosophy towards what it means to live well. Rather than continuing on the treadmill of perfectionism, chasing the elusive carrot of “someday I’ll be good enough,” why not offer yourself the gift of, “I am enough.” Allow yourself to live free rather than to live perfectly.

Basically, any paradigm shift involves a change in attitude. Following are ten steps you can take beginning today to give yourself the gifts of freedom and self-acceptance.

The difference between an adventure and an ordeal is your attitude~Mary Englebriet

  1. Remind yourself that perfection is not a worthy goal. Striving for the elusive trophy of perfection hurts you and those around you.  It robs you of your happiness and freedom to enjoy life.
  2. When faced with failures and disappointments, rather than taking them as personal attacks on your self-hood, learn to welcome them and give these experiences space to do their work.
  3. Make room for change. It’s okay if things don’t look like you think they “should.”
  4. In fact, quit using the word “should.” Stop “shoulding” yourself and others; be grateful for what is.
  5. Do something you want to do just because. No “shoulding” allowed.
  6. Continually remind yourself that you are a part of a flawed human race. You are no more or less flawed than everyone around you.
  7. Get some scars. You will only find success by putting yourself out in the world; however, it’s foolish to think you aren’t going to get a few bruises in the process. Your scars and bruises are proof you showed up to participate.
  8. Choose to stop comparing yourself to others. Choose to find peace and contentment in what you have.
  9. Be brave enough to separate from people who hurt you. You were not put on this earth to be anybody’s whipping boy.
  10. The next time an “ordeal” comes to your “in box,” take a deep breath, go to your “files,” and rename that “ordeal” as an “adventure.” Open your heart and hands and let life happen.


Wolfe, E. (2017). President, Lifeline Counseling and Educational Services. 10 Steps for having an attitude of adventure in 2017

Aronson, D. (2009). Cortisol — Its Role in Stress, Inflammation, and Indications for Diet Therapy. Today’s Dietician. Vol. 11 No. 11 P. 38

If you would like to receive a free copy of my newsletter, the psychology of abuse, please email me at

Sharie Stines, Psy.D <![CDATA[How to be thin]]> http://7.972 2017-01-02T18:12:57Z 2017-01-02T18:12:57Z loseweightThinness, just as fatness, is a lifestyle. In order to develop a thin lifestyle, it helps to develop thin habits.  This involves doing what thin people do and thinking like thin people think. If this is something you haven’t done before than it might be challenging, but not impossible. Old habits can be broken and new habits can be formed.

One reason so many people find it difficult to live thin is because of how they were brought up. Many people grew up with eating habits that have become firmly entrenched in their way of life.  It is much harder to undo something already learned than it is to start out that way from the get go.

Here are some basic “dos and don’ts” of thinness”

  • Don’t eat when you’re not hungry.
  • Be active rather than sedentary.
  • Don’t get seconds.
  • Stop “grazing.”
  • Eat fruits and vegetables, particularly when you snack.
  • Don’t drink your calories – limit sodas, alcoholic beverages and other sugary drinks.
  • Stop dieting.
  • Exercise every day.
  • “Forget” to eat.
  • Do not obsess about food.
  • Learn to feel hungry.

Now, to be fair, some people are emotional eaters and eat to assuage their anxiety or depression. Eating obsessively brings comfort and numbness to someone who is trying either consciously or unconsciously to avoid negative emotions, particularly ones of rage and emptiness.  In some ways, eating is the activity and comfort and/or numbness is the addiction.

If this is your problem, then the above list of habits to develop is a great start, but is not the complete program needed to make lifelong change. In addition to developing thin habits, some emotional and cognitive (thinking) overhaul is necessary.

To eliminate emotional eating, it is beneficial to learn how to have the uncomfortable emotions you are avoiding and also how to come to terms with your relationship with food.  Get out your journal and start putting your pen to paper, bringing forth your unexpressed emotions in the process. This will help you on your journey to learn how to “live thin.”

Ask yourself some pointed questions:

  1. If food is comfort, what does comfort mean to you? What price are you willing to pay to buy comfort?  What beliefs do you have regarding the feelings of being uncomfortable? This requires rigorous honesty. Somewhere in your mind you have an underlying belief about your “right” to feel comfortable.The flip side of this belief is the belief that you can’t bare feeling uncomforted.  This is personal; analyze your own belief system and see what you uncover.
  2. If you are eating to feel full and not empty, what fears do you have about facing your emptiness? What are you lacking within yourself that scares you?  Security? Belonging? Love?Oftentimes people overeat because they have “love hunger,” caused from not being sufficiently loved as children, and so spend the rest of their lives trying to find fulfillment in food. This might be a temporary fix, but long term satisfaction is never found in food.   Food is meant to enjoy, but not to fix unmet emotional needs.
  3. Many people “stuff” their feelings, particularly, feelings of anger. Try not eating for a while and see if you can get in touch with your anger. What and who are you angry at or with? What are your beliefs about anger? What messages did you receive as a child regarding anger (and other emotions for that matter?) Was it unsafe for you to express anger as a child? Were you not allowed to freely be yourself?treadmill
    If you were to be angry with someone today, how uncomfortable would that be for you?The more you can understand your fears and beliefs about emotional expression, the more you will connect the dots between your emotions and your relationship with food.  Anger is a complicated emotion. Some people are very comfortable expressing anger, but many are not.

Dieting doesn’t work in the long run, and actually contributes to the problem of not being thin because it encompasses a mindset involving a technique or method for accomplishing a goal.

The best and only way to have lasting transformation in your weight is to make a lifestyle change.  This requires a complete paradigm shift. Not only is it essential to develop new habits, but more importantly, it requires a change in mentality; this involves altering your attitude towards food, emotions, and comfort.

Note:  By the term, “thin” I do not mean anything sickly, unhealthy, or anorexic.  By thin, in this article, I refer to a healthy body weight for the individual.