Psych Central Professional For mental health, psychiatric and psychological professionals. 2017-02-24T03:04:38Z Jessica Dore <![CDATA[Yoga + Addiction: An Interview with Filmmaker and Yoga Teacher Lindsey Clennell]]> 2017-02-24T03:04:38Z 2017-02-24T03:04:37Z Lindsey Clennell is a filmmaker and senior teacher of Iyengar yoga. In 2007, he created and distributed the documentary film Addiction, Recovery and Yoga, which he distributed for free online. The film includes in-depth interviews with people who struggled with serious addiction problems and used yoga and 12-step programs as a part of their recovery.

 Tell us about your experience as a filmmaker, therapist and yoga teacher.

I’ve been practicing yoga since 1970, and I’ve found it to be really useful in keeping myself together in very demanding creative situations. When I began practicing yoga, I was making documentaries and music videos, running a production company and had a family. I found that practicing yoga was the best way that I could function well with that kind of life.

As a student of BKS Iyengar, I’d been to India more than  20 times and when he introduced a certification program, I became as senior teacher. While in India, I’d also photographed and documented the therapeutic aspects of yoga quite a bit and had become interested in this way of teaching.

coming out madWhen I retired from filmmaking around 1990, I decided that I would teach yoga and created a yoga therapy practice. I’d get referrals from medical doctors, psychotherapists, psychologists and such, and I’d teach yoga in a way that was appropriate for each student’s particular condition.

 These days, I’m slowing down a bit; I teach less and am finishing off a film on BKS Iyengar which I’ve been making with my son and will be released this spring.

When you talk about getting referrals from mental health professionals and working with people who came with health and mental health issues, how did you know what would be good for a particular issue or ailment?

Experience and one’s own practice. But if you have a copy of Iyengar’s classic yoga text
Light on Yoga, you’ll see that the book has a great deal of therapeutic information in it. Iyengar has also published other books—one specifically on therapeutic yoga called Yoga: The Path to Holistic Health—and so this aspect of yoga has been traditionally written about and taught.

 At Iyengar’s institute in Pune, India, there were weekly therapeutic classes. Thirty or 40 people would gather in the hall, and there would be Iyengar, his daughter, and a couple of doctors from the local hospital, who were also students of his.

People would come in with different conditions—high blood pressure, cancer, injuries, spinal problems—and Iyengar would give instruction on different sequences of postures and so forth that could be done depending on the issue.

 Through attending these classes over the years—watching, participating, photographing—one gets an idea of how to adapt asana to different conditions. To teach people yoga in such a way that they immediately feel better. It’s a way of fitting the person to the yoga and fitting the yoga to the person, if you know what I mean.

 Did you ever experience any issues in the US not being a licensed therapist treating mental health issues?

I never had any issues with that because I was getting referrals from psychologists and medical doctors. I had known about and studied therapeutic yoga since 1970, but it was informal simply because it wasn’t formalized at that time.

Eventually, of course, the business of yoga expanded, with now some 30 million people doing yoga in the United States. The Yoga Alliance established a qualification to be a yoga therapist and a lot of younger people who were enthused with the impact yoga had had on them went about completing teacher trainings, yoga therapy trainings and so forth.

 What that entailed or how substantial that qualification was may have been questionable to a lot of people, but it was the beginning, nonetheless. Sort of like how acupuncture was in the seventies; people were doing it, then training came together, then licensing, then it became what it is today. It became an add-on to conventional medicine.

That’s interesting, particularly for those who don’t have clinical training but want to work with people in mental health settings, still. So you’ve done a lot of film work around the yoga community, what is the role that film plays in getting this information out?

 As far as I’m concerned, you have to respond to your experience in the way that you think is appropriate. And my experience has always been that it’s important to get yoga out there because it’s such a substantial benefit to people’s everyday lives.

With yoga practice, we’re a bit more energetic. We’re generally less difficult to get along with. Relationships blossom and we have a little bit more capacity to manage our heads. And people really need that, as we know. So I’ve always seen yoga as something which should be promoted in one way or another because of its general benefit.

 Filmmaking came into this particular picture in a very narrow way. I had one or two students who had drug and alcohol problems. One particular person had an alcohol problem which interested me in Alcoholics Anonymous (AA). I’d never been to a meeting and didn’t know anything about AA. I’d never had a drug problem myself.

 The Gay and Lesbian Community Center in Greenwich Village, where I lived at the time, would have AA meetings on Sunday at noon. Somebody I knew was doing sign language interpretation at the meetings and invited me along. So I went, and it blew my socks off. I thought, “Wow, this is so good.”

 The meetings were so open, so dramatic, very nice people were sharing their experiences. It was an eye opener for me. The ethical structure of AA also really impressed me. It struck me as a good community thing. Healing, positive and just like yoga, it was relatively cheap.

So the idea of putting yoga and AA together was, I felt, an important thing to get out there. As a filmmaker, I do this by making a film about it and putting it out for free on YouTube. I felt that making a film about it would help reach the person with the drug or alcohol problem, or the yoga teacher who works with people dealing with addiction.

 Why do you think yoga is such a good fit with addiction?

 The thing is, yoga can make you feel good. Apart from detoxifying the body or giving you something to do or go to, there’s a very good chance that when a person goes to a yoga class they’ll leave feeling better. It makes you feel good.

 So for a lot of people with drug problems, having a feel-good practice really makes sense to them. Addiction is such a difficult thing and yoga gives a person hope that they’ve got something—an agent of their own causality—which is effective. People are empowered with the realization that they can effect their own condition in another way, apart from taking a substance.

 The thing about yoga is that unlike traditional talk therapy, you do it, you don’t talk about it. That engagement with the experience of being causative over one’s physical self provides a parallel and is similar to being causative over oneself at a psychological level. That is, being able to manage the mind, to some extent. Or simply establishing self-observation so that we become a bit more sensitive to when we are anxious or reaching for a drink, or whatever.

Through the practice of self-observation, the person who struggles with addiction becomes aware of those things which normally take them over. They establish a bit of breathing space as they become more self-aware.

 Hope is a funny word and I don’t use it a lot, but there’s something in that process that I think revolves around the idea of hope. A person struggling with addiction finds some hope in yoga practice, whereas addiction for people can be very demoralizing. People often feel humiliated by their condition.

Do you think simply doing yoga is enough for addiction recovery? Or is it a complementary therapy? 

 I think in a therapeutic application, yoga is an add-on. It’s an add-on to AA or should be done in  rehab center.

 Yoga is not an exercise system, it’s a psychology. It’s a matrix for self-observation. Yoga’s initial assertion is that it’s about modifying fluctuations in consciousness, which firstly means being aware of fluctuations in consciousness, which means managing fluctuations in consciousness, which means observing fluctuations in consciousness.

So the primary fluctuation in consciousness—a change in head state that you want someone to observe—is that by doing yoga you feel better. I would always joke with people when they came to see me that “the only reason you are here is because nobody has fixed you yet.”

 And yoga is not a punishment. Because punishment is so pervasive in this culture, people can’t really think outside of that particular equation. But to introduce yoga as a sort of feel-good game can get people started.

It can make you feel good, but ultimately it is a long-term game. It’s not something you do for a week and you’re fixed.

 Lindsey’s film, Addiction, Recovery and Yoga is available to watch for free on YouTube. His film on BKS Iyengar is currently in progress and will be available this spring.

Christine Hammond, MS, LMHC <![CDATA[10 Common Mistakes Therapists Make During the First Session]]> http://5.1243 2017-02-23T14:38:34Z 2017-02-23T14:38:34Z Not everyone who comes into counseling truly wants to get better. Some are present because a relationship, an employer, or the legal system mandates it. Unfortunately for the therapist, this is not always transparent initially. Or is it?

In Galvin De Becker’s book The Gift of Fear, he identifies patterns of behavior that can be seen at a first encounter which help to discern the difference between a safe and unsafe person. The same concept can be utilized in a therapeutic setting.

While not every client who doesn’t want to get better cannot be deemed unsafe, there are some who are. In addition, there are those who are not honest in therapy for the purposes of continuing to manipulate or control another person. And then there are those who attempt to gain control of the therapy session and therefore the therapist for the purpose of not having to accept responsibility for their issues.

There are three types of clients who potentially fit this situation: those with a personality disorder, an abusive person, or an addict.

Within the definition of a personality disorder is their lack of having an accurate perception of reality so their awareness is already misguided. This affects their opinions on morality, safety, authority, relationships, and laws. Some examples include anti-socials, narcissists, borderlines, histrionics, and obsessive-compulsives.

An abusive person or some addicts go to a therapist to demonstrate to others that there is nothing wrong with them. They frequently blame their victims with colorful stories of how they are actually the ones being abused. Then they take the information gleaned and use it to continue to abuse their victims or justify their use of substances. While the abuser or addict is usually honest about the reason for therapy (relationship issues), they intentionally withhold their abusive/addictive nature.

Understanding these concepts will save hours of frustration during therapy and will ironically make all of the future sessions far more productive. The book applies these concepts to an abusive partner or a first-time encounter, but here it is applied to a therapeutic environment instead.

  1. PINs (pre-incident indicators). Before an action takes place, a person has to have the thought. Before the therapy session takes place, the client rehearses it in their head. This type of client intentionally says something to get a surprise reaction from the therapist. For instance, they may say, “The last time I heard you speak I almost died,” having rehearsed in their head what the therapist might say in response. If the therapist bits, and opens with what the client wants, then the client has gained control of the session.
  2. Charm and Niceness. This is easy to spot in the beginning because this client will come in smiling and extending compliments. They will seem very put together, with little to nothing wrong. But people who come to counseling usually have some sort of issue that needs to be addressed. Those trying hard to hide their flaws are the ones that need most revealing.
  3. The Interview. This is apparent within the first few minutes of the session. The client responds to the therapist’s opening remarks but then redirects the conversation to asking the therapist a couple of questions. Some questions are to be expected and part of the normal initial session, others are more personal in nature and have little to nothing to do with therapy. A client who has researched the therapist already knows general information so they usually go for a question that demonstrates this knowledge, goes beyond it, and might even be a bit intimidating. “I see you went to… (therapist’s university), do you happen to know… (they use the name of therapist’s roommate).”
  4. Typecasting. The client makes some personal general statement about the therapist that is slightly insulting. This is done to engage the therapist and see if they become defensive. If they do, the client learns an area of vulnerability of the therapist. This is useful to the client because they can return to the issue later whenever the therapist starts to notice their abusive tendencies. This technique was done very well during several of the counseling sessions of Good Will Hunting.
  5. Forced Teaming. During the session, the client begins to use the word “we” in reference to them and the therapist. For example, “I know you agree with me, we would never act that way. I can tell you and I are like.” First of all, the client should have no idea in the first session of what the therapist is thinking; this is not part of best counseling practices. Next, there is no united front in therapy. It is not the client and therapist united against another person.
  6. Loan Sharking. This technique is precisely why most regulatory boards strictly limit or prohibit gift giving from the client to the therapist. The client offers something to the therapist such as a weekend at their condo on the beach or a connection to a famous person. If the therapist accepts, they owe the client on some level and this client intends to collect more than the offering of the gift. During the first session, the gift offering might be implied before it is given such as, “I have a lot of friends. If you can help me, then I will refer them to you.”
  7. The Unsolicited Promise. While the client is telling an elaborate story, the therapist through their body language or an expression on their face reveals disbelief. The client immediately picks up on the signal and says, “I promise it happened this way.” This should signal back to the therapist that something is not right about the story. Otherwise, there would be no need to offer a promise. When trying to convince someone of a hard to believe matter, offering a promise is an easy way to put someone at ease and question their judgement.
  8. Discounting the Word “No.” This is not as difficult to test in a first session as it might appear. During a story or explanation, politely redirect the client to another subject. Almost always they will acquiesce initially. But a person who is unwilling to take “No” for a response will go back to where they were before. Remember, they are trying to control the session and cannot accept “No.” Another strategy is to tell the client that the issue they came in for is not the one that needs immediate attention. If they refuse to accept the input, they most likely don’t take “No” in other environments.
  9. Too Many Details. This is easy to hear as the client offers too many details before getting to the point of the matter. However, some anxious or obsessive clients naturally do this without having any manipulative intent. A client whose intent is otherwise offers the details as a distraction, not as further clarification. The details are more random in nature and have nothing to do with the story or the person. Asking the client to wrap up the story will not frustrate the anxious client as this has been said to them before. However, it will aggravate this type of client.
  10. Rule of Opposites. Things are sometimes best viewed from their opposite. For instance it is much easier to distinguish between the colors navy and black when placed on a white background. Likewise a client who sits on the edge of their seat in forward position as if trying to get close to the therapist is very different from one who sits back comfortably in their seat. The same is true for a client who intently stares at the therapist without looking away even when answering a question instead of one whose gaze glances off to the side for a brief moment before returning back to normal eye contact. This type of client is likely to sit aggressively and have “the stare” down pat.

If any of these concepts appear during the first session, just take note at the first instance. But if several emerge, than listen to your instincts that something might just be off.

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.

Sharie Stines, Psy.D <![CDATA[Creative Counseling]]> http://7.1100 2017-02-21T18:53:33Z 2017-02-21T18:53:33Z One attribute of a good counselor or good leader is the ability to be creative.  This article is an overview of Samuel Gladding’s ideas for implementing creativity into one’s counseling practice.

The acronym SCAMPER was created by Bob Eberle as a creativity technique to help teach children how to develop their thinking skills.  Over time, it was obvious that these concepts could be incorporated in a variety of applications.

Here are some suggestions for bringing the concepts of SCAMPER into your counseling sessions, and thus, enabling both you and your clients to develop increased creativity:

S stands for substitute; to have a person or thing stand in place of another.   For instance, in counseling, you can substitute a large group for a small group, or silence for talking.  The point of this concept is to learn to make one slight change in your counseling methodology in order to bring variety to your sessions.

C stands for combine, which means that you are to bring together and unite for the purpose of enhancing synergy.  In a counseling session this would involve all members in the group or session sharing their individual ideas in order to find solutions or suggestions for problems.  Another C word related to this idea is collaboration.  It is always important to remember that your job as a counselor is to collaborate with your clients.

A stands for adapt, adjust, or alter.  Help your clients come up with different ways to adjust to a problem or situation, rather than doing the same old thing all the time.  Brainstorm and write a list of ideas for your clients to try.  Help them think “outside the box.”

M stands for modify.  To modify something means to change the form of it by either magnifying or minimizing one aspect of it.  In therapy, modification can change the entire gestalt. You can recommend a client change one behavior he or she does slightly, by minimizing or maximizing a certain aspect of this behavior This slight modification can change the impact it has on him or herself and others.

P stands for “put to other uses.”   That is, to put things to uses other than what they were originally intended.  The theory behind this term is that clients are often not so much sick as they are stuck, and they just don’t think creatively enough about how to change their circumstances. Your role is to help your clients get “unstuck” by teaching them to think differently.

E stands for eliminate.  To eliminate something means to get rid of part of it or to get rid of all of it entirely.  For instance, a client who wants to lose weight may eliminate a certain food from his or her diet; or, another client may want to change their thinking by eliminating negativity.

R stands for reverse or rearrange; that is, to turn around, change the order of, or follow a different plan.  For example, an addict may need to rearrange his or her routines.  In narrative therapy, the client may need to rearrange the story or emphasize one part of the story more.

In order to maximize creativity it is helpful to:

  • Eliminate fear.
  • Make time to be quiet and alone.
  • Be around people with healthy interpersonal interactions.
  • Allow for mistakes.
  • Take action.

Being creative improves insight, self-awareness, and identity; it inspires, energizes, and motivates people.



Gladding, S.T. (2007). Becoming a Creative Counselor: The SCAMPER Model. Alexandria, VA: Microtraining Associates

Mind Tools. SCAMPER: Improving Products and Services Retrieved from: pages/article/newCT_02.htm

Bret Moore, Psy.D. <![CDATA[Posttraumatic Growth in Combat Veterans]]> 2017-02-21T15:48:04Z 2017-02-21T15:48:04Z Mental health professionals are well aware of the problem of posttraumatic stress disorder (PTSD) in our combat veterans. Estimates vary, but researchers tend to agree that around 10-15 percent of veterans of the recent wars in Iraq and Afghanistan suffer from the disorder.  It is estimated that this rate is consistent with previous conflicts as well.

Understandably a tremendous focus has been placed on developing and refining effective interventions for PTSD.  Slowly, but surely, studies on prolonged exposure, cognitive processing therapy, and eye movement desensitization and reprocessing, specifically with combat veterans, have hit the pages of psychiatry, psychology and medical journals of all stripes.

These recent wars have also given rise to greater interest in the idea of posttraumatic growth (PTG).  Sharing similarities with some principles of psychological resiliency (although resiliency and PTG are not interchangeable notions), the discussion of PTSD is finding its rightful place alongside discussions about the effects of combat trauma.

The Theory of Posttraumatic Growth

The theory of PTG has been popularized and advanced by psychologists Richard Tedeschi and Lawrence Calhoun of the University of North Carolina at Charlotte.  Over the past 30 years, Drs. Tedeschi and Calhoun have studied the enigmatic and seemingly contradictory concept that people are able to grow in multiple life areas after experiencing a significant negative event. Their research has shown that people from all walks of life can find greater personal strength, renewed appreciation of life, better relationships, new possibilities and a higher degree of spirituality in the weeks, months and years following a tragedy.  And PTG is not just an abstract theory that makes for great conversation in the faculty lounge or at conferences.  Drs. Tedeschi and Calhoun have tested their hypotheses with their scale the Posttraumatic Growth Inventory, an instrument that has been used in hundreds of studies.

Support for Posttraumatic Growth in Combat Veterans

In their 2011 article titled “Can We Facilitate Posttraumatic Growth in Combat Veterans?” Dr. Tedeschi and Dr. Richard McNally of Harvard provide evidence that combat veterans can and do indeed experience PTG.  They cite multiple studies conducted with former prisoner of war (POW) veterans, a group that has suffered some of the greatest traumas associated with combat and military service.  Broadly, the majority of POWs experience growth following their experiences.  And in some cases data supports the notion that the more severe a trauma is for a person the greater potential there is for growth.   Furthermore, studies looking at multiple war eras (World War II, Vietnam, Persian Gulf) and cultures (United States, Israel) support the presence of PTG.

 Facilitating Posttraumatic Growth

The primary model for facilitating PTG is found within Tedeschi’s and Calhoun’s theory and practice of expert companionship (EC). EC is the process in which the clinician takes the role of a consistent and compassionate companion who can convey interest and respect in the trauma survivor’s experiences while helping them identify and nurture positive changes.  Although there are slight variations in the delineation of the process, the main tenets include: 1) helping the trauma survivor understand the trauma response; 2) learning methods of emotional regulation; 3) adaptive self-disclosure; 4) writing a new life narrative or story; and creating and fostering a new way of life that protects one’s self against future obstacles.  For a more detailed review of these concepts, see Tedeschi & McNally, 2011.

Points to Remember

■ Growth can and does occur after trauma.

■ Some experts believe posttraumatic growth is the norm and not the exception.

■ Combat veterans are exposed to high rates of trauma, but also have some of the highest rates of growth.

■ Expert companionship is the process by which the clinician can help facilitate posttraumatic growth.


Tedeschi, R. G. & McNally, R. J. (2011). Can we facilitate posttraumatic growth in combat

veterans?  American Psychologist, 66, 19-24.

*You can learn more about Posttraumatic Growth from the “Posttraumatic Growth Workbook: Coming Through Trauma Wiser, Stronger and More Resilient” written by Drs. Richard Tedeschi and Bret Moore.

Christine Hammond, MS, LMHC <![CDATA[30 Preemptive Signs of Abuse Turning Deadly]]> http://5.1238 2017-02-20T18:33:59Z 2017-02-20T18:33:59Z Abuse has a pattern similar to an addiction. Once the abuser has utilized an abusive method for a long period of time, the victim develops a tolerance to the abuse so it no longer has the same effect. This aggravates the abuser who then escalates.

It should be noted that there are seven primary ways a partner can be abused: mentally, spiritually, physically, emotionally, financially, verbally, and sexually. So abuse is not just about physical violence.

However, it is in the escalation that the abuser can become more obsessive, intense, erratic, and dangerous. Knowing these signs can be the difference between life and death.

The following checklist is slightly modified to be gender neutral but taken otherwise in whole from Gavin De Becker’s book, The Gift of Fear. Remember an abusing partner (AP) can be male or female, from all socioeconomic groups, from any demographic, and have a variety of traumatic history.

  1. The victim has intuitive feelings that they are at risk.
  2. At the inception of the relationship, the AP accelerated the pace, prematurely placing on things as commitment, living together, and marriage on the agenda.
  3. The AP resolves conflict with intimidation, bullying, and violence.
  4. The AP is verbally abusive.
  5. The AP uses threats and intimidation as instruments of control or abuse. This includes threats to harm physically, to defame, to embarrass, to restrict freedom, to disclose secrets, to cut off support, to abandon, and to commit suicide.
  6. The AP breaks or strikes things in anger. They use symbolic violence (such as tearing a wedding photo, marring a face in the photo, etc.).
  7. The AP has a history of battery in prior relationships.
  8. The AP uses alcohol or drugs with adverse effects (such as memory loss, hostility, and/or cruelty).
  9. The AP cites alcohol as an excuse or explanation for hostile or violent conduct (“That was the booze talking, not me; I got so drunk I was crazy”).
  10. The AP’s history includes police encounters for behavioral offenses (such as threats, stalking, assault, and/or battery).
  11. There has been more than one incident of violent behavior (including vandalism, breaking things, and/or throwing things).
  12. The AP uses money to control the activities, purchases, and behavior of the victim.
  13. The AP becomes jealous of anyone or anything that takes the victim’s time away from the relationship; AP keeps the victim on a “tight leash,” requires the victim to account for their time.
  14. The AP refuses to accept rejection.
  15. The AP expects the relationship to go on forever, perhaps using phrases like “together for life,” “always,” and/or “no matter what.”
  16. The AP projects extreme emotions onto others (such as hate, love, jealousy, and/or commitment) even when there is no evidence that would lead a reasonable person to perceive them.
  17. The AP minimizes incidents of abuse.
  18. AP spends a disproportionate amount of time talking about the victim and derives much of their identity from being in the relationship.
  19. AP tries to enlist the victim’s friends or relatives in a campaign to keep or recover the relationship.
  20. AP has inappropriately surveilled or followed the victim.
  21. AP believes others are out to get them. AP believes that those around the victim dislike them and encourage the victim to leave.
  22. AP resists change and is described as inflexible, unwilling to compromise.
  23. AP identifies with or compares themselves to violent people in films, news stories, fiction, or history. AP characterizes the violence of others as justified.
  24. AP suffers mood swings or is sullen, angry, or depressed.
  25. AP consistently blames others for problems of their own making; AP refuses to take responsibility for the results of their actions.
  26. AP refers to weapons as instruments of power, control, or revenge.
  27. Weapons are substantial part of AP’s persona; AP has a gun or they talk about, joke about, read about, and/or collect weapons.
  28. AP uses “male/female privilege” as a justification for their conduct (treats victim like a servant, makes all the big decisions, and/or acts like the “master of the house”).
  29. AP experienced or witnessed violence as a child.
  30. The victim fears the AP will injure or kill them. The victim has discussed this with others or has made plans to be carried out in the event of their death (designating someone to care for children).

All thirty characteristics do not have to be met before the AP is determined to be a threat. However, the most important ingredient in determining the level of threat an AP poses is the intuition of the victim. Listen to it, it might save a life.

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[Foster Care and Child Psychiatry: A Primer]]> 2017-02-20T16:18:54Z 2017-02-20T16:18:54Z Foster Care Child PsychiatryIn this issue of CCPR we focus on the treatment of children in foster care systems. Nearly one in three of these children have significant psychiatric problems during their time in foster care—especially those related to trauma and neglect that brought them into the system (McMillen JC et al, J Am Acad Child Adolesc Psychiatry 2005;44(1):88– 95). Recently, psychiatrists working with foster kids have been under fire for allegedly overusing medications, especially antipsychotics.

The articles in this issue will help practitioners answer questions such as: When do we use medications, and why, and what other options for treatment exist? In this introductory article, I’ll provide you with a brief primer on how foster care works, and how psychiatrists get involved.

What is Foster Care?

When children are in a tough home situation—whether involving abuse, neglect, or other circumstances—it’s not a given that they will end up in foster care. At least 25% go into what’s called “kinship care” (; Winokur, M. Cochran Database System Review 2014 (1)). This means that the child goes to live with a relative or a family friend for a while, often in an informal arrangement that does not involve the courts or legal action. This is not foster care, because the child is not a “ward of the state.”

Foster care typically enters the picture when an untenable home situation comes to the attention of the police or a state agency such as child protective services (Schor EL Pediatr Clin North Am 1988;35(6):1241–1252). Sometimes, the parents call the authorities because they are concerned for their child’s well-being. Other times, someone else such as a teacher, physician, mental health worker, or neighbor reports concerns. When the situation is dire, police respond to a complaint and are dispatched to the home, often with a social worker. The child may then be taken into temporary protective custody with an organization such as a state’s department of social services or children’s shelter care system for 48–72 hours. After this, there is a confusing set of hearings that will vary from state to state. During these hearings, the child might be living with a temporary foster family or in a group home.

There are various reasons psychiatrists might need to know about this process. First, as a mandated reporter, you may be the one who contacts child protective services because of concerns about a child’s safety. Second, you may be asked to do an evaluation over the course of the hearings to determine whether placement outside the home is in the best interest of the child. If it is decided that the child should be returned to the current home environment, you may be asked to complete a reunification readiness assessment. Third, if you end up treating the child, some of the first records you review will be reports detailing the outcomes of the hearings.

The Carlat Psychiatry Report <![CDATA[New Editor of CCPR: Glen Elliott]]> 2017-02-20T16:18:09Z 2017-02-20T16:18:09Z Glen Elliott, MD, PhDWe’re happy to welcome Glen Elliott, MD, PhD, as the new Editor-in-Chief of the Carlat Child Psychiatry Report. Dr. Elliott is a board-certified child and adolescent psychiatrist with a distinguished and varied career. His education spanned both coasts: he went to medical school at Stanford (where he also received a PhD in neuro- and biobehavioral sciences); he did his psychiatry residency at McLean Hospital in Belmont, Massachusetts; then he returned to Stanford for his fellowship in child and adolescent psychiatry.

For many years, he was the Director of the Children’s Center at Langley Porter Psychiatric Institute, U.C. San Francisco. He has received numerous teaching awards for his work with residents. He is currently the Chief Psychiatrist and Medical Director at Children’s Health Council, a community mental health center affiliated with Stanford, as well as Associate Training Director for the Stanford Child and Adolescent Psychiatry Residency Training Program.

We’re thrilled that Dr. Elliott has joined the Carlat team!

Kelly Higdon, LMFT <![CDATA[Who supports you?]]> http://4.923 2017-02-20T11:44:51Z 2017-02-20T11:44:51Z Let me be the first to tell you , when you do everything yourself, it’s also a perfect recipe for burnout.


Here are some key people we think you should have


1. A friend who has been there – someone who knows you, who loves you and has built a business too. They get it and they understand where you are coming from. This is the person you can whine too but also get some great encouragement and feedback from.


2. A mentor/coach/consultant – this is someone who doesn’t know you so personally that they hold back in how they help in fear of losing your friendship. This is a person who has created their own business but also has some specific tools that you can use that have been proven to help many others.


3. A financial person – at the very least you need an accountant, someone who can help you navigate the waters of tax law as a business owner. Trust us, they will save you money and a big headache.


4. Software – ok ok, this isn’t a person, but from an electronic health record to easy bookkeeping, these tools will have your back and help you stay on top of the business day-to-day.


Who else do you have supporting you in practice?


Here’s the cool thing, we have an upcoming Launch Party where we are giving away the services of some of these key people! It’s amazing – from court support, documentation services, electronic health records to coaching – there is going to be a ton to give away. So check it out here!
Jessica Dore <![CDATA[Clean Language in Therapeutic Practice: Q & A with Nicholas Pole]]> 2017-02-19T17:27:01Z 2017-02-19T17:27:01Z Nick Pole, MA, MRSS(T) has more than 25 years experience integrating eastern and western approaches as a mind-body therapist. With a background in Shiatsu, neuro-linguistic programming (NLP) and Clean Language, he has also trained in Mindfulness-Based Cognitive Therapy and is the director of London Mindful Practitioners, a group for health professionals who use mindfulness in their work. He has taught his course on Clean Language for Shiatsu therapists internationally for more than 10 years, and is the author of the forthcoming book, Words That Touch: How to Ask Questions Your Body Can Answer.

What is Clean Language, and what is its function in the context of healing work? 

 In Clean Language, we ask very simple questions, and each question is built around the patient’s own words to help him or her explore issues by discovering the metaphors, gestures and felt sensations behind those words.

 Symptoms and feelings are usually there to tell us something, and Clean Language is a very direct way to find out what that something might be.

Clean Language is a mindful way to use language in healing work for two reasons. First, it helps patients to bring their attention to their direct, in-the-moment experience and to do that with curiosity and openness to what’s happening, rather than through their existing labels and narratives.

 Secondly, it helps us as practitioners to be more mindful of anything we say, which might be coming more from our own map of the world than the client’s.

As practitioners, we all have our own interpretations, judgments, preferences and prejudices about what the client may need, so this language is called ‘Clean’ because the questions are designed to keep all the stuff that comes from the practitioner out of the client’s space. 

 In your new book, you write, “Clean Language takes a fundamentally different approach to what needs to happen between client and practitioner.” How is this approach fundamentally different from the approach taken in other traditional therapies?

 In both eastern and western medicine, the doctor or the practitioner is traditionally the expert. The most important principle of all in using Clean Language is to reverse that; to work towards a relationship where the client is in charge of the process.

 It’s a more systemic approach and of course, it’s not unique to Clean Language, but the questions we ask are very good at facilitating that kind of relationship.

 In every area of healthcare, we have all kinds of pressures on us to “get results” for our clients. The whole point in Clean Language is for the client to learn how to get their own results, by bringing this kind of mindful awareness to what is really going on for them.

 Tell us a bit about your own background and practice and your unique combination of shiatsu, Clean Language and mindfulness that you do in your work with clients.

 I don’t know if it’s unique, but there certainly aren’t many bodywork therapists using Clean Language yet, which is why I wrote the book.

 My dad was a successful academic historian; he spent his working life reading, writing, and working with words. Maybe it was some kind of reaction to that that I found myself drawn to studying Japanese Shiatsu, working with touch and this very Zen emphasis on what is beyond intellect and beyond words. Looking at the moon and not the finger pointing at it, and all that.

But as I got more experienced in shiatsu, I found language beginning to tap me on the shoulder again. I wanted to find a way to help my clients make sense of the wordless sensations of bodywork and how it might relate to their issues in life. In the west, this is what clients expect.

 When I found Clean Language, I realized its potential to help patients make these connections between mind and body, left brain and right brain or however you want to put it. I loved using it, but not all my clients did. When people are coming for bodywork, they can be suspicious of too much talk.

Then, when my father died, I suddenly started getting quite acute anxiety and depression—worse than I’d ever experienced—though my father had suffered from that all his adult life.

 By one of those strange coincidences, a friend told me about a center where they were doing scientific research on the effectiveness of mindfulness in treating depression. It was the Oxford Mindfulness Centre, and to my surprise it was right at the top of the road my dad had lived on for 20 years.

 I did their training course in mindfulness teaching—just before mindfulness started to be the buzzword it is now—and I found it not only got rid of my anxiety and depression, it was also the missing ingredient, the perfect medium to blend Clean Language with meridian-based bodywork.

 Like Clean Language, it is about teaching the client life skills—any therapeutic results are a side effect of that learning. And like shiatsu, the first principle of mindfulness (despite its name) is to help us live in a more embodied way.

 You say that the use of Clean Language in sessions can help clients along the way to living a more embodied life. From your perspective, and perhaps an overall somatic-focused perspective, what does an embodied life mean or look like?

From a Clean perspective, that would be different for everyone. But when I asked one of my clients recently, what she said was this: “I’m learning to listen to my body and let it speak for itself and that gives me a sense of opening inside, like I’m becoming more alive to myself.”

I think that sense of aliveness—however each person experiences it—is the subjective essence of embodiment. But of course, from a neurological point of view, we’re learning more and more about how our minds are not disembodied computers stuck inside our skulls. The mind is, as professor Dan Siegel says, “embodied and embedded.”

 The way we think has evolved from living in a human body and is also profoundly influenced by our culture and relationships, including our therapeutic relationships.

 You mention something called the “triangle of trust” between the verbal mind, the body mind and the practitioner. What is this, how is it established and what is the benefit?

 By “verbal mind” I mean the everyday, cognitive mind, which thinks in words and has its home mostly in the left hemisphere of the brain.

 By ‘body mind’ I mean all those embodied ways of knowing that animals are so good at, and which we humans keep forgetting, until we get in touch with them again through things like yoga or dance or meditation, for example.

 Through our embodied sense of being we know ourselves in a different way. The verbal mind finds it hard to understand that kind of intelligence. It sees the body as a machine made up of separate parts—just as western medicine does—and is very results-oriented, so when the body malfunctions, it wants it fixed.

 It doesn’t want to listen to it, because it doesn’t know how to. Its primary medium is words and anything that can’t be described in words doesn’t really exist as far as this verbal mind is concerned, so it doesn’t trust the body and its messages. It prefers to medicate it rather than listen to it.

 Of course, this is not true for everyone, but statistics show how true it is for most.

 Normally, when clients talk about their body, they use the verbal mind’s vocabulary. They impose this mechanistic way of thinking on the body mind.

 Any kind of language we can use that shows them how to turn that around—that allows them simply to listen to their body mind, and to be patient with its non-verbal messages—helps the client’s cognitive mind to trust the body.

Quite quickly you start to build an evidence base that shows the body mind has a language and a logic of its own and that it responds positively when listened to. The practitioner’s job is to facilitate that—to be like a mediator between verbal mind and body mind and asking Clean questions is an effective way of doing that.

 So the triangle of trust is built between the practitioner and these two aspects of the mind, with their different and often conflicting values.

 Researching my book I was very inspired by Dr Iain McGilchrist’s “The Master and His Emissary,” which is a brilliant update on the old left brain/right brain model.

 The reason I was impressed was because it seems to mirror exactly my experience of how the verbal mind relates to symptoms in the body. His great contribution is to show that it’s not so much about what the two hemispheres do differently—since both sides of the brain are involved in almost anything we do—but about the different values the two hemispheres have.

 The left hemisphere knows the world through language and dominates the way we communicate with the outside world. But it’s the right hemisphere that is much more tuned into direct felt experience and the embodied ways we know things that can’t necessarily be put into words.

Of course, the two sides of the brain communicate, and the more they do, the more we build the neurological pathways that help us trust our gut feelings, our heart-felt responses,and the body’s self-healing ability.

Clean Language, like poetry, engages both sides of the brain. Through words we approach the wordless and eventually an answer comes that we can put words to.

I’ll be honest; the term “Clean Language” makes it sound like something that requires a great deal of control on the part of the therapist. It sounds like something that would take a lot of practice and be somewhat hard! Is that true?

 It’s easy to get started with Clean Language. There are only 12 basic questions that you need to know. In that sense, it’s a lot easier to learn than most languages!

 But as I said, it’s a very mindful way to use language, and like mindfulness, if you stay with it, it can take you as deeply into yourself as you care to go. So when you use it in therapeutic conversations, the more experience you have, the safer your clients will feel about exploring their own internal landscape and being accepting towards whatever comes up.

You cite three basic and versatile Clean Language questions in the book, and say that just these simple questions can help clients make a significant shift in whatever issue they’ve brought to you. What are those questions and why are they so impactful?

 Remember, the power of Clean Language isn’t in the questions themselves. There’s nothing very special about them and you probably use them all the time. It’s about putting the client’s exact key words into the questions and inviting them to explore the next layer of meaning that those words may have.

When you do that, and trust that the client knows, somewhere inside, exactly what they need, things start to happen.

So the three basic Clean questions are:

And what kind of…?

And where is…?

And is there anything else about…?

 I had a client who said she was exhausted from having to complete a project at work to a very tight deadline. So the first thing I asked her was, ‘And what kind of exhausted is that?’ She said, ‘It feels very tight around my heart‘. So I asked her, ‘And is there anything else about very tight around your heart?’ She said, ‘I really wanted to please them.’

The dialogue continued like this:

And is there anything else about really wanted to please them?

I feel something here (putting her hand on her abdomen).

And what kind of something?’

It’s like a layer around me.

And would it be okay to find out more about that layer around you?

It’s protection.

What kind of protection?

It comes out of here (indicating her abdomen) like threads of energy making up a layer of protection around me.

And is there anything else about those threads of energy?’

It’s really draining me.

With just these three basic questions, she had created a kind of ‘psycho-energetic’ map of how ‘really wanting to please’ her client had contributed to that exhaustion. From there, we started some meridian-based bodywork, using more Clean questions to help her ring awareness to other somatic and psychological aspects of the issue.

By the end, the tightness around her heart had released and she was thinking of ways to care a bit less about pleasing her clients and to care more about looking after herself.

For more about Clean Language and Nick Pole’s work, visit him online at



Jennifer Rollin, MSW, LCSW-C <![CDATA[Helping Patients to Explore Their Values in Therapy]]> 2017-02-15T20:50:35Z 2017-02-18T11:50:14Z One thing that I have found to be very helpful in working with patients is to examine their values as well as ways in which their current behaviors may not be in-line with their values.

I specialize in working with teens and adults with eating disorders and body-image issues. I often talk with my patients about how eating disorder behaviors-as well as other self-harming behaviors-are often ways that they are attempting to get their needs met (i.e. to feel a sense of “control” or manage anxiety). These behaviors may temporarily provide relief. However, in the long run, they only serve to bury the underlying issues and cause people to feel even worse.

I utilize a variety of tools and strategies in helping people to break free from eating disorders and body-hatred. However, regardless of the issue that brings someone to therapy, I believe that helping clients to develop a greater sense of their values is important.

The following is a brief exercise that I often will have clients do, which is adopted from “The Happiness Trap” by Dr. Russ Harris.

  • Imagine that you are in your 80s looking back on your life and complete the following statements:
  • I wish I would have spent less time….
  • I wish I would have spent more time…
  • If I could go back to (client’s current age) and do something differently, I would…

This exercise can be very helpful in defining the client’s ultimate values. Thinking about what your perspective could be like in your 80s can often help to put things into a broader context.

 The following is another exercise that I sometimes will ask patients to do, to help them to examine their values.

  • Imagine that you have a bunch of jars in front of you. Each jar is a different category of your life, i.e. romantic relationship, career, health, appearance, hobbies, friendships, family, etc.
  • Now imagine that you have a jar with a limited amount of marbles. Into each jar you put some of the marbles that you have based on the amount of mental energy and effort that you put into each category.
  • Which jars are the fullest?
  • Which jars are the least full?
  • Knowing that you only have a limited amount of marbles, are there any shifts that you would like to make?

Lastly, while it may seem morbid (and you must carefully consider that it is appropriate prior to using it with a specific client), I will sometimes talk with clients about how they ultimately would like to be remembered. I have had conversations with clients about how no one writes in an obituary, “she was the perfect weight” or “she ate so healthy.”

Ultimately, it is our passions, our relationships and the way that we give back to others that is how most of us will be remembered.

I also will talk with clients who are struggling with body image issues about how even if they loved their bodies and appearance, the reality of life is that we are all going to change as we age. Thus, tying your self-worth to your appearance is a recipe for discontent.

Thinking that we only have a finite amount of time is one way to start to recognize that the ways in which we spend our time matters. If mental illness is getting in the way of someone living according to their true values, it is so important that they seek appropriate help and support.



Tiffany McLain, LMFT <![CDATA[How To Build Powerful Professional Relationships]]> http://8.491 2017-02-17T22:16:46Z 2017-02-17T22:16:46Z Back in my oh-so-awkward high school days, I remember looking around at those cool kids and wondering, what – exactly – they were doing to be so tubular. (Well, probably they weren’t using the word “tubular,” for starters.)

And this inquiry didn’t stop once I graduated high school or college or even beyond that. I was happy enough with the friendships I had, but there was always this seemingly ambitious group of people who continued to make strides. I’d try to converse with them and be flooded with anxiety, realizing that I didn’t really have anything of substance to offer them. In truth, I largely kept myself away from successful others because I was at a loss about how to engage.

I know. I know. We can have a rousing debate about what it means to be “successful”. I’ll leave that debate to be taking up by you and your therapist. But I will say this, when I refer to successful people, I mean people who have the capacity to set a goal and then take the steps to achieve that goal. They have fulfilling relationships. Their conversations are spent less on complaints or gossip or airing their frustrations about their significant others and primarily focused on creativity, expansion and joy.

Nope – these aren’t fantasy people. They actually exist! In fact, somehow, to my surprise, I have eked my way into this delightful club.

But it wasn’t easy, nor – I must say – was impossible.

I so often hear from ya’ll in private practice who talk about the difficulties of creating a successful business – the constant fear, the stress, the overwhelm. It makes it seem like frenzy, anxiety and poverty are synonymous with practice building.

But, I also hear that you want something different for yourself and your practice. You would love to be surrounded by those people who are actually making it happen-  who are truly enjoying their businesses, setting clear boundaries with time, attracting the clients who feel wonderful to work with and are even setting their sights on the next big thing beyond working exclusively in the one-to-one private practice model.

Ooh, damn. What might it be like to sit down for a nice glass of wine and learn from someone like that?!

Then you look around you, and there is literally no one you can think of who falls into that camp. Which then leads you to raise a skeptical eyebrow and scroll your cursor dangerously close to the “x” at the top of your browser window.

But wait!

Today I’m here to tell you how you can, not only find these mystical creates of private practice ease, but also learn from then and even (*gasp*) build real, honest to goodness friendships with them.

Over the past few weeks, we’ve taken a look at the way our relationships can have a huge impact on our ability to live fulfilling, kind, thoughtful and – yes, wealthy – lives.

This week, I want to give you a couple of tips to help you in your quest to build relationships that truly support the growth of your business (and your self). These relationships challenge your limiting beliefs, rather than reinforce them, and ask you to be step fully into your potential so you can make a greater impact in the long run.

How to Build Relationships with Successful Colleagues

Seek a Dissenting Voice: Look for people who disagree with you. I don’t mean that one person in your community who simply challenges everything anyone says as a personal mission (you know who I mean). Rather, look for those people who you respect, whose work ethic you admire, whose relationships seem un-conflicted and peaceful. Those are the ones from whom you have something to learn. If they highlight an area of growth or challenge your viewpoint, take heed, try to be curious.

Look to be Un-Validated: Seek out people who don’t rush to soothe away your difficult emotions. Unless these folks are sociopaths (and you know the difference), chances are they truly understand what it means to struggle, sit in the struggle and move beyond it. Your accusation that they don’t understand you if they don’t rush to soothe you is misplaced and dismissive of their experience. Trust that they do know what it means to feel hurt, betrayal and devastation – and then open yourself to curiosity about how they live gracefully even so.

Ask the Most Important Questions: When someone gives you a piece of feedback that stings, even something so simply as pointing out your poor web design, don’t start with justifications. Start with a question, “What do you mean?” or “What might you change?” This is not easy, especially when you’ve put a lot of work into being a particular way. But, it’s worth it.

BE the Change: Be the kind of friend you’d like to have. If you want someone to call you on your shit, start doing that for the people around you. If you want more friends who are holding themselves accountable for making changes, start holding yourself accountable first.

Get Your Own Therapist: If you find yourself collapsing without constant validation from friends or partners or, quite frankly most people around you – then definitely seek out a therapist. If you (like many of us) had early experiences of being psychologically missed, then it’s likely you’re continuing to seek mirroring from people whose job is not to mirror you. This constant demand that external relationships provide you with safety and attunement is interfering with your capacity to develop rich professional ties. A therapist can provide you with the consistent support you need, so that you can approach other relationships with something something beyond the need to be safe and seen.


photo credits: rawpixelIon Chiosea

Bret Moore, Psy.D. <![CDATA[Study Finds Antidepressants Increase Risk of Birth Defects in Depressed Pregnant Women]]> 2017-02-15T20:49:31Z 2017-02-17T11:49:13Z One of the toughest decisions in clinical psychopharmacology is whether or not to prescribe medication to a patient who is pregnant.  Data is available that supports the connection between antidepressants and birth defects. However, the data is limited in amount and scope and the literature is not in complete agreement about the degree of risk associated with antidepressants.  In fact, the field is not even in complete agreement that there is indeed a connection.

Canadian researchers have shed additional and critical light on this important subject.  Just this year, the British Medical Journal (BMJ) published online a study titled “Antidepressant Use during Pregnancy and the Risk of Major Congenital Malformations in a Cohort of Depressed Pregnant Women: An Updated Analysis of the Quebec Pregnancy Cohort.” Here is what they did, what they found and what it means.

What They Did

The Montreal-based researchers pulled data from the Quebec Pregnancy Cohort (QPC).  Their primary variables of interest included pregnant women with a diagnosis of depression or anxiety, those exposed to an antidepressant medication during the 12 months prior to pregnancy and a live birth.  They were mostly interested in ascertaining if any congenital birth defects (including specific organ defects) were associated with any antidepressants during the child’s first year.

The types of antidepressants used in the analysis include selective serotonin reuptake inhibitors (SSRI), serotonin-norepinephrine reuptake inhibitors (SNRI), tricyclic antidepressants (TCA) and “others.”

The sample size was large at 18,847 women.  Pregnant women taking antidepressants were compared to those who were not.

What They Found

The results are alarming and support the notion that birth defects are associated with antidepressant use during the first trimester of pregnancy.  Specific risks associated with specific medications include: paroxetine (heart defects, particularly ventricular and atrial septal defects); citalopram (musculoskeletal defects and craniosynostosis); and venlafaxine (respiratory defects).  The TCAs were associated with greater risk of eye, ear, face, neck and digestive problems.  It should be noted, however, that the risk associations between the medications and birth defects are very low and occurrence of these defects is still quite rare.

As with most studies, there are several strengths and weaknesses. The authors report two notable strengths as being the large sample size and a sample with diverse and broad data available (e.g., potential confounds).  Notable limitations include potential for recall bias (patients misremembering important information) and the large number of comparisons that were made of medications between the two groups. The authors state that this could lead to results that are a byproduct of chance.

What Does it Mean?

The decision to prescribe medication to a pregnant woman, regardless of psychiatric illness, is a difficult one.  We have further support that antidepressant medications can and do hurt the developing fetus.  But, we also know that untreated depression can lead to problems during gestation to include spontaneous abortion.

We also know that severely depressed pregnant women are less likely to adhere to healthy prenatal nutritional plans.  They are more likely to smoke or drink.  Sleep is less regulated.  And in extreme cases, suicide occurs.

When faced with the dilemma of prescribing or not prescribing medication to a depressed pregnant woman it is imperative that adequate informed consent is obtained.  The patient should be fully aware of the risks associated with taking antidepressant medication during pregnancy. The decision should be a joint one between the patient and prescriber.  And at any time the patient’s concerns about taking medication during this vulnerable time should be acknowledged, considered and validated.

Points to Remember

■ Research shows that antidepressants increase birth defects in pregnant women

■ Serotonergic medications seem to carry the greatest risk

■ Patients should fully understand the risks associated with taking antidepressant medication during pregnancy during the first trimester

■ The decision to prescribe medication to a pregnant woman should be jointly made between the patient and prescriber

■ Not treating depression pharmacologically can also cause indirect harm to the developing fetus


Bérard, A., Zhao, J., & Sheehy, O.  (2017). Antidepressant Use during Pregnancy and the Risk of  Major Congenital Malformations in a Cohort of Depressed Pregnant Women: An                         Updated Analysis of the Quebec Pregnancy Cohort. BMJ Open, 7. doi: 10.1136/bmjopen-2016-013372.

Christine Hammond, MS, LMHC <![CDATA[The Dangerous Lure of Narcissism]]> http://5.1232 2017-02-16T17:35:27Z 2017-02-16T17:35:27Z The media loves to cover narcissists almost as much as a narcissist loves to be covered by the media. And why not? The narcissist’s stories are colorful, prone to exaggeration, intentionally divisive, and feature them as the star. It is easy reporting because it is naturally interesting, requires limited verification, and is emotionally charging. A person either loves the narcissist or intensely hates them; there is little area for grey which makes for a great story.

The same is true on a smaller scale when meeting a narcissist for the first time. They have larger than life personalities, can command large or small crowds, exude confidence, and are immensely charming. Who won’t want to capture the attention of such a person? It validates the hidden desires of worthiness, acceptance, and recognition. It is an immediate ego boast to capture the attention of a narcissist.

But there is danger in being lured in by a narcissist. What looks good now can have devastating consequences later. How?

Begins with attraction. The problem with being lured in by narcissism is that it is more like indulging in crack cocaine than taking a refreshing drink of water. The narcissist is similar to crack in that once it is lit up, it immediately exudes an exciting euphoric “I can do anything” feeling. But this short lived fantasy is shocked back to reality the minute the drug wears off. The reality of the crash leaves the media or a person completely deflated, yet desiring the drug even more intensely.

Sets stage for control. This “I want more, I can’t stand it” struggle is exactly what the narcissist is trying to entice. They want to create this in the media or other person because it mirrors one of their favorite abuse mechanisms: push-pull. A narcissist will intentionally draw a person in with their charm, then push them away by ignoring, pull them back in with gifts, and reject when there is non-compliance. If the narcissist can get the media or other person to accept responsibility for their own attraction, then they can slide out of responsibility for using the push-pull tactic.

Meets a need. Of course none of this would be possible if the narcissist wasn’t meeting some hidden need of the media or other person. The media needs viewers to survive and thus requires a constant flow of exciting stories. A person wants to be validated and therefore loves the attention. The narcissist instinctively perceives the hidden agenda of others because it is similar to their own. Naturally the narcissist knows how to fill their needs and therefore can instantly and instinctively do it for the media and others.

Becomes an addiction. Before too long, the lure of the narcissist becomes an addiction. Just like crack cocaine, the drug takes control of the person just as the narcissist takes control of the media or another person. But the drug and the narcissist are both fickle. The first high of engagement is never repeated despite the increased dosage. The deliverance of euphoria is promised but not achieved. Yet the media or other person craves more and more. It is a cycle that is hard to break because it means giving up on ever feeling that same level of high again.

Hitting rock bottom. Once the drug or narcissist has gained complete control, the media or other person loses all sight of who they once were. This loss of identity causes them to hit rock bottom. The choices at this point are simple and clear: either remain this way or change. Remaining means allowing the attention hungry addiction to win. Changing means rejecting the drug and its’ effects. But desiring the change is not enough. It requires the hard work of self-evaluation, accepting responsibility, setting new boundaries, asking for support, and lots of determination.

Addict thinking. At the heart of every addiction is incorrect thinking. The hardest part of coming out of an addiction is changing thought patterns. Most addicts develop a victim mentality to escape responsibility which must stop or another addiction will surface. An addict must stop blaming the narcissist (drug) and find satisfaction from within. And the media must return to their roots of responsible journalism instead of the attention grabbing sensationalism.

Balanced approach. Crack cocaine is powerful only when being lit up. Otherwise it is just another shiny clear rock. The same is true for narcissism. It is only powerful when a light is being shined on it. The narcissist doesn’t care what type of attention they get, as long as they get it just as crack does care what type of lighter is utilized. Recovering addicts learn to approach life with balance instead of giving into their cravings. The media should do the same.

Every addict knows they cannot do this journey alone, it requires support and encouragement. Perhaps now is the time for an attention obsessed country to abandon their addiction and stop feeding the narcissists either through love or hate. Together we can diminish the lure of narcissism by recognizing our own short-comings and not falling prey to quick fixes.

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.

Susan Gonsalves <![CDATA[The Victorian Era of the Twenty-first Century: A Risky Business]]> 2017-02-15T20:49:03Z 2017-02-16T11:48:41Z One thing we have never been short on in the history of the United States is powerful language constructing the right kind of sex. As a Utah-based sex therapist, I find myself frequently responding to my conservative clients as they grow in awareness of the impact of this phenomenon, “Yep; we are still recovering from the Victorian Era.” Session after session I am struck by how much the language around sexuality today is eerily similar to that from well over 100 years ago.

It’s fascinating (and troubling) to see how a particular collection of words can create the most powerful messaging. Voices from government, medicine, media, religion, public education, pop culture and more, continue to construct what sociologist Janice Irvine describes in her landmark book Disorders of Desire[i] as “the categories, concepts and languages that tell us how to be sexual; that delineate what is good, bad, evil or acceptable sexuality.”

Our Historical Amnesia

It may surprise some to learn that the language around treating what was perceived to be deviant during the Victorian Era, ushered in what became the medicalization of sexuality and welcomed the field of sexual science. And it makes sense when you think about the context of that time! Haunted by disease and illness, 19th century doctor’s targeted solo sex, “too much” sex and same-sex relations, unilaterally categorizing these “conditions” then as sexual deviance. Soon medical providers and the culture at large believed deviant pleasure caused ailments like seizures, loss of intelligence, weakness, exhaustion, insanity, paralysis, coma and, even, death.

Adults and children began to receive life-altering treatment ranging from institutionalization, metal underwear, physical restraints and even genital mutilation to young girls and women, in an effort to rid the person of becoming consumed by such “unnatural” use of their quickly deteriorating fragile nerves. As well intended as treatment providers were, these types of treatment were horrific, not to mention incorrect, and lasted well into the 20th century.

Two Sides, Same Coin

Just as during the 19th century, influential voices in the United States continue to use specific language in describing what they believe sexuality should be and anything outside is reflexively a cause for concern. Today, there are two treatment models that talk about sexuality with language eerily similar to days long gone by.

The first is Reparative Therapy. This treatment model proclaims the ability to assist those who want to change their sexual orientation. Even though homosexuality as a mental illness or biological deficiency has been thoroughly debunked for more than 40 years and the destructive impact of change efforts are well documented, some medical and mental health providers have continued in what can only be classified as pseudoscience by today’s professional standards.

Secondly, the Sex Addiction treatment approach uses language describing certain sexual desires and behaviors as inherently unhealthy, similar to those in the 19th century when people were told their desires would lead to disastrous outcomes without medical treatment. Sex Addiction advertising warns of changes to the brain, providing a terrifying modern day layer of icing on an already angst-ridden cake. Rather than identify and treat the distressing concern as one aspect of a person’s life, clients in treatment for Sex Addiction are asked to embrace the identity of an addict, as they adhere to language so powerful, they become the illness described to them.

It Is Not Necessary

So here we are today – the dominant language of our culture perseveres in proclaiming those with certain sexual patterns as “sick.” Thankfully, we no longer have strong language suggesting that a misuse of sexual pleasure can lead to conditions like seizures, insanity or paralysis; however, as with Sex Addiction treatment, we do still have language identifying certain sexual behaviors or desires as inherently destructive and dangerous, leading to the slippery slope of biological degeneration and categorizing the person as ill until treated.

If we are honest about our history in this department, this approach should make us very uncomfortable.

Outside of our absolutely disturbing history of misdiagnosis, the most difficult part for me is – it simply is not necessary. I have yet to encounter a client experiencing considerable distress related to sexuality (yes, it happens) where there weren’t more effective and affirming treatment approaches in comparison to Reparative Therapy or Sex Addiction language.

Countless times, the distress was directly related to language and meanings attached to sexuality from the culture or their upbringing. The distress mixed with the belief that they had deviated from what is “normal” lead to common experiences such as, significant internal conflict between sexual desire and values system, conflicts over desire discrepancies in a relationship or difficulty communicating erotic desires with a partner.

In other cases, we know now that sexual patterns can often be a symptom of an underlying mental health concern such as anxiety, depression or obsessive-compulsive disorder, all of which can include an impact on their brain, yet are not marketed as an addiction, thankfully.

Often, sexual desires or behaviors that are categorized as pathological or troubling are more appropriately qualified as coping mechanisms, even if conflicting with values, of common everyday human experiences such as, desire for connection, excitement, loneliness, stress, anxiety, sadness and desire for pleasure.

It’s Not What You Said – It’s How You Said It

I wish I was cool enough to be the first person to notice the profound impact of language on a culture. I’m not. A major hat tip is owed to historian Michel Foucault who identified the importance of discourse[ii] in describing the unbelievable impact language has on our perceptions of sexuality – simply by the way it is talked about.

The way we talk about sexuality matters. When we say that non-predatory sexual behaviors are a disease or a disorder, we give the person a “sickness” which, since the 19th century, has resulted in countless people having their entire personhood reduced to one specific sexual behavior or desire.

In an interview back in 1997, Foucault warned against the arrogance of using one’s sexual desire as a way to conceptualize who they are in comparison to the perceived norm of any given day. He remarked, “Tell me what your desire is and I will tell you who you are, whether you are normal or not. . .”[iii] Perhaps it is time for us all to refuse to be so arrogant.


Kristin Marie Bennion is the owner of Intimate Connections Counseling and is a Licensed Mental Health Therapist and Certified Sex Therapist“.





[i] Irvine, J. (2000). Disorders of desire. Berkeley: University of California.


[ii] Foucault, M. (1978/1990). The history of sexuality: Volume I, an introduction. (R. Hurley, Trans.). New York: Vintage Books.


[iii] Foucault interview: Lochrie, K. (1997). Desiring Foucault. Journal of Medieval and Early Modern Studies. 27(1), pp. 3-16.


Marie Hartwell-Walker, EdD <![CDATA[Professional Development is a Personal Responsibility]]> 2017-02-15T20:48:11Z 2017-02-15T20:48:11Z One senior clinician told me that, at age 55 and with 30 years experience, he didn’t need to learn any more. It was an outrageous assertion. As expert and kind as he is as a clinician, he isn’t doing his job if he has really stopped learning about new developments in our field.

We can’t coast on what we think we know if we are to serve our patients well. What he, in fact all of us, learned in grad school was out of date within years of graduation. Some of the most important work we are asked to do may not have been taught while we were in school. Research findings challenge what we think we know. Solid, important research that is being done now, today, won’t get to us clinicians for years. According to an article in the APA journal in 2011, it takes on average 17 years for scientific advances to be applied in clinical practice.

Competence, then, requires being an active, interested, and consistent seeker of what is developing in our field. It’s been found that it is far better to underestimate our degree of effectiveness than to assume we know enough. We never do.

It is up to each of us to recognize and take seriously the importance of our own professional development. With concerted effort, we might earn the right to see ourselves as competent professionals.

Don’ts and Dos  For Your Professional Development


1.Don’t believe your own assessment of your competence. Researchers have found that self-assessment isn’t a reliable indicator of competence. The Better Than Average effect (BTA), the tendency to see ourselves as above average on positive traits and to ignore or downplay negative traits, has been repeatedly found to apply to therapists as well as the general population. By definition, we can’t all be “above average.”

2. Don’t confuse getting CEUs with getting an education. Although boards of registration, professional organizations and even insurance providers require clinicians to stay current with our ever-developing field, there is little quality control. All we have to do is sit through workshops and, Boom !, we have the CEUs that certify that we have fulfilled the requirement. But true evaluation of learning is rare. A satisfaction survey is not the same as a meaningful assessment of participant learning.

You may have to accept spending time and money for continuing education units that are useless and then spending additional time and money to get the education you need in a different way.

3. Don’t settle for “coverage” of an important issue. There are speakers who create razzle-dazzle PowerPoints that march the audience through a complicated issue or skill set. They cover the topic but that’s all they do. Real training requires working with the information by intellectually wrestling with practice cases, doing supervised work, role playing and/or having the opportunity to engage in meaningful dialogue about the issue.

4. Don’t take the “easy way out.” Recently, a young therapist gleefully told me that there’s no point in going to workshops when you can obtain CEUs by reading articles and answering some questions. As if sharing a state secret, she went on to tell me you don’t even have to really read. All you have to do is look back at the article to find the answers. She may be right. But she’s not doing herself or her clients any favor by gaming the system.


1.Recognize that staying current is an ethical responsibility. We owe it to our patients to be all we can be. They come to us for healing. They pay us for our insights, our support and our time. It is only right and fair that we provide the best treatment possible.

2. Enhance your breadth of knowledge as well as your depth. Yes, it is helpful to your practice to develop a niche by focusing on a specialty or two. But to be an effective member of a treatment team, it is also crucial to widen our perspective to include awareness of new research, new treatment options and challenges to what has been thought to be true.

3. Look for workshops and learning experiences that challenge you. Watching PowerPoints or listening to lectures are the least effective ways to acquire new skills. Real learning takes active involvement. You will learn more and increase your confidence if you have to wrestle with new information through activities like simulations, application to case studies, practice using role plays and live supervision.

4. Be an active participant in conferences and webinars. Don’t just sit there. Resist the temptation to doodle or consult the latest posting on your phone when a presentation is boring. Ask questions, comment, engage with the workshop leader and the material. Use breaks and lunch time to talk with other participants about what you are learning.

5. Seek out externships. As a working professional, you may not have time to take ongoing classes or to do an additional internship. But you may be able to find an “externship” that will give you the practice you need to truly develop competence in a new area. Large training institutions and some large private practice groups sometimes offer opportunities to participate in training and get good supervision on a weekly or monthly basis for a year or two.

6. Work on your cultural competencies. Developing our sensitivities to issues of gender, race, class, sexual orientation and economic circumstances is not optional. A 2008 study by APA found that the practices of 86% of APA members served racial/ethnic minorities. We all need to take care to be sensitive to our own possible biases and to be conversant with treatments that various communities find helpful and acceptable.

7. Make time every week for reading your profession’s journals and/or participating in webinars. Designate a few regular hours per week as a time for staying up to date and for reflecting on research findings and its relevance to your work.

As long as we’re in practice, we owe it to our clients, and indeed to ourselves, to be always open to new information, new understandings and new experience. By doing so, we may become as competent as we think we are.

Christine Hammond, MS, LMHC <![CDATA[The 9 Stages of Sexual Harassment]]> http://5.1224 2017-02-14T20:28:34Z 2017-02-14T20:28:34Z Twenty years ago, men were the thought of as the main perpetrators of workplace sexual harassment with women as their victims. Having been one of those victims in two separate work industry environments, with a boss and co-worker, the demoralizing encounter left a scar. It was frustrating to be recognized not for my hard work but rather, my appearance and naivety.

But as with everything else, times have changed. There are now mandatory trainings on the subject, reporting is semi-confidential, and awareness has increased. But unfortunately, the perception that it is dirty old men sexually harassing young women has remained. This could not be further from the truth. Women can be perpetrators and the harassment is not confined to heterosexual interaction.

Regardless of the players or their sexuality, the pattern is the same for the perpetrator. I have seen this entire pattern happen over a period of years or as short as a couple of hours. It depends on the agenda of the perpetrator and their level of skill.

  1. Belief. In order for a perpetrator to walk through these steps, they must first believe that they are entitled to whatever or whomever they want. This process demands confidence and arrogance to be executed fully. It takes practice to perfect their assault especially with sexual harassment warning posters in a workroom. There are many missteps and almost victims along the way.
  2. Awareness. In the first stage the perpetrator becomes aware of their potential victim. There is most certainly a one-way sexual attraction in which the victim is completely unaware. The perpetrator cannot get the victim out of their mind and often fantasizes about having sex with them. The role of perpetrator to victim is one of dominance to submission. The perpetrator wishes to dominate the victim into submission. This is about power and control, not love.
  3. Glimmer. The perpetrator will have a glimmer in their eyes when near the potential victim. This is the first warning to the victim that they might be a target. Unfortunately, the perpetrator often misreads signals the victim is sending back. While the victim might be acting friendly, the perpetrator views this as a sign that they can proceed.
  4. Game. Now begins a cat and mouse game of sorts in which the victim unknowingly participates. To reaffirm the dominance, the perpetrator will show off their power, influence, money, position, or control over the victim and others. They will create opportunities to assert themselves in positions of authority in front of the victim. Then they will retreat, assert, and retreat again. This is done to lure in the victim and generate interest.
  5. Innuendo. Every now and then, the perpetrator will drop an inappropriate line in the middle of a work related conversation with the victim. Most victims are so caught off guard that they quickly dismiss the suggestion. But the perpetrator is studying the victim’s reaction like a hawk. The more shocked or surprised the victim reacts, the more enticing it is to the perpetrator. Strangely enough, the excitement often disappears if the victim reacts expectantly because this does not fit within their dominance/submission game.
  6. Brushes. Seeing astonishment in the victim’s eyes with the innuendos, the perpetrator moves to physical touch. It might be an accidental brush against the victim, a demanding hug, an unwanted back rub, or a hand placed on the thigh. Most victims freeze in moments like this which further draws in the perpetrator who views this as a sign of compliance or worse desire. With each physical contact, the boundary of acceptability is stretched more and more.
  7. Gifts. One of the easiest ways to continue to lure in a victim is gift-giving. This could be something small such as a card or obvious such as a potential promotion. Usually the perpetrator will offer something in exchange for overlooking their advances. It is not commonly openly stated, however, some well advanced perpetrators will be bold enough to admit it. But only to the victim. If caught, they will deny everything and blame the victim instead.
  8. Isolation. In order for something to happen, the perpetrator must physically isolate the victim. This could happen behind a closed office door, during a private lunch meeting, or at an overnight business trip. The first time the two are together, it is all about creating a “safe” environment. The perpetrator, sensing the victim’s level of discomfort, may pull way back to give the victim time to let their guard down.
  9. Assualt. When the victim least expects it, the perpetrator will attack. Their boldness in this moment will be appalling. The victim will feel as though they have no option especially given all of the advances and gifts they have let slide at this point. Remember the perpetrator has imagined this moment for quite some time and put a great deal of thought into planning this attack. So they will be over-prepared for any response including complete deniability should the matter come forward. All of the previous steps are done to discourage and intimidate the victim into submission.

If you find yourself as a victim, unknowingly in the middle of one of these steps, there is time to get away. Tell a trustworthy friend outside of the workplace first before notifying human resources. You will need the support as the perpetrator is confronted. Don’t let the perpetrator get away with their harassment, remember, they have practiced on several others before you.

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.

Heather Gilmore, MSW, LLMSW, BCBA <![CDATA[Multiple Tips for the Toddler Years]]> http://3.790 2017-02-13T19:33:48Z 2017-02-13T19:33:48Z

  • When working with (or parenting) a toddler, keep in mind the typical areas of development such as those identified by MedlinePlus:
    • Gross motor – walking, running, climbing
    • Fine motor – feeding themselves, drawing
    • Sensory – seeing, hearing, tasting, touching, and smelling
    • Language – saying single words, then sentences
    • Social – playing with others, taking turns, doing fantasy play
  • The Centers for Disease Control and Prevention provide an amazing document of typical child development in the early years. Click here for a PDF document from the CDC. It outlines basic developmental milestones.
  • Here are some tips on promoting speech and language from the American Speech and Language Hearing Association. Just a few of the examples provided include:
    • Encourage your baby to make vowel-like and consonant-vowel sounds such as “ma,” “da,” and “ba.”
    • Reinforce attempts by maintaining eye contact, responding with speech, and imitating vocalizations using different patterns and emphasis. For example, raise the pitch of your voice to indicate a question.
    • Imitate your baby’s laughter and facial expressions.


  • What is separation anxiety and strategies to help a child cope with it. See KidsHealth for more information.
    • Some strategies you can use to address separation anxiety include following through with what you say, remaining calm, and providing reinforcement for improved behavior in the situations that trigger the child’s anxiety.


  • Toddlers learn through play, so encourage this activity as much as possible. See Kids Health for more information about the importance of play.

image credit: Halfpoint via Fotalia

The Carlat Psychiatry Report <![CDATA[Research Update in Psychiatry: Food and Cognition]]> 2017-02-12T16:09:27Z 2017-02-12T16:09:27Z Mediterranean diet cognitive functionFOOD AND COGNITION

Mediterranean Diet and Age-Related Cognitive Decline: A Randomized Clinical Trial

(Valis-Pedret C et al, JAMA Intern Med 2015. 11.doi:10.1001/ jamainternmed.2015.1668. Epub ahead of print.)


As our patients age, they often worry about their memory and ask us if we can prescribe them something to either improve their memory or to prevent memory loss in the future. Unfortunately, we don’t have much to offer in terms of medications. Acetylcholinesterase inhibitors are somewhat helpful for those already diagnosed with dementia, but don’t seem to prevent cognitive decline. What about diet? Some observational studies have hinted that specific foods might protect against cognitive decline. This study was a randomized clinical trial conducted to determine if a Mediterranean diet (an antioxidant-rich cardioprotective dietary pattern) does indeed delay cognitive decline.


• 447 cognitively healthy men and women from Barcelona, Spain (mean age 66.9 years) were enrolled in this trial. They all had cardiovascular risk factors, but no actual heart disease (this was part of a larger study about the effects of diet on heart disease).

• They were randomly assigned to one of three intervention groups: a Mediterranean diet supplemented with extra virgin olive oil, a Mediterranean diet supplemented with mixed nuts, or a control diet (advised to reduce all dietary fat). Everyone had neuropsychological testing and Hamilton depression scale testing both at the beginning of the study and at the end. They were followed for a median of 4.1 years.


• A lot of participants dropped out of the study before getting their second neuropsych tests—113, or 25.3% of the group. Those who dropped out had somewhat lower MMSE scores, and were more likely to have the ApoE allele, a risk factor for dementia. This means that the results of the study are more likely to apply to elderly people who are sharper and who don’t have the ApoE allele.

• Participants assigned to the Mediterranean diet plus olive oil significantly outperformed those on the control diet in two of the three composite scores: frontal cognition and the global cognition. Those assigned to the Mediterranean diet plus nuts outperformed control on the memory composite score. Over the study period, 37 people developed mild cognitive impairment, with no significant difference among the different diets. The intervention had no effect on depression scores.

TCPR Take:

• The bad news: There were methodological problems with this study. (1) This was a post-hoc analysis of a subsample of data from a larger clinical trial. (2) There was substantial dropout rate, limiting the generalizability of the findings. (3) The subjects were not blinded to their treatments (eg, their diets). (4) The sample size was not big enough to be really confident in the findings.

• The good news: Nonetheless, the researchers did show that randomly assigning people to Mediterranean diets leads to measurable cognitive improvement relative to people asked simply to reduce dietary fat.

• Practice implications: Since the Mediterranean diets have been shown to improve heart health, and given these positive findings on cognitive functioning, go ahead and recommend this diet to your elderly patients. You can find more specifics about the diet from the National Center for Biotechnology
Information site:

Dr. James Megna is director of inpatient psychiatry and associate professor psychiatry and medicine at SUNY Upstate Medical University in Syracuse, NY.

Dorlee Michaeli, MBA, LMSW <![CDATA[Got Countertransference? A Journal Exercise to Better Understand]]> 2017-02-11T01:53:40Z 2017-02-11T01:53:40Z Do you find the emotions a client has stirred up in you sometimes confusing? Would you like to have a tool to help clarify your countertransference towards a client?

If yes, you may wish to employ Dima Dupéré’s “Understand Your Countertransference” Exercise. Dima Dupéré is a creative social worker and therapist who works in Canada and specializes in therapeutic journaling. She is also the author of the book “Feeling, Writing and Empowering,” a guide for helping professionals on integrating therapeutic writing into practice.

Before delving into the journal exercise, a brief refresher on the difference between transference and countertransference follows. Transference refers to the client’s conscious and unconscious feelings, fantasies and reactions toward the therapist, which are based upon feelings and perceptions the client has from past relationships.

Countertransference, on the other hand, is the therapist’s transference towards the client (Berzoff, 2008).  Lisa Schwartz, M.Ed. and Ron Schwenkler L.M.F.T., L.P.C. provide some suggestions on how to cope when triggered by a client.

Denying or avoiding the emotions triggered by your clients is likely to interfere with the therapeutic process. Conversely, by recognizing and working through your countertransference feelings towards your clients, you gain valuable data about your client and/or personal issues that you need to address yourself (Berzoff, 2008).

To that end, employing Dupéré’s “Understand Your Countertransference” exercise may be helpful to you when you seek clarity for why you are experiencing various reactions during or following certain sessions with patients. For your convenience, the steps are described below, as well as summarized in a graphic.

Understand Your Countertransference Exercise

Complete a cluster exercise as soon as you can after having some sort of reaction/emotion (positive or negative) during or following a client session.

List all feelings, thoughts and body sensations of which you are currently aware. Do so in a circular pattern, as illustrated in the graphic below, with the strongest emotion in the center and the other emotions and sensations surrounding it.

For each feeling/thought/body sensation listed, write how you feel about it and consider:

  • Is it a new feeling, thought or body sensation that you are feeling when working with this client?
  • Have you thought or felt this way in previous sessions?
  • Does the client’s story remind you of a person/situation in your own life?
  • Are any of the thoughts or feelings ones your client needs to express, but has not yet done so?

For example: Your client has told you about several losses over the past six months but has expressed no sadness or anger. Your client retells the story in a detached manner.

When Your Thoughts/Feelings Belong to Your Client

Focus on Self-Care

If continuing to think of a client, write down some ideas of what you wish for him or her and then move on to taking care of yourself.

  • Make a list of self-care strategies that you may refer to when needed.
  • Create and employ a ritual for yourself to use between sessions to help you let go of your clients after each session. Some ideas you could try include: walking around the block, deep breathing for five minutes, saying a prayer or visualizing the client as well and whole and mindfully washing your hands to let go of what you are holding onto.
  • Tap into what you have learned from past supervision sessions about similar situations.
  • Consider consulting with a colleague or supervisor who can help you.

When Your Feelings/Reactions Belong to You

 Try to process your feelings in one of the three below suggested ways.

Write using one of these prompts:

  • Right now, I feel (or think)…
  • This particular client’s story reminds me of…
  • Today I am affected by this client…

Chat with your feeling/thought by asking it a question with one color ink and write what you think its response would be in another color ink.

  • Just jot down your first thoughts and try to avoid judging or worrying about the content of what you are writing. Please see the graphic below for sample chat with “Frustration.”

Write about your current life situation. Consider the following questions as helpful prompts.

  • What is going on? How is your self-care? Are you sleeping enough, working too much and/or have leaky boundaries?
  • Is there a personal situation interfering with you/your work/your life?
  • How will you take care of yourself?

Conclude process by completing these statements:

  • I didn’t know that…
  • I realize that…
  • What I need is…

In this manner, you will be nourishing yourself by acknowledging the learnings you have gained from this exercise, ensuring separation of your issues from those of your clients and taking steps to ensure better self-care.

Do you have some suggestions on how to better understand your countertransference emotions? Please share them below!

Got Transference Infographic



Berzoff, J. (2008). Freud’s psychodynamic concepts. In J. Berzoff, L. Flanagan, & P. Hertz (Eds.), Inside out and outside. Psychodynamic clinical theory and psychopathology in contemporary multicultural contexts (pp. 17–47). Lanham, MD: Rowman and Littlefield.

Dupéré, D. (2016, November). Email exchange.

Dupéré, D. (2015). Feeling, writing, empowering: Integrating therapeutic writing into practice with groups and individuals.




Christine Hammond, MS, LMHC <![CDATA[Top 10 Misguided Perceptions of Therapy]]> http://5.1219 2017-02-16T02:37:36Z 2017-02-10T22:43:35Z Do you wonder what it is like to go see a therapist? Perhaps you’re in is a troubled relationship that is rapidly deteriorating? Or you have a boss who can’t be satisfied and who chooses to verbally assault employees? Or you’ve experienced a traumatic event that never seems to leave your current thoughts? Or you’ve had a recent loss that is so overwhelming, it feels as if will forever change your future?

Therapy is very useful in these cases and can improve a person’s life. But the expectations that people enter into the therapeutic process with often limit the ability of therapists to do their best work.

Over the years, clients have shared with me some misguided perceptions of therapy. Here are a few:

  1. “Therapy should make me happy.” The intent of therapy is not ‘make’ a person happy. Happiness is a feeling that can be based on circumstances, outlook, and personality. The real purpose of therapy is to become fully functional, present, and connected in all environments and relationships.
  2. “You need to change my … (spouse, kid, parent, or co-worker).” Every person is entitled to choose whether he or she wants to change or not. This is a process that cannot and should not be forced; otherwise the relationship takes on an abusive aspect. Therapists can’t make someone change, they can only encourage or inspire.
  3. “I want to be fixed in one session.” The process of therapy takes time because it requires self-discovery. As a result, there are no quick therapeutic fixes but each person has individual needs, perceptions, and motivation. For therapy to work best, it must be customized to the individual. This generates a lasting, long-term effect.
  4. “I feel close to my therapist.” Therapy is designed as a one-way relationship meaning that only the clients expose themselves, not the therapist. This ethical boundary is set for the protection of the client. While it is not unusual for a client to feel close to the therapist, the relationship is not one of besties.
  5. “I shouldn’t have to pay someone to get better.” Therapists are specialists in their field who have and continue to study, research, and develop an expertise. Just like other medical professionals, there are licensing requirements, specialties, and additional certifications all of which cost money. Remember, you get what you pay for.
  6. “Tell me what to do.” Too often clients believe therapy should solve their problems. Therapists can shed light on options, explain potential outcomes, and connect the past to the present. But the point of therapy is to guide clients into making their own decision, not to make it for them.
  7. “All therapists are the same.” No, we are not. Each therapist brings unique perspectives and expertise to a practice. Some therapists’ personalities and methods are better suited to certain clients. They are as different as each type of client. It might take visiting a few therapists to find the right match, but it is worth the effort.
  8. “Why can’t you help me with this?” Different types of therapy require an extra level of proficiency and should not be practiced by every therapist. Part of the ethical guidelines of therapy is to refer a client to someone who might be better suited with more know-how for a particular disorder or diagnosis.
  9. “I’m all better now that someone else knows.” Just because a person has confessed an intimate secret doesn’t mean he or she is completely healed. The healing process is unique to everyone, just as grieving is. Therapy must be customized based on personality and usually requires additional action or change in behavior.
  10. “I should feel better after each session.” Exposing areas that need to be worked on is not always a happy journey, sometimes it is painful. But it is through the hurt and healing that growth happens. It takes time to complete the process, which rarely is done within a 50-minute time frame.

Before going to a therapist, make sure you have an accurate picture of the process. This will allow you to get the most out of therapy in the least amount of time.

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