Life has thrown us all some unexpected turns recently with the rise of COVID-19. The question to ask yourself is how do you stay within your emotional window of tolerance? When you are in your window of tolerance you feel secure or safe. You feel that you can handle your emotions as they surface, and you can find your sense of direction. Your responses are congruent with the situation at hand and you feel open, curious, and present. Feelings of empathy remain intact and you are able to maintain healthy boundaries. However, a stressful event can lead to movement out of your window of tolerance.
Some years ago I noticed a higher number of cancellations due to the flu than other seasons. This year the Corona Virus is putting fear in many hearts. People are stockpiling toilet paper and essentials to have around the house and some offices are preparing to have their employees work from home. Vacation plans are being canceled as fear rises like the tide. Around 7 years ago I started on a quest for natural health
Once you’ve experienced the shock and euphoria that accompanies the news that you’re having a baby, your thoughts move on to the physical and financial preparations that need to be made. There’s a nursery to be assembled as well as equipment and supplies to be acquired so you’re ready to go when the big day arrives.
For parents who find they’re expecting a child with a physical or mental disability, the shock they experience is of a slightly different nature.
Tis the season for intensified feelings of grief, despair, and loneliness. The feelings of sadness of the loss of a loved one increases exponentially during the holidays. The memories of past holidays together can flood the mind and intensify the feelings of loss. When our lives aren’t perfect and we look around at everyone else’s seemingly perfect lives, despair sets in with feelings of inadequacy. The feelings can spin around in our minds like a tossed salad with too much dressing, “They have an intact family, they have money to go skiing, they don’t have financial problems, their kids have good grades…
I have learned that it takes around 3 years for a bamboo plant to be fully established once it is planted. It will have long periods in which the plant doesn’t appear to be making any growth progress. It is during this time that growth is occurring underground within the root system. The roots are actively growing and pushing water up to the plant above ground.
First I apologize for not writing in my blog for so long. We moved, and other things have held my attention and so I have not been actively writing in here for you. I plan to resume my writing and offer topics of interest. First, on a personal note, I felt compelled to write about my own quest to find a counselor here in Colorado.
Yes, counselors do go to counselors for help with their own personal issues. My personal quest to find a counselor in Colorado has been a challenge.
In today's world we have a lot to be worried about; job loss, bill payments, rising grocery costs, keeping our children safe, and keeping up with everything on our plates all while maintaining a smile in public. Some of us are chronic worriers and some not. Generalized Anxiety Disorder is a condition of chronic worry. It occurs when our worries never seem to subside. An ongoing wave of anxious thoughts and behaviors invade our lives daily and we may struggle to let go of them. My counseling intern, Jill Oulman, Unlicensed Psychotherapist, who will be completing her counseling degree in the next few months, wrote a few thoughts on Generalized Anxiety. I thought that I would share them with you.
Generalized Anxiety Disorder
By Jill Oulman
It can be easy to confuse Anxiety for Depression. Both affect one’s ability to concentrate, both affect mood, often both anxiety and depression affect sleep, and with both disorders one can appear agitated or restless. Because anxiety is a part of natural human existence, it can be something many individuals brush off as normal. When it begins to affect their daily lives, they assume it must be something more severe than anxiety. Many people assume they are depressed and seek help because they cannot deal with their feelings of hopelessness.
By properly assessing the condition as Generalized Anxiety Disorder, the therapist can work to teach the client tools to reduce anxiety and feel in control again. Human beings are programmed with a fight-or-flight mechanism. In an individual with Generalized Anxiety Disorder, that mechanism can be faulty and the body is not able to restore itself to a decreased state of adrenaline once that mechanism has been activated. Often the feelings of anxiety are automatic and not controlled by the client. Using relaxation techniques can be an effective management tool for the client to restore order to their day.
When patients can be taught techniques to help themselves, it brings the focus of control from external to internal. That may be the most important skill as often patients feel as though the source of their anxiety is beyond their control. This lack of control is what worries them the most. Enabling clients to have control over their treatment can be a first step in healing. The therapist can allow the client to focus on controlling their environment instead of the other way around.
Many individuals live with anxiety but it can be
Worry is a constant struggle for many of us. Sometimes our mind will latch onto a concern and not let go. It's as if worrying will somehow solve the problem. If we obsess, we reason, we will figure out a way to solve the problem eventually.
Worry is often linked to feeling out of control of something. It is a fear that something "horrible" will happen and we will have no control to stop it. I often call it living in "what if land." We ponder; "What if I lose my job," "what if my son gets in a car accident," "What if the dog throws up on the carpet," "What if I don't like my new job."
Many worriers have trouble falling asleep. It can take an experienced worrier hours to fall asleep sometimes. Often, a worrier will be awakened at 3 am stare at the clock helplessly while the redundant list of worries cycle through; 3:00 am, 3:15 am, 3:45 am, 4:30 am. Sometimes even though we know worry doesn't help anything we still do it. It just is a hard habit to stop.
A well known sleep specialist described the worry box as a method to combat nighttime obsessions. I have been pleasantly surprised by
When Seeking Counseling Should You Use Insurance?
When I was first trained in counseling Managed Care was just starting out. The Professors at my school were adamant against using insurance for clients. They were afraid of confidentiality getting compromised and, as a result, urged students to tell clients to “self-pay” for counseling. This would protect confidentiality, a hallmark of the trade. They gave an example of someone running for public office who was denied the opportunity because they had been diagnosed with Adjustment Disorder in childhood.
However, I have found insurance to be very useful for clients and helps clients who need counseling gain access with a manageable co-pay for sessions. Counseling can add up and is a significant investment in yourself. People tend to minimize the importance of such an investment because it is often difficult to see tangible results without first giving it a try. People are very private about counseling. Unlike seeing a good haircut and asking “who is your hairstylist?,” people don’t usually say, “Wow, your attitude is so much better, who is your therapist?” The word doesn’t get out about good therapy because most of us are very private about it.
Insurances are getting better at recognizing the need for counseling and some plans have good coverage. Other plans have poor coverage for counseling and limited choices in counselors. A diagnosis does have to be made in order to use the insurance. Most therapists try to
I set my alarm for 5:10 am so I could head out to Colorado Springs for a Continuing Education seminar. I remember thinking that I was over scheduled this week and wondering how this was going to affect me. I reassured myself it would be okay.
I used to push myself past my limits regularly. Somehow I would always find time to crash and recover but 11 years ago I learned the hard way that it is not a good idea to push yourself past your limits on a regular basis. That was before I had kids when time to “recover” has become more and more difficult to find.
I groggily got up at 5 am on this midweek day, and headed out to Colorado Springs for my seminar on Play Therapy Techniques. I was excited about this seminar but was also acutely aware of how fatigued I was. My son had had the flu on the weekend and I was up with him at night helping him and cleaning up throw up. Then by Monday I had an upset tummy myself but chose to push through it since my clients are counting on me to be there for them and I knew I would be taking the next week off.
Because of the scheduled time off, I had a full work week with long days. I managed to make it through but felt the effects on my body as I slogged into the next day with the enthusiasm of a hippo wallowing in the mud. Then by Friday I got home from work and my husband seemed cheerful and excited to emphasize that I had made it through the tough week. Even with the flowers he brought me my happiness waned. I was grouchy and couldn’t even stand the sound of my favorite music. I turned off the radio. I reminded him in a monotone voice that I still had a Toastmasters meeting the next day.
I was supposed to do a speech after the main meeting for the nursing home residents in the “Speech-a-thon.” Fortunately I came to my senses and chose not to do the speech-a-thon but went to the main meeting with my makeup on to cover over my dark circles, and a smile (faking it was one of my old coping skills). I managed to win “best evaluator” and even did a Table Topics talk when you are given a topic on the spot to talk about without preparation time. By the end of the meeting my muscles in my neck and back ached and my head hurt. I knew I was well over my limit.
What is a “limit” and why is it so important? Learning what my limits are and respecting myself enough to honor them was one of the main components to my recovery from the severe burnout I experienced 11 years ago. It is also one of the concepts I try to teach my clients when learning to manage stress and anxiety.
A limit is an invisible line that exists between emotional, physical, and psychological well being and becoming anxious, irritable and stressed. Once you have crossed the line it is important to pull yourself in quickly by slowing down, implementing self care, and getting rest.
There was a time in my life I had no perception of a limit. I had no awareness that one should exist and I lived past my limits all of the time. I thought I was just driven and “hard working.” My need to please others, to work hard, and be involved was tremendous. I thought I was doing what I was supposed to do, and I had an insatiable need to do because I lacked the self esteem to understand that my worth was not linked to how well I did things. I would push and push. I pushed myself all of the time, and the funny thing is, when people find out you are a hard worker, something else happens...you get asked to do more things. Then I found that the pressure also came from others that were expecting me to do for them. I was programed to feel that nothing was ever good enough so I would strive and strive to perfect things.
My burnout was actually a gift. It was a gift that helped me to understand what a limit is and how to enforce it. I learned that you can’t expect anyone else to enforce it for you. You have to first respect yourself and your well being enough to be determined to honor your own limits. I went over them this past week and the result was not pretty. I don’t even like being around myself when I am in that place. Fortunately, last week was an exception and there were parts that were out of my control. I’ll get back on track and be determined to take better care of myself this week. That should be easy since I am on vacation. What are your limits? How can you honor your limits this week?
I welcome your comments.
Relationships are extremely challenging. Even people who love each other deeply will have challenges communicating sometimes. Here is a list of barriers to help you see what may get in the way. These barriers may be in the pre-conscious states. Realize you may need to reflect further on your thoughts and actions to identify your barriers.
Barriers to Listening (not exhaustive):
Denial- "I am the victim. I am not contributing to this problem."
Entitlement- Making demands on the other, "You ought to treat me the way I expect you to." "I expect you to fulfill my demands of special treatment."
Mistrust- "If I listen to you, you will take advantage of me."
Revenge- "I have every right to punish you because of the way you treated me."
Defensiveness- "I must argue and defend myself."
Barriers to self-expression (not exhaustive):
Conflict Phobia- adhere to the belief that "People with good relationships don't fight. Conflict should be avoided.".
Emotophobia- "I shouldn't feel angry." The belief that anger is an unsafe emotion to have or express possibly due to imbalances in family of origin.
Emotional Perfectionism- "I should always feel happy and loving. I should be in control of my emotions at all times."
Fear of rejection- "If I tell you how I feel, our relationship will fall apart and I will end up alone."
Passive aggression- "I will punish you with silence. I will get back at you indirectly (burn your toast, show up late, forget things important to you)."
The Problem with Matching:
Couples often will start an argument and fall into a trap called "Matching." One will raise his or her voice and the other will match it with an equally strong statement. The other raises his or her voice to defend their cause and the other will also raise their voice. Both are saying a lot and neither is hearing what the other is saying. Each walks away having convinced themselves they are right because they only heard their own side of the argument.
In order to change this vicious cycle each needs to speak more calmly and listen to what their beloved is saying. Listening and hearing your beloved doesn't mean you agree with them it just means you are trying to understand them. If you are both trying to hear the other and let them share their feelings you are more likely to get at the root of the issue. Most couples just want to feel understood.
EAR:
Once you identify your barriers to self expression and listening it's time to learn how to be a better listener. Dr. David Burns, MD calls his method EAR (copyright 1991/2006).
E= Empathy
In communication giving your spouse or friend a sense that you care about them comes through empathy.
1. Disarm- Find some truth in what the other is saying even if you don't completely agree with them.
2. Empathize- Try to see things from their eyes and not your own. Reflect back what you hear they are saying and what you think they are feeling. Give them a chance to clarify.
For example, "I hear you saying that you think the sky is purple and that makes you feel happy." Notice how you don't have to agree with the person to show them you heard them. Refrain from sarcastic tone or rolling you eyes.
3. Inquire- Ask questions to demonstrate interest and to learn more about their perspective.
A= Assertiveness
4. I Feel Statements- Once you have spent the time needed hearing your beloved's thoughts and feelings respond with assertiveness (as opposed to aggressiveness or passivity). If you use "You always" or "You never" statements you will put the other on the defensive and a fight will flair up again.
"I feel _________________ when _________________." Is a good sentence structure to use.
Often couples have a small feeling vocabulary because they are so busy fighting over facts and details. The true emotion behind what has happened gets lost.
Basic feeling words are: angry, sad, hurt, lonely, afraid, uncertain, frustrated, disappointed, upset, confused, happy, glad, good, proud, etc....
R= Respect
5. Stroking- Take time to validate the other persons' feelings. Treat them with respect and even when you feel frustrated or upset. Try to say something positive about the other person. For example, "I appreciate that you helped me out the other day." Or "Thank you for taking time out of what you were doing to help me." or, "I can see that you are working really hard at work, you must be really tired." or even "Thank you for listening to me!"
Make sure you take turns listening and sharing so both of you have been able to address the issue. Healthy Relationships are not one sided.
With these tools you will find that you can resolve your conflicts and learn to understand and appreciate each other.
(Taken in part from David D. Burns Attitudes that Inhibit Intimacy, Therapists Toolkit, 1989/2006).
If you are interested in my seminar Foundations For Marriage. Please contact me at counseling@gretchenflores.com if you would like me to present this seminar at your church or local library.
What Questions to Ask:
I am often surprised by the lack of questions asked by new clients. I make it a point to offer a chance to ask me a few questions. Most clients will say they don't have any, and want to know when can we start. To be honest with you, I think that it is really important to ask a few good questions before you start with your therapist, even if they have been recommended to you.
I have often wondered why prospective clients don't ask many questions. Possibly it is difficult to know what to ask. Or maybe there is a sense that the therapist is an authority figure and people feel disinclined to ask pertinent questions. Possibly, there is an assumption that credentials automatically mean you know what you are doing. Here are a few tips on what you might consider asking.
Even if you are not particularly interested in the answer, it is a good idea to ask a few questions upfront. This gives you a sense right away for your therapist. A highly skilled therapist might not be a good match for you personality wise. If this is someone you are going to hire to share your deepest struggles with, then you need to know you might feel comfortable with them before you get started. Clients sometimes have difficulty discontinuing and then starting over with a new therapist once they have started to open up and share their story.
Even if you don't have a clue about psychology or theory it is a good question to ask. A well grounded counselor should be able to answer this question easily and give you a sense of their approach. There is a wide range of theory bases and they vary in how they approach a problem. If you don't feel at ease with hypnosis for example and you start with a Therapist who relies on it in counseling, then you may not be compatible.
If you are looking for a faith based counselor then you may need to know what faith means to that therapist. Does it mean that they went to church a few times growing up or does it mean that they live out their faith daily? A good therapist-client match can be a real dynamic environment for positive growth and change. Clients need to understand that they have a say in the relationship and they should feel free to ask such questions upfront. You are in fact hiring someone to help you with your life. Go ahead and ask.
A very brief summary of some common theory types (These descriptions barely scratch the surface):
DBT (Linehan)- Dialectical Behavioral Therapy is all the rage right now. Insurance companies even reimburse for it (quite frankly a big deal considering their lack of support for mental health). It is based on Eastern Religion practices of mindfulness/meditation practices. If you are desiring to stick to a faith based therapy choose instead a Cognitive Behavioral, Person Centered, or Rational Emotive therapist who has an active faith. Or make sure the DBT therapist has a strong faith and can point you back to faith principles while using DBT workbooks/exercises to improve insight. I personally don't recommend a blending of the two.
Cognitive Therapy (Beck)- Based on the concept that how one thinks is reflected in how one feels and behaves. If you address dysfunctional thought patterns than you modify feelings and behavior. The goal is a "cognitive shift" in which misperceptions are discovered and moved to a more balanced position of function.
Behavioral Therapists (Pavlov, Skinner)- The concept is that behavior needs to be changed first and then cognitions, and feelings will adapt. Concepts of conditioning, social learning, behavior modification are predominant. Understanding is not important.
Person Centered (Rogers)- Based on the concept that when a client is provided with an environment of acceptance a client will work toward "self-actualization" on their own. The therapist provides unconditional positive regard while the client works out their issues of concern.
Rational Emotive (Ellis)- Addresses how our emotions are linked to our behaviors and linked to our thoughts. Finds an Activating Event and analyzes how the thoughts and behaviors are connected to it, and then works to modify the thoughts (irrational beliefs) to modify reactions (Emotional Consequences).
Gestalt (Wolfgang von Goeth and others)- Therapist will engage in dialogue rather than focus client on a goal. Purpose of the dialogue is to increase awareness. Gestalt is understanding of the shape of an entities form. Pictures and symbolism are used to capture the "Gestalt" or shape. Clients are encouraged to do their own decision making. Various therapy models may be used in the context of the therapeutic relationship. Focus on the "here and now" or present awareness of present issues as opposed to lengthy analysis of the past.
Analytical Psychotherapy (Jung)- Focuses on the unconscious psyche and archetypes (i.e. the self, the persona, the shadow). The goal is to become more conscious trough psychotherapy, dream analysis and a process of self knowledge.
EMDR- Eye Movement Desensitization and Reprocessing (Shapiro)- An 8 phase treatment based on information processing therapies. Traumatic memories are paired with a series of eye movements (mimicking REM sleep patterns), and tapping (soothing movements). The pairing has been found to produce diminished trauma symptoms and resolution of the memory. It has been found to be effective for severe trauma including veterans with PTSD. Select a therapist with demonstrated training in the method.
Psychoanalysis (Freud)- emphasis on analysis of the subconscious and dream interpretation. Traditionally this is the one where clients lie on the couch and look away from the therapist while the client speaks. Many of the concepts are still used in current theories but through different means. Dream interpretation, and analysis of the unconscious and conscious states are common components. Transference (the clients projected reaction to the therapist) and counter-transference (the therapists reaction to the client) are used to increase understanding.
Transactional Analysis (Berne)- Addresses three prevalent ego states in within each individual; Parent, Adult, Child. The idea is that we function out of ego states and our response to life will reflect either a Parent, Adult, or Child ego state. Ego states are considered patterns of feelings and experiences as related to behavior. TA therapists use simple vocabulary and set up treatment goals for their client.
Adlerian (Adler)- Individual psychology is interpersonal in recognizing how we interact with others. Emphasis on choices, family history and social interactions. People are studied in the contact of social interactions. The meanings we interpret from life will influence our behavior. Emphasis on meanings and perceptions drawn from life.
Family Systems (Whitaker, Ackerman, Bowen, Minuchin)- Families typically come in with an "identified patient" (symptom bearer). The goal of the family therapist is to modify the family relationships to attain harmony and balance so that the symptomatic behavior is alleviated. The focus is not on the individual but on the system of the family. Concepts of triangulation, double bind, marital schism and enmeshments are addressed.
Side note: I always say you want to make sure you have a sane therapist, not a "psycho" therapist... Har har!
Why choosing a Licensed therapist is important:
After moving to Colorado from Illinois where requirements for private practice are stringent I was shocked to learn that in Colorado you do not even need to have a degree to become an "Unlicensed Psychotherapist." I personally find this appalling because it fails to protect the public from untrained therapists who have not had the training to learn the skills of the trade.
It also fails to protect the counselor from severe pathology. Most clients are high functioning individuals who just want to improve their life. Other clients can be incredibly manipulative and even dangerous. I, myself, have been in life threatening situations.
Please select a therapist who is licensed. This shows that they have dedicated a lot of time and effort to learning how to be effective at helping people. Their skills have been tested and their knowledge base has been established through at least one, if not two, 4 hour examinations on counseling skills. If you want a good therapist but cannot afford a licensed therapist choose a therapist who is working toward licensure. They should have lower fees but are meeting weekly with a licensed therapist to help them with their cases and then are studying to take the examination.
What the letters mean:
LPC- Licensed Professional Counselor
LCPC- Licensed Clinical Professional Counselor
LMFT- Licensed Marriage and Family Therapist
PsyD- Doctor of Psychology
PhD- Doctor of Philosophy (Can be specifically in Psychology)
CADC- Certified Addictions Counselor
What theories do I adhere to?
Well, first and foremost I feel the ultimate therapist is the Holy Spirit, "But the counselor, the Holy Spirit, whom the Father will send in my name, will teach you all things and will remind you of everything I have said to you." John 14:26 He is described often as a counselor. I rely most on Him, and often as clients are sharing their problems I am praying inwardly at the same time asking, "show me how I can help this client." He brings to mind what I need from my training and experience to help clients through their circumstances.
I feel it is unfortunate that some Christians (Authors, Pastors) are opposed to counseling. I assume this is a result of bad experiences from inexperienced therapists, or therapists who rely heavily on secular philosophies rather than faith principles. Again, that is why it is important to interview the therapist you are hiring to help you. Pastors should meet with and interview any therapist they are considering using as a resource for them. A good faith based counselor can really help support pastors who are very busy overseeing ministries.
In my approach, I draw from a range of theoretical methods. My graduate school training taught all of the afore mentioned methods. However, I utilize Cognitive-Behavioral, Rational Emotive, and Person Centered Methods most frequently. If it seems a present behavior is linked to a past experience or event I will spend time there exploring the connection to add insight. I feel insight gives you the freedom to choose how you will proceed rather than just reacting automatically to life as it happens to you.
Dreams can also add insight and are often rich with symbolism that can be looked at to draw from the pre-conscious states. However, I don't spend too much time on dreams because they can also be overemphasized. An occasional peek into dream states can open up a fresh perspective.
An example of dream symbolism, is a frequent dream that I have. When I step out of my comfort zone by accepting a challenge I often dream that I am standing on the edge of a cliff with my back pressed against the outer wall of a house (house offers comfort). I'm usually on a small ledge and considering how I will proceed. This reflects my fear and awareness that I am not in my comfort zone.
I also rely heavily on the concept of forgiveness. What's the point of analyzing past hurts if you don't forgive those who have injured you. Forgiveness releases you from the burden of bitterness and buried rage that finds its outlet in other unhealthy ways that can damage our relationships, "Refrain from anger and turn from wrath; do not fret-it only leads to evil." (Psalm 38:8). The lack of forgiveness brings about more hurt for more people. Forgiveness is not tolerance of abusive or hurtful actions, firm boundaries may be important. It is an acknowledgement that a wrong was done but a decision is made to forgive and let go of bitterness.
I know that was a lot of information but I hope it is useful as you now are armed with a sense of what to ask your prospective therapist.
Best wishes to you in you personal journey toward health,
Gretchen
Resource:
Current Psychotherapies, 4th Edition by Raymond Corsini and Danny Wedding; F.E. Peacock publishers, Inc. Illinois, copyright 1989.
