Tag Archives: therapist

Revamp: Uncomplicated Considerations for Therapists

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Atlas Concepts LLC | Rock Hill SC | Mental Health

Regardless of your experience as a therapist, you should well know there is value in both consistency and flexibility. Like most professions, the field of counseling is ever-changing. Conversely, the acknowledgement of the impact consoling words and encouragement have on humans is well-known; a conservative historical reference dates back to at least ancient Greece. So while digital software, phone apps, advancements in neuroscience, as well as, electro this-and-that keep things fresh, it is difficult for therapists to be confident they are doing all they can to provide any given service. Arguably, there is always a better, more efficient, or more innovative way to provide therapeutic healing. On the other hand, somewhere in the middle of my degree pursuit I concluded a great counselor can perform effective therapy inside a cardboard box. While I still believe this statement (and share it with others often) I am not without understanding the weight of social constructs on myself and my clients. In that light, the following will address some of my thoughts on engaging therapy outside of the box.

Consider the wave of holistic treatment. An effort similar to self-actualization of which achievement lies in understanding of the insolubility. In our plight as helping professionals we push through the marring of our ego to eventually find we can make a difference. We discover in the moment we work with a client we are best served by leveraging the skills, tools, and environment we are allotted in that instance. Moreover, we harness the capabilities and capacities of our clients. Within ethical and legal borders, there is something to be said for simply a method or an approach that works. So while you continually hone your craft, I hope to offer a few uncomplicated considerations that may bolster your effort. At the least the following points may serve as a periodic self-check or perhaps a starting point for your next self as the therapist remodeling.

The Traditional Five Senses

You don’t have to be an ecotherapist to harness the power of the environment; however, many therapists overlook ways to integrate stimulation of all the five senses and create a healthy space.

Ever run across the term biophilia? As I understand, the term is used in reference to human connection to nature. While there is a perception the use of natural products in any environment reduces toxins, these statements may often be reduced to bold claims grounded mainly in marketing. In truth, natural toxins exist as well. The difference boils down to selecting natural non-toxic materials in lieu of manufactured off-gassing materials (Kennedy, Smith, & Wanek, 2015). What is more important are the benefits of being connected to nature such as positive emotional experiences and increases in overall well-being (Lumber, Richardson, & Sheffield, 2017). Items such as wood, silk, wool, and cotton are easily integrated. Living plants add a number of benefits and offer great metaphors related to growth and life. A low maintenance indoor planting of lavender may be a great starting place.

If you have the latitude to change the wall, ceiling or floor colors in the place you provide mental health services, do so with some level of insight on the effects of color on human emotion and cognition. A discussion with an art therapist may be worth your time. Beyond the color of the more permanent aspects of the room, colors can be integrated in several ways including pillows, rugs, therapist clothing, pictures and other decorations, etc. Keep in mind that various shades and tones may hold different meanings.

A bottle of water, healthy snacks, candies and mints are options to intrigue the sense of taste. This effort must be minded carefully as clients may be dealing with shame related to body image, have emotional eating tendencies, or allergies. Being mindful of the issues clients are facing is critical, as there is a difference in supporting a bad habit and giving a client an opportunity to choose a healthy alternative. Keep in mind organic or natural foods have sensory and emotional appeal and can create feelings of tradition, comfort and safety (Franco, Shanahan, & Fuller, 2017).

Diffusing essential oils is becoming increasingly popular in therapy and healthcare settings. The trick here is to know both what you’re buying and the impact. Quality matters as the benefit is not simply fragrance. The effects of essential oils are driven by chemical makeup and concentration (Cardia et al., 2018). A bit of knowledge goes a long way in this area; for instance, some oils which promote stress relief and relaxation also promote sleep. Unless you’re a hypnotherapist this may not be an intended result. I mentioned lavender earlier regarding live plants; lavender is also a popular essential oil. In both cases, there should be caution when using lavender as allergies and skin irritation are both possible (Cardia et al.). By many accounts, the jury is still out on the effects of essential oils as much of the information available is conflicting though the evidence is chiefly anecdotal (Franco, Shanahan, & Fuller, 2017).  If you order essential oils from a third party it is wise to verify protective seals have not been tampered.

I would be remiss in not mentioning lighting. Especially considering the success (however short-lived or debatable) light therapy has evidenced concerning Seasonal Affective Disorder (Moscovici, 2006). In general counseling offices, I don’t suggest anything near the 10,000-lux associated with light therapy, but there is science behind “good lighting.” It’s safe to say the age of fluorescent lighting is nearing its end in most settings. But what of the amount of light? Studies suggest dimly-lit therapy settings result in a more positive experience for clients, increasing disclosure as well as feelings of safety and comfort. While low lighting can cause your eyes to tire/strain, it’s not linked to permanent harm.

We’ve all tried those noise makers outside of our doors at one time or another. In many cases they work well. Most people will believe if they can hear someone else, they themselves can be heard and if this occurs during your session it’s a problem. Aside from keeping the session private and without distraction, there are other ways to mind the auditory sense. Have you ever asked a client if you can play a musical request? Perhaps disrupt the monotony of your voice with a relevant and insightful video. Additionally, a simple internet search can offer relaxing sounds of nature which may also be leveraged in a session. In fact, a great deal of evidence supports human preference of natural sounds such as wind and water over industrial noises and sounds related to traffic (Franco, Shanahan, & Fuller, 2017).

What about a quote of the day? These have been inspiring people for ages, but are easily overlooked by therapists as a tool in practice. Sure if a client mentions a quote or cliché they thought of during their long day at work that helped them push through, you’ll acknowledge it. But what if you put your own quote on a dry erase board or easel each day or week? The avenues this tactic opens are endless. Before you know it, you’ll have clients offer you quotes and those same clients will be validated when their quote ends up on your wall. If there’s no room for an easel, or you don’t want to tie up your only dry erase board, quotes can be printed on small slivers of paper and given to clients.

These “practice boosters” can be truly refreshing to you and your practice. Your clients recognize both your consistency and irregularity in addition to your flexibility and rigidity. Modeling is an age-old technique; however, it doesn’t have to occur in a rehearsed or traditional sense and likely works better when it’s simply a display of who you are. If you aren’t willing to change, don’t expect your clients to be.

References

Cardia, G. F. E., Silva-Filho, S. E., Silva, E. L., Uchida, N. S., Cavalcante, H. A. O., Cassarotti, L. L., … Cuman, R. K. N. (2018). Effect of Lavender (Lavandula angustifolia) Essential Oil on Acute Inflammatory Response. Evidence-Based Complementary & Alternative Medicine (ECAM), 2018, 1–10.

Franco, L. S., Shanahan, D. F., & Fuller, R. A. (2017). A Review of the Benefits of Nature Experiences: More Than Meets the Eye. International Journal of Environmental Research and Public Health, 14(8).

Kennedy, J. F., Smith, M. G., & Wanek, C. (2015). The Art of Natural Building : Design, Construction, Resources (Vol. Second editon, completely revised expanded & updated). Gabriola Island, BC: New Society Publishers.

Lumber, R., Richardson, M., & Sheffield, D. (2017). Beyond knowing nature: Contact, emotion, compassion, meaning, and beauty are pathways to nature connection. Plos One, 12(5), e0177186.

Moscovici, L. (2006). Bright light therapy for seasonal affective disorder in Israel (latitude 32.6 degrees N): a single case placebo-controlled study. Acta Psychiatrica Scandinavica, 114(3), 216–218.

Jordache Williams

Jordache Williams is currently based in Rock Hill, SC and is a Licensed Professional Counselor with Atlas Concepts, LLC.

Caregivers, Therapists, and Race Cars

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“Tires will smoke when you reach the point of volatility or vaporization of the materials in the tread compound,” says Goodyear race-tire engineer Robert Bethea (as quoted in Huffman, 2011).

I know where all the statistically genius minds went but never mind the association of standard deviation and variance with volatility.  This isn’t a composition on research and evaluation, so for the other 98% of you out there, keep reading.  This is actually your invitation to take a vacation this summer.

Why?  To avoid the smoke.  After all, one thing caregivers, therapists, and race cars have in common is the potential for burnout.

There is often a distinction made between burnout and compassion fatigue.  Burnout is recognized as being more predictable, as it occurs over time, and is less treatable.  Marked by chronic stress, irritability, low self-esteem, and exhaustion, burnout symptomatically resembles depression and anxiety.  Compassion fatigue on the other hand, can happen suddenly and is associated with a shock or stress reaction to helping or desiring to help others.  However, similarly, compassion fatigue can result in chronic physical and emotional exhaustion, depersonalization, somatic complaints, irritability and difficulty sleeping.  Both burnout and compassion fatigue occur in situations where the susceptible individual is caring for or desires to assist a person who has experienced trauma or is experiencing emotional distress.  Therapists, lawyers, and nurses are among the individuals who should be concerned with self-monitoring for burnout.

Essentially, in a mental health setting, therapists are subject to burnout if they are affected by their clients’ stories outside of work.  In order to prevent burnout, workloads must be manageable, vacations and time-off must be observed, and sleep should be monitored; journaling as well as exercise are also preventative measures.  As a medical or helping professional, it is necessary to collaborate with peers, mentors, and supervisors throughout one’s career vice simply when a problem is identified.  These long-standing relationships in themselves may very well be the best preventative measure against burnout.  Isolated environments such as private practice increase susceptibility to the aforementioned and other ethical hazards.  Simply put, notwithstanding your experience, or how well you do your job, a level of vulnerability exists.  No matter where you are in your career, it is always a great time to assess the measures you have in place to protect yourself and those you serve.  The less supervision you require, the further removed you become from your formal training, and the more isolated you are from peers—the greater the risk.

So before your office is filled with smoke and you completely breakdown all of your grey matter, take a moment to evaluate the conditions—your condition and those around you.  Be encouraged to create and sustain an atmosphere that is conducive for your work, and concerning the signs of burnout, remain vigilant.

Reference

Huffman, J. P. (2011, February) Burnouts: An Appreciation. Retrieved from http://www.caranddriver.com/features/burnouts-an-appreciation-feature

Jordache Williams

Jordache Williams is currently based in Rock Hill, SC and is a Licensed Professional Counselor with Atlas Concepts, LLC.

The Improbable Therapeutic Relationship

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Jordache Williams | Therapy | Fields of Knowledge

How does a therapist appear inviting, even friendly, when they don’t know who you are?  When you don’t know them?  How do they encourage you to tell them every single deep, dark secret in your life?  How can you tell them things you have never told anyone else?

MYTH: If I see a therapist, I will have to tell them things I don’t want to share with anyone.

TRUTH: Effective therapy does not always consist of digging into your past.  If this is something you are worried about, it’s simply not a valid excuse for avoiding counseling services.  However, since this is a common practice in several models of therapy, it is best to share your concerns with any potential therapist early in the process.  This allows the clinician to determine if they are skilled to work within your comfort zone.

For more myths, take a look at Margaria Tartakovsky’s Therapists Spill: 11 Myths About Therapy.

What things effect you prior to your first therapeutic encounter with a particular therapist?

Past experiences with therapy.  “I’ve tried this before and it didn’t work.”  Whether you have bad, or even good, recollections of past therapeutic encounters, these expectations may prove to be obstacles in your current effort.

Baggage being brought to therapy.  The intensity of the presenting problem(s) at the time you arrive is likely heightened.  The final straw has landed on the camel’s back, so to speak.

Starting over.  You may feel like you already know your problems and having to relay information about them requires starting back at step one.

The journey to the office.  Most people experience anxiety in some form or fashion—bad traffic, you’re running late, or the simple fact you’re missing work (i.e. “Things are going to pile up before I get back” or “I need that money”).

Paperwork.  The amount of paperwork you fill out beforehand and how much or what type of information is requested may leave an impression.

Fees.  You are anticipating paying for a service in some form or fashion, which you are not entirely sure is worth it.

So what happens when you see the therapist for the first time?

You’re looking to be wowed.  You’re evaluating the environment, the therapist’s clothes, and the way they present themselves.  You expect their presentation to be on point, and you expect to see several framed degrees perfectly positioned on the wall.  In a way, you want to feel better by simply being in their presence.

You’re looking for them to be relatable.  You make judgements based on things you perceive: race, ethnicity, mannerisms, and level of attractiveness.  You’re looking for any religious symbology in the office, a golf bag in the corner, maybe photos of their family.

Ultimately how do you know if you and a particular therapist are a match?

The therapist’s experience.  It is your right to ask the clinician if they have experience working with clients of your race, gender, and general perspective.  It’s a good idea to ask if they have experience assisting others with issues similar to yours.

Observation.  Evaluate whether the therapist appears to show genuine concern and a willingness to be present in the moment.  Understand that therapists must inform you of their experience and credentials but they are not required to pontificate.

Are they “working?”  Oftentimes, therapist don’t work by doing all of the talking.  In most settings, if therapy is going well, you are the one doing the majority of the work.  Therapist work may include: enabling you to express yourself openly, asking questions you can’t answer with one word, using words you have introduced into the session, and asking how you feel about certain things you describe.

You leave with a shopping bag.  When you walk away you may leave some things behind, but you should also exit understanding what you should be doing prior to your next appointment.  Whether or not the counselor has specifically told you to do something (i.e. homework) or you’ve gained a certain clarity, you should feel like you have work to do.

Here are a few things you may have to get over—they may not mean what you perceive them to mean.

The therapist doesn’t stand to greet you, they don’t walk you out, they don’t shake your hand or hug you, they don’t open doors for you, they sit beside you, they don’t sit beside you, they offer you drinks or snacks, they look at you over the top of their glasses, they write notes while you talk, or they type on a computer during the session or intake process.

The point is, that it’s okay to not like everything about a therapist.  While most clinicians have been trained in some form or fashion on cultural competence, you must understand that each client is different and most of the time a counselor is just being themselves.  Many times, if you ask about a particular nuance which bothers you, the clinician may be able to make accommodations for you.  If things aren’t adding up for you as the client, express yourself, and make a determination on whether you would like to continue seeking the services of that particular therapist.

The more important point is that you should not write-off the mental health industry because of one bad experience (or several for that matter).  For more information on how therapists may differ, take a look at Therapists Differ and so do Their Approaches.

Finally…

It is an expectation of therapists to establish trust.  Many do this well which creates an unrealistic view of the splendor of its accomplishment.  Factors exist outside of the control of the clinician, but others they do direct: the physical environment, the way they dress, talk, act, and present themselves, and sometimes the administrative processes.  As interaction increases, the use of “I” statements, being present in the moment, active listening, rapport building, joining, and even the manner they orchestrate therapeutic transitions can all affect trust.  It’s difficult in itself to build someone’s trust in you, because trust is a personal process—they’ve just met you.  Trust is more probable over time and through shared experiences.  If there are barriers to trust based on superficial things such as gender and race, these barriers can only be overcome through conversation—conversation which is relatable.  Finding common ground may be an effective way, in the early stages of counseling, to achieve trust.  This can be done through acknowledging similarities and the clinician proving motivational.  Establishing individualized and agreeable goals as well as serving as a beacon of hope, also assist the formation of a therapeutic alliance.  When you land across the room from a therapist for the first time, understand the number one objective may very well be the establishment of a relationship between the two of you.  Engaging this process with an open mind is one of the best things you can do to get the most from the experience.

Additional resources (paid links):

Rosen, D. C., Nakash, O., & Alegría, M. (2016). The impact of computer use on therapeutic alliance and continuance in care during the mental health intake. Psychotherapy, 53(1), 117-123. doi:10.1037/pst0000022

Smith-Hansen, L. (2016). The therapeutic alliance: From correlational studies to training models. Journal of Psychotherapy Integration, 26(3), 217-229. doi:10.1037/int0000012

Wiarda, N. R., McMinn, M. R., Peterson, M. A., & Gregor, J. A. (2014). Use of technology for note taking and therapeutic alliance. Psychotherapy, 51(3), 443-446. doi:10.1037/a0035075

Jordache Williams

Jordache Williams is currently based in Rock Hill, SC and is a Licensed Professional Counselor with Atlas Concepts, LLC.

Therapist Self-disclosure

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The matter of self-disclosure in the professional therapeutic setting is one that can be daunting to understand.  Foremost, disclosure in therapy is most identified as originating from the client.  Many of us picture a somewhat small, dimly lit office where the client is lying down with their eyes closed telling their personal secrets.  In many instances, however, this is not so.

Therapy has become so diverse that a generalization such as this can be very far from the reality a client faces when they enter the therapeutic setting.  So aside from not really knowing what to expect regarding the physical environment, clients are also leery about the process of therapy.

It is helpful for clients to understand that therapists have also undergone similar thought processes, such as the internal debate regarding how much of themselves they are to share.

Therapists teeter between disclosing too much and not enough about themselves to clients.  As a therapist, where do you draw the line? As a client, what are your expectations?

In general, self-disclosure should be used at the discretion of therapists with the intention of promoting wellness while avoiding harm at all costs (i.e. primum non nocere).  Self-disclosure is a natural (or promoted…or even integral) part of several models of individual and group therapy, thus for therapists practicing such models it is necessary in many cases.

Other models of therapy do not require therapist’s self-disclosure, and may even work more effectively if such disclosure is avoided.  So for therapists, the answer is to understand your model, and work within that frame…be comfortable and be authentic.

Hint: As a client, if you have the opportunity to research and select a therapist, you should consider what you perceive to be your presenting problem and evaluate the approaches of the potential therapists.

Not all therapists are created equally and some therapeutic models have been evidenced to work well with specific issues.  You also want to consider qualifications, credentials and reputation, but this will be covered more extensively in another blog.

As a client, you should expect therapists to be forthcoming with their particular intentions regarding the progression of the therapeutic experience, which may or may not include their intentions regarding self-disclosure.  At any case, therapists’ disclosure should be in keeping with the intent of the therapeutic experience as outlined during the process of informed consent.

The process of therapist self-disclosure is unique to each therapist, and clients who may have had previous experiences must understand that their own expectations can make their experience more or less productive.  If, as a client, you were forced to change therapists (e.g. because you relocated), you may be jaded.  If you discontinued seeing a therapist in search of a better experience, you may be disheartened by having to start over again (i.e. the administrative processes and the initial “introduction” sessions).

If you are completely new to therapy then your understanding of the uniqueness of therapists will prove helpful.  You are making an important decision in your life, and, in that regard, being informed is a process which you can directly influence…being informed is also something you should expect during the course of therapy.

In other words, be informed going in and be even more informed coming out.

Atlas Concepts, LLC_Jordache Williams

Jordache Williams is currently based in Rock Hill, SC and is a Licensed Professional Counselor with Atlas Concepts, LLC.