Telehealth is getting a lot of attention right now as Coronavirus has affected how medical services are provided. This blog will focus on the concept of telehealth as it pertains to mental health therapy sessions. There are various terms used to describe the concept of telehealth. It is sometimes referred to as “telemedicine” or “teletherapy,” but regardless of what it’s called, the concept includes therapy sessions being conducted over video conferencing with the client in one location and the therapist in another.

Is it as effective as in-person therapy?

This is one of the most common questions in the minds of potential clients when deciding if telehealth is right for them. There is an emerging body of research on this topic, and the findings are consistently concluding that yes, telehealth is as effective as in-person therapy.

What are the benefits?

You can do therapy from the convenience of your home, office, or other environment that works for you. All you need is access to a computer with internet access or a smart phone.
There is no travel time. You don’t have to commute to your therapist’s office and can save the time.
Your therapist might get a better sense of you as a person. If you’re in your home, office, or other space you value, the environment may become a topic of conversation that provides insight for your therapist.
You get to be comfortable. By staying at home you get to settle into your favorite chair or even your bed. You can wear your pajamas. You can grab a cup of tea, coffee, or other tasty beverage.
You can work with a therapist in a different city (but same state-see below). This broadens your options for therapists, and as a result, increases the chances of you finding a good fit.

How do you actually do telehealth?

There is a variety of video conferencing options therapists can utilize to conduct telehealth. Our practice uses a platform called Doxyme for sessions. Doxyme is designed to be HIPPA secure and protect the privacy of clients. The process is very straightforward. I send a link to my clients by email or text, and all they need to do is click on the link using a computer or phone with internet access. I am notified my client is ready to start, and I click a button on my end to initiate the session. At that point we can see and hear each other on our respective screens. The experience is similar to Facetime or Skype.

Telehealth and State Laws

This is a tricky area to say the least, and it’s gotten even more convoluted as states have been suspending telehealth laws to help ease the impact of Coronavirus.

When it comes to telehealth, therapists are able to conduct sessions with clients in states where the therapist holds a license and the client is physically present at the time of sessions. I am licensed in Colorado, so I can see clients who reside anywhere in this state. If I was contacted by a potential client who lives in Florida wanting to do telehealth, I do not have a license in the state of Florida, so I would not be able to work with the client. However, if I live in Colorado, but held a license in Florida, then I would be able to work with the client. Some states make exceptions to the licensing issue. For example, if I start working with a client in Colorado, and the client moves to Illinois, Illinois grants permission for me to continue to see that person via telehealth even though I’m not licensed in that state.

The vast majority of states require therapists to hold a license in the state where the client is physically present without exception. If you have any questions if you would be able to work with a particular therapist who is in a different location than you, give the therapist a call or shoot them an email as the situational factors are different in every case. The therapist can then investigate applicable state laws and verify if they’d be able to work with you.

If you are interested in telehealth or have additional questions, I’d love to chat with you. Please give our office a call, and we can discuss further.

-Lindsey-

It’s a strange time we’re living in. For most of 2020, we’ve been dealing with Coronavirus and the adverse effects it’s been causing. Most people still feel a certain level of stress, overwhelm, uncertainty, or depression as a result of Coronavirus. Why? We’ve had time to accept what’s going on and make adjustments, but there are still these nagging negative emotions that continue to plague us. The answer is likely related to the on-going loss we continue to encounter.

1.) What is Loss?

The basic concept of loss is that something unpleasant happened, which was out of our control, and now we have to adapt to a new normal. We were all very aware of the initial losses and death associated with Coronavirus at the outset of the pandemic, but additional tragedies continue to occur that we may not think of as losses. Graduations didn’t happen, attending school in person stopped, birthday parties with friends are being cancelled, there won’t be large get togethers for fireworks displays on the 4^th of July, concerts are being cancelled, vacations are gone, employment has been deeply affected, and weddings are being rescheduled or cancelled entirely. Every time we encounter something that disrupts our “normal,” that’s a loss, and it takes a toll.

2.) Don’t Compare

When it comes to loss, it’s very natural to say “Well, no one in my family has died from Coronavirus, so what am I complaining about?” We tend to want to create a hierarchy of loss and tell ourselves that the more “minor things” don’t deserve an emotional reaction. Experts in grief and loss universally agree that it’s OK to think of any departure from normal, big or small, as a loss and call it a loss. Even if we label them minor, losses affect us, and there is no sense in trying to deny that fact. A healthy approach to loss includes naming it as such, accepting that it exists, and acknowledging that it is having a negative impact on you.

3.) Stages of Grief are Misleading

Grief is the emotion most commonly associated with loss. We tend to think of grief as occurring in stages based on the work of Elizabeth Kubler-Ross. She developed a theory of grief that includes five stages based on her research with people facing their own deaths. This research is highly important, but it inadvertently created this idea that people move through stages of grief in a linear fashion and that there is a “right way” to grieve. Let all of those misconceptions go. There is no right way to grieve. Feel how you feel and don’t judge yourself for grieving in a right or wrong manner. Even if an emotion is confusing or contradictory to what you thought you’d feel, let it be. Experts on grief encourage people to experience whatever emotion comes up and adopt an accepting attitude toward it. Fighting the emotion or judging yourself harshly for not grieving correctly is only going to pile on the negative emotion you’re already experiencing.

If you are struggling with loss related to Coronavirus and want to work through it in counseling, I’d love to chat with you. Please give our office a call, and we can discuss further.

-Lindsey-

The process of starting therapy can be daunting, and a major part of the stress is selecting a good therapist. It can be difficult to know with whom you will have a positive experience. The tips below are intended to help guide your search.

Tips:

1.) Take the time to research. Looking into potential therapists will give you a sense of who it is you’ll be working with. Check out the provider’s website, Psychology Today profile, other online directories, and/or call their office and ask questions directly.

2.) Request a consultation. Most therapists offer a free meeting where potential clients can talk to the provider directly and see if the therapist will be a good fit for them. Consultations are about 30 minutes and can be done over the phone or in the therapist’s office.

3.) Learn about the therapist’s specialty. Therapists are like doctors in the sense doctors are very specialized. If you have a heart problem, you see a cardiologist. If you have cancer, you see an oncologist. If you have a stomach problem, you see a gastroenterologist. Therapists specialize in certain diagnoses, populations, or therapy modalities. Find someone that specializes in the issue you want to address. If you have been through something traumatic, find a trauma therapist. If you struggle with addiction, find a substance abuse specialist. If you have panic attacks, find an anxiety therapist. If you are looking for therapy for an tween or teen, find a therapist that specializes in adolescence.

4.) Learn about the therapist’s theoretical orientation. Therapy can be done a multitude of different ways. It’s important that your therapist is working from a theoretical framework to bring consistency and efficacy to therapy. It may give you even more peace of mind if the orientation is “evidence-based” meaning significant research has been completed that suggests the orientation is effective. Learn how the orientation will play out in sessions-What does it look like? What can you expect? What’s the purpose of the orientation? How does it produce change?

5.) Consider gender, age, years in practice, etc. These items can help ensure comfortability with your therapist. If you are generally uncomfortable being open and vulnerable with men, then a female therapist will likely suit you better. If you are young and have a hard time relating to older adults, you may want to look for someone who is younger.

6.) Notice professionalism. If you call or email a therapist to learn more about them, do they respond to you in a reasonable amount of time? Do they respond at all? If not, these can be signs the provider is unorganized, unprofessional, or doesn’t have good office systems in place which can translate to a poor experience in therapy for you.

7.) Don’t prioritize convenience over quality. Insurance and location are two conveniences that potential clients can over-emphasize. If you find the perfect therapist, but he/she doesn’t take your insurance, it is very likely worth paying out of pocket for services and checking into your out of network benefits to see if you can get reimbursed. If you find the perfect therapist, but they are not located close to you, the commute is worth it. Plus, you’ll get some extra time in the car on the drive home to reflect further about your session.

8.) How did you feel when you interacted with your potential therapist? This evaluation requires a bit of intuition. Were you comfortable? Did you feel like this person could help you? Were you concerned about their professionalism? If you left the interaction with all your questions answered and feeling good about the therapist, that’s a good sign you will work well together.

9.) Don’t settle. If you had high hopes for a potential therapist, but they left you feeling like something was missing, don’t ignore that concern. Keep the search going. Even if you start with a therapist, and you’re a couple sessions in, if you don’t like the dynamic, you are able to end therapy at any time and look for another provider.

If you have questions about finding a therapist and/or what to look for, I’d love to chat with you. Please give our office a call, and we can discuss further.

-Lindsey-

“Just breathe.” We hear this expression a lot, especially when we’re worked up. But why do we encourage breathing to calm down? Turns out there is a physiological process that happens when we focus on our breath that can truly calm our emotions and bodies.

A Crash Course in Anatomy/Physiology

Your autonomic nervous system is comprised of two components: the parasympathetic nervous system and the sympathetic nervous system. Each is responsible for a different function. The parasympathetic nervous system is responsible for feelings of calm and relaxation while the sympathetic nervous system is responsible for agitation and arousal. This is where the fight or flight response lives. Both branches of the autonomic nervous system can’t be activated at the same time. It’s one or the other that is operating at any given moment. Breathing is a means to activate the parasympathetic nervous system and induce relaxation.

How to Breathe Mindfully

We breathe all day every day, and it’s such an automated process, we hardly notice it. This type of breathing isn’t going to make us feel calmer. When we breath to relax, it’s an active process that requires attention and focus on our breath. This type of breathing is called mindful breathing. Our minds like to wander and sometime race with thoughts. In mindful breathing, our mind is attentive to each individual breath and attune to every sensation involved. We notice the air entering our nose, filling our lungs, expanding our rib cage, and exiting our bodies. When our mind wants to wander, we notice, and bring it back to focusing on the sensation of our breath.

Options for Mindful Breathing

Mindful breathing can be done in a variety of ways. Below are a few options you may want to experiment with:

• Some people engage in mindful breathing with counts. They count slowly 1-2-3-4 to inhale and slowly 1-2-3-4 to exhale. Other people like to breath in with a count of 1-2-3-4-5, hold the breath for a count of 1-2-3, and breath out for 1-2-3-4-5. The options for counts are limitless. Create a count pattern that feels good to you.
• Words/mantras paired with mindful breathing can increase relaxation as well. Some people like to breath in, say a peaceful word like “calm” or “relax,” breath out, and repeat the word.
• Picturing a peaceful scene can also be relaxing. Some people focus on an image in their mind of a tranquil scene as the engage in mindful breathing.
• There is also the most basic version of mindful breathing where we just observe. We don’t try to change or influence our breath. We just let it be and notice if it’s short or long, deep or shallow.

If you have questions about mindful breathing or want to engage in training, I’d love to chat with you. Please give our office a call, and we can discuss further.

-Lindsey-

“Unprecedented,” “Scary,” “Overwhelming,” “Surreal,” “Uncertain,” and “Stressful.” These are the words used most commonly by my clients to describe the impact of Coronavirus. Everyone has been affected by Coronavirus in some way, and some people have been impacted more than others. The concerns Coronavirus has created are profound, and one of those concerns is the impact of this pandemic on people’s mental health.

The Risks

The new world we are living in comes with elements that can contribute to mental health issues:

• Stress-Stress is a precursor linked to several mental health problems including depression, anxiety, and PTSD.
• Unemployment-Work gives us structure, purpose, connectedness, and even enjoyment. With these benefits gone, people can feel like there is a major void in their lives.
• Financial Concerns-Especially if you’ve lost your job, there is concern about how to pay rent, bills, or unexpected expenses.
• Isolation-Social distancing is the new norm, but isolation or minimal connection with others feeds depression and anxiety.
• Loss-We feel disappointment and sadness from all sorts of cancellations including trips, school, weddings, graduations, family events, etc.
• Illness-When we don’t feel physically well, our mental health tends to decompensate as well.
• Damaged Relationships-If you’re quarantined with others, you may be getting on each other’s nerves which can lead to hurtful statements and conflict. For other relationships outside the house, decreases in contact may compromise the connection.
• Worry-Whether we’re concerned about ourselves, family members, our communities, or the world, worry is a form of stress that can take its toll.

Appropriate Concern vs. Anxiety

The current circumstances warrant concern. Concern is appropriate, whereas anxiety is unhelpful. Unfortunately, people have a tendency to amplify their concern and induce anxiety. As a Cognitive Behavioral therapist (see August 2019 for a quick introduction to CBT), I help clients examine what it is they are saying to themselves that is causing unnecessary anxiety. We work to change those thoughts to be more neutral or objective, and thus the restructured thoughts produce less anxiety or a different feeling altogether. Let’s look at an example:

Anxiety-Producing Thought: Coronavirus is an utter disaster. We will never get out of this. This is going to destroy our world. I can’t handle this!
Feelings: anxiety, panic, hopelessness, despair

Restructured Thought: This is a challenge, but we have faced adversity and been resilient in recovering from it. This will end at some point, and we can heal from the damaged that’s been caused by Coronavirus.
Feelings: hope, motivation, calm

As you can see in the example, the restructured thought acknowledges the challenges of Coronavirus, but imparts a message of getting through this tough time. On the other hand, the anxiety-producing thought, does nothing but fuel negative feelings and make us feel powerless in this situation.

Is Therapy Even an Option Right Now?

The short answer is yes. Some therapists are seeing clients in-person with precautions (extensive disinfecting, sitting more than 6 feet apart, and not trading items that could have germs on them). Attending a therapy session is considered a “Healthcare Operation” which falls under an “Essential Activity.” Essential activities are exempt from the Larimer County stay-at-home order. So, long story short, people can visit their therapist’s office if they’d like.

Other therapists are offering telehealth or teletherapy services. Telehealth is like Skype where you can interact with your therapist through your phone or computer. With this format, you can stay in the comfort and safety of your own home and still participate in counseling services.

People need support more than ever right now, and therapists are prepared to help you through this difficult time. At Evolve Counseling Services, we are offering both in-person sessions with precautions and telehealth.

If you are struggling with the stress of Coronavirus and want to work through it in counseling, we’d love to offer my support and help. Please give our office a call, and we can discuss further.

-Lindsey-

The main therapeutic approach we use at Evolve Counseling Services is Cognitive-Behavior Therapy (CBT). If you need a quick introduction to this modality, check out our blog from August 2019 titled “Cognitive Behavior Therapy.” In CBT, clients examine their problematic thoughts and work to restructure them to decrease the frequency and intensity of negative emotions. Cognitive distortions are patterns of thinking that are inaccurate, harsh, or negative. It’s important clients recognize these distortions in their thinking and work to dispute them. A brief list of common cognitive distortions is outlined below. Do you recognize any of these patterns in your thinking?

Common Cognitive Distortions

Selective Abstraction

You ignore the total context of situation by only focusing on the negatives and discounting the positives.

All or Nothing Thinking (Black or White Thinking)

You see things as absolutes; there are no in-betweens.

Mind Reading

You assume others are thinking the same thing you are (that they share the same critical thought you’re having), or you assume you know what others are thinking (that they hold a negative evaluation of you).

Double Standard

You hold yourself to a higher standard than everyone else.

Catastrophizing

You expect the worst case scenario to play out consistently.

Labeling

You make a global assessment of yourself and label yourself negatively.

Magical Thinking

You think everything will be better when ___________ (you’re thinner, smarter, richer, when you get a new job, and so on).

Should Statements

You judge yourself and criticize yourself for what you should be doing (usually an unrealistic expectation)

If you recognize these patterns of thinking in your thought process and want to work on them in counseling, I’d love to chat with you. Please give our office a call, and we can discuss further.

-Lindsey-

In honor of Valentine’s day, I thought devoting a blog to relationships would be in order. It’s important to know what you need in a relationship to make it work, but it’s as equally important to know what to keep out of relationships to keep them healthy. This is essentially a blog about what not to do in relationships based on the work of John Gottman.

John Gottman is a leading researcher in the field of relationships and divorce. He has studied couples for decades and identified several behaviors that will kill a relationship. He calls these “The Four Horsemen of the Apocalypse.” The more often these appear in the relationship, the more likely it is the relationship will end.

1.) Criticism

Criticizing is attacking your partner at the core of their character. It’s a global assessment of them as a human being (i.e. “You’re selfish!”). It makes the recipient feel assaulted, defensive, rejected, and hurt. Criticism can become pervasive, and when that happens, it sets the stage for the other horsemen to appear.

2.) Contempt

Contempt will follow if there is frequent criticism in the relationship. This is the most damaging of all the horsemen. The purpose of contempt is to hurt, and it manifests itself with mean-spirited communication including disrespect, mocking, sarcasm, ridicule, name-calling, eye-rolling, and scoffing. The recipient will feel despised and worthless. Based on Gottman’s research, contempt is the single greatest predictor of divorce.

3.) Defensiveness

We all do this. It’s generally a reaction to criticism where we feel unjustly attacked. We make excuses, deny, or play the victim. This strategy is not usually successful and can escalate frustration in our partner. It sends the message we won’t take accountability for our mistakes and don’t take their concerns seriously.

3.) Stonewalling

Stonewalling happens when the listener disengages from the interaction, shuts down, or stops responding to their partner. This tends to appear as a response to contempt. Stonewalling indicates a person has hit their limit and reached a level of emotional and physiological escalation that they can’t continue in the interaction in a productive way.

If you are struggling with a relationship and want to work through it in counseling, I’d love to chat with you. Please give our office a call, and we can discuss further.

-Lindsey-

Our therapist, Ben has extensive experience working with men from adolescence to later adulthood. He has developed a specialization in Men’s Issues that will be a focus of his clinical work at Evolve Counseling Services in addition to working with clients who are dealing with depression and anxiety. Below is a summary of how Ben approaches therapy with men:

1. We will talk like regular people: Men often speak in ways that are down to earth and to the point. No need for vague, flowery statements. I always thought of what I do as just a sincere conversation between everyday people, no different than friends catching up during a lunch break. Humor is often a part of my time with people. Not everything needs to be serious and learning to laugh at something is often good for us.

2. Keep it practical: Men often think in practical, cause and effect terms. When our car breaks down we don’t “feel” like the head gasket is blown, we understand the mechanical relationships between all of the parts and see what isn’t working. Problem solving for personal challenges are no different. It will be obvious how any tools used in therapy can make your situation better.

3. A hyper-focus on emotion is not essential: Two common stereotypes about therapy. 1.) Therapy works by being intensely in touch with your emotions. 2.) You have to talk about the hardest and most personal things in your life for therapy to work. Let’s address these. A high emotional focus may work for some people but there are so many more options to improve your life that don’t involve intense connection with feeling or dwelling on the past.

4. Talk about what you want to: Your time in therapy is just that, YOURS! I’m here to help you with the projects that you want to tackle. No need to talk about things that are too personal. I’m not here to “fix” you for someone else. I’m in your corner. Period.

5. An understanding of men’s issues: It is statistically supported that men do face unique challenges. For example, men more commonly receive threats of physical violence, work dangerous jobs, and spend more time away from family for work. Being a man has its benefits and burdens but the fact that men are facing such daunting challenges speaks volumes to our nature and implies we experience stress unique to us. Not only have I taken the time to understand what is unique to men, but I have lived much of it myself.

If you are interested in addressing Men’s Issues and working with Ben in therapy, we’d love to chat with you. Please give our office a call, and we can discuss further.

-Lindsey-

This time of year can be tricky. It’s been labeled “The Most Wonderful Time of the Year,” but for a lot of people that doesn’t seem to be the case. Many of my clients note increased stress and depression this time of year. Here are a few things you can do to help keep joy in the season.

Lower Your Expectations

So many of us get caught up in throwing the perfect get together, or finding the perfect present, or cooking the perfect meal that we’re inadvertently putting intense pressure on ourselves. That pressure builds, and what’s supposed to bring happiness, ends up being an exercise in stress. Things don’t have to be perfect. It’s OK that they are decent or good enough. The pursuit of perfection will make you overlook the real purpose of what you’re intention is-nurturing relationships and enjoying your loved ones. Instead of focusing on perfection, focus on the connection with others, and if the holiday meal is overcooked, oh well.   

Be in the Present

Because this time of year demands so much from us, we tend to get caught up in everything we have to do, and life becomes a never-ending checklist. Before we know it, the season is over, and we feel like we missed it. As much as possible, try to be in the present moment and focus on what’s going on in front of you. Yep, I’m talking about mindfulness. If you need a quick refresher on mindfulness or a brief introduction, read the blog from June 2019 titled “What’s Mindfulness.” This skill is particularly helpful during this busy season. It will keep you enjoying the present moment instead of being subjected to all the stressors floating around in your head.

Reconnect with what the Season Means to You

This time of year means different things to different people. For some, it’s about spending time with loved ones and deepening relationships. For others, it’s an especially spiritual or religious time that requires additional devotion. Whatever the reason, try to clarify what this season means to you and live those values. When we have meaning attached to things, we tend to feel more fulfilled. Instead of a season of stress and aggravation, focusing on purpose can bring a sense of satisfaction and contentment.

If you are struggling with holiday stress and want to work through it in counseling, I’d love to chat with you. Please give our office a call, and we can discuss further.

-Lindsey-

Coincidentally, many of my clients have been dealing with grief recently. This prompted me to learn more about it, so I picked up The Grief Recovery Handbook by John W. James and Russell Friedman to see if there would be anything helpful for my clients contained in their writing. Several concepts stood out to me, and I believe they are essential to understand when dealing with grief.

What is Grief?

This is a tough question, and there is no one universal answer. James and Friedman conceptualize grief as the normal and natural emotions one experiences in response to a loss event. These can be any emotion, and often, they are contradictory. For example, it’s quite common to feel sadness as well as relief when a loved one dies as the result of a chronic illness. The authors highlight there is no “normal” grief process. Grief is unique to each individual, and whatever that person feels is appropriate.

What we are told about grief

Grief is complicated by the fact that societally, we are not well-trained to handle it. Typically, well-meaning friends and family will try to provide comfort and reassurance by making statements that are not helpful. James and Friedman distill the messages we receive about grief into the following:

• Don’t feel bad
• Replace the loss
• Grieve alone
• Just give it time
• Be strong for others
• Keep busy

They explain that these messages stifle the grief process. How many of these messages look familiar to you? What have you been told about grief?

The G Word

Many of my clients express guilt after a loss and beat themselves up for actions or inactions they took. I hear consistently “I should have…” or “Why didn’t I…” James and Friedman call guilt “The G word” and explain many people experience it after a loss; however, guilt is not needed in these situations. They break down the definition of guilt which includes INTENT to hurt someone. If there is no intent, they argue that guilt is not warranted and does nothing except exacerbate an already painful situation. They explain that people may wish they had done things differently or have regrets. There are things they wish they could have said or actions they would take back. However, as long as there was no intent to hurt their loved one, guilt does not need to be a part of the grief process. James and Friedman point out this piece of information is generally helpful for grievers to know as they can free themselves of the guilt and focus on healing from their loss.

If you are struggling with grief and want to work through it in counseling, I’d love to chat with you. Please give our office a call, and we can discuss further.

-Lindsey-