Author: Megan Jernigan

Here we are in the year 2020 and some things just have not changed.  For so many, there is a stigma around seeking and receiving mental health counseling services.  For some populations of people, the stigma may be higher.  While I am not going to get into details on sex, race, culture or any other specific factor, I am going to discuss some of the considerations behind the stigma and how we can overcome together.

It is estimated that about one in five individuals in our country suffer from some type of mental health issue (https://www.nami.org/mhstats).  With the number of individuals experiencing mental health needs being so high, you wouldn’t expect the barrier of stigma to be as prevalent as it is!  For some people there is shame and hurt that comes along with receiving mental health care.  You may feel that you become less of a person in the way that you identify yourself (male, Asian, Christian, etc.) Some families may have stigmas around associating with family members who have mental health needs.  How hard it must be to seek out help when you have been made to believe that there is something wrong with you if you do or that you are a lesser part of the family for doing so.  For many there is a fear of isolation from others.  Fear of isolation from people, institutions, and legal matters.  If you are in the military or were raised in a military family, you know this well.  Other careers may reject you too.  If you are adopting children, you may fear the rejection of a placement.  For some there are fears about losing rights as a result of having a severe mental health need.  There are so many reasons that one may feel the realness of stigma associated with mental health care which can keep them from obtaining the support and care that they need.

So, how do we change that?  Awareness is a great start.  Even though we are at the end of May and Mental Health Awareness Month, we can still help others know about the great needs of others and that it is okay to seek out help.  We can share our own stories. We can help others know that it is possible to have a mental health need and receive mental health care services without becoming less of a person.  We can help others by showing them they are not their disability and that they shouldn’t live in isolation by caring about them in ways they understand their value and need in society.  We can provide information about about support groups and join in alongside those we care about to share our support for them.  We can discuss treatment options with others and address the stigma by being real and providing real information.  We can check up on those we care about to see how they are doing while starting and following through with mental health care treatment, which will show others that this is not an issue to be ashamed of.  If you are someone who suffers from a mental health issue or suspected mental health issue, you can seek out the support from family, friends, groups, and professionals to show that you are willing to break the stigma associated with mental health needs.

If you or someone you care about would benefit from mental health care treatment, talk to them and share information about treatment options, providing them with referral sources.  Share with them in ways that they will be able to overcome the barrier of stigma.

Since this whole COVID-19 Pandemic, I have had several clients that I work with discussing the changes they feel they are going to make as a result of having gained some insight since this experience.  I heard one mom state that she was never going to be the same, and that she was going to always have a stocked closet of toilet paper!  For some, it has been a time to slow down and increase self-care.  For others, it has been eye-opening to spend more time with their family members and realize what changes they need to make as a result.  Regardless of what your experience has been, it is likely that you will have a desire to make some sort of change.  With this being a hot topic right  now, I figured it was a good idea to write a blog focusing on the stages of change.

I learned about he stages of change when I was working with adults in a substance abuse program, and the developers of this theory or application are Carlo C. DiClemente and J.O. Prochaska.  And, even though the concept is mostly used in substance abuse treatment, it can be applied to other areas where one wants to see change.  These are the stages of change: precontemplation, contemplation, preparation/determination, action, maintenance, and relapse/recurrence.  In precontemplation, the individual is not yet willing to or unable to make a change.  Then, in contemplation, the individual is able to see the possibility of change but is somewhat ambivalent about it.  During preparation/determination, the individual becomes committed to changing even though still considering what needs to be done.  An individual in the action stage would be taking steps towards change but not yet having mastered the change itself.  In the maintenance stage, the individual, has achieved their goals to change and is striving to maintain that change.  Lastly, an individual will face either graduation/termination or possibly a relapse/recurrence.  It is obvious that at the graduation/termination stage, the individual has achieved their goal long term and has had no recurrence in the behavior or symptoms.  Then, in the relapse/recurrence stage, an individual would be experiencing the original problem or symptoms and facing consequences or determining what to do next. As the image shows, then the stages of change would cycle again.

Considering the stages of change may help as you reflect on where you are as you consider what things you feel you need to change.  Due to COVID-19 you may have learned that you need to walk more, spend more time engaged with family and off of social media, spend more time in meditation and prayer, or give up some bad habits.    Hopefully, this can help you or someone you care about move towards making lasting changes.  And, if you feel stuck or are not knowing how to make positive changes, it is always an option to reach out to a professional for counseling services.

As we are continuing to adapt to the impact that COVID-19 has had, we sometimes find ourselves experiencing one or more strong emotions.  Fear is a common feeling, as we may worry about the health of ourselves and loved ones, or we may even fear not being able to obtain adequate supplies of necessary goods.  Anger can also be a common emotion, and we may feel angry about the spread of the virus, restrictions put in place by the government, or even at the political messages surrounding the pandemic.  You may also find yourself with displaced anger, during these times, which you may direct at the children, spouse, co-worker, or pets.  Denial was the reaction that many had initially when the spread of the virus became more of a concern in America, and some people will continue to be experiencing denial.  When experiencing both denial and anger, you may experience resistance.  You may find yourself going out of your home to hang out with friends or out shopping for more than essential items in order to feel a sense of control over the situation. Acceptance is another reaction, which you may experience after experiencing the other emotions or even going back and forth between other emotions.  While it is normal to respond and experience any or even a mix of these emotions and reactions, it will impact you and those whom you surround yourself.

You may find resolution in the comfort of your family, spiritual/religious beliefs and meaning-making, or other activities that allow you to refocus your thoughts.  You may find that it helps to reduce the anxieties by considering what you can and cannot control and allowing yourself the freedom to respond to only the things which you can control, such as using good hand washing and social distancing.  For others, this time may bring a sense of overwhelming stress, confusion, anxiety, and lots of other feelings.  If you find yourself needing help, reach out to a counselor. Many practices  are utilizing tele-therapy at this point.

*The 5 Stages of COVID-19 Grief was used with permission of Parenting and Family Solutions therapy practice in Pennsylvania, USA (https://parentfamilysolutions.com/)

This image and information was made shareable and provided by Parenting & Family Solutions

All of a sudden, everything is moving digital.  This blog post is focusing on ways to move your therapy practice to a tele-therapy practice. Thank goodness that the Corona Virus Pandemic happened during the 21st Century!  There are so many people whose income is going to be impacted in a horrible way, but therapists are among the lucky workers who can move to a fully virtual setting.  And, your client’s are lucky that they can continue to be seen by you, continuing to receive the care that they need the most during stressful times such as these.  Let’s look at the ethical considerations, platform and usage possibilities, and barriers that the people you serve may have when implementing tele-therapy.

First of all, every state, licensing board, insurance company, and so on will have different ethical views. Of course, there have been changes since the Corona Virus changed our country in the past week!  It is always best to consult with your licensing board, your liability insurance carrier, and the panels for the insurance you are in network with before moving forward.  It is a good idea to take a few CEU’s on tele-therapy practice or listen to some podcasts and webinars.  If you work for a company that provides you access to Relias Training, they offer a few courses in tele-therapy or tele-health.  There are tons of online resources, too, and many podcasts available.  The National Board of Certified Counselors offers CEU’s towards a specialty area, if you are interested in that.  There are a few ethical concerns that would apply regardless of what state you live in, whom you serve, or what area you happen to be licensed.  Confidentiality is one of those ethical considerations, and you will need to ensure that your area for work is free of distractions (like those kiddos who are also home now that everyone is home bound), doesn’t leak sound, and uses HIPPA compliant technology to communicate with clients.

Speaking of technology, there are tons of ways to incorporate technology while still being HIPPA compliant.  If you are looking for short-term teletherapy options, there are platforms like Zoom that are HIPPA compliant and are great for videoing, screen sharing, and even giving control to users.  Zoom has a whiteboard that younger clients would love to interact with you on, as they can color images, write or text, and share things with you.  There are programs, like Smart Notebook, that run well in Zoom as well, and you can incorporate even more interactive activities into the sessions with younger clients.  If you are looking for a more long-term solution for your teletherapy practice, there are quite a few great video platforms that offer the ability for the clinician to make documentation, like notes and treatment plans, and for clients to make payments.  Typically, scheduling is easy.  Some platforms allow only the therapist to schedule and others allow either therapist or client to schedule.  The therapy platform that I use in my own private practice is TheraPlatform, and I recommend this site as it has many options that I value in my practice and pricing is fair.

Finally, let’s address the barriers that your client’s may have with using teletherapy.  For some older individuals, the thought of using technology will be a barrier, but this can be addressed through a little care in helping them download or search and save websites to use.  I will be honest that most of my teletherapy clients are millennials, who are confident using the technology.  Even so, though, there can still be barriers, such as client’s not being comfortable on video.  This is when you can explore the use of telephonic sessions for sessions that will not require videoing.  Even teenagers, who are super comfortable with the technology, may have barriers, such as finding it easier to be distracted by other social messages coming in during the video session, so it is best to address these barriers by creating interactive sessions that will help to engage them.  And, like any other therapy practice, there are the typical barriers such as priority, scheduling, finances, time, and other things that you already know how to address.

Even though moving into a virtual world of therapy can be frightening or even feel inappropriate for such a personal type of work that we do with others, so much research shows that teletherapy can be just as effective as the typical out-patient, in clinic therapy.  If you are considering moving your therapy practice to teletherapy in order to  help curb the spread of Corona Virus and ensure the safety of your clients, then I would encourage you to find out exactly what your state, licensing board, and insurance requires before getting started; take a few courses or webinars to better prepare yourself; and consult with some professionals who have been using teletherapy in your state, and in your specialty area or licensing credentials.  If you are still sitting on the fence, why not take a poll from your clients to see how they feel about the matter.  I hope that this blog post was helpful to any therapist considering moving to teletherapy!

After the much talked about Superbowl 2020, I got to thinking about how New Year’s resolutions may be starting to fade away for many of us by this time.  I really started to think about why we make these New Year’s resolutions and why change is so hard.  We all have things to improve on, be it to exercise, eat better, pray more intentionally, spend time with family, engage in self-care, stop smoking or stop drinking, and on and on. Do you ever wonder why we get stuck doing the negative things, our bad habits?  Even though we know we should do better, we struggle and find ourselves stuck in a rut.

For most of us, we set our New Year’s resolution and start of really strong during the first month of the year.  We have paid for that gym membership, so we better start going, right?  I remember the year that I paid for a gym membership and went something like two or three times.  I fell off really quick that year!  I was reading up on habits and decision making after thinking about writing this post, and I was really interested in the triggers that are associated with our habits.  “Triggers” is such a buzz word these days, but basically things that occur prior to our action and cause us to have a memory (not all memories are vivid images either) of something.  For both our good habits and bad habits there are triggers associated with what we chose to do.  So, how do we then go from what we were doing that was the bad habit to change things to a become a better self?

Just like with our bad habits, our good habits will require some kind of trigger or antecedent.  Let’s think about the 2020 Superbowl for a minute.  Football, lots of food, a crowd of certain people, and this crowd of certain people may behave and make certain choices are all the triggers or antecedents.  If you had decided to stop drinking or stop drinking too  much this past New Year’s then you may have been triggered by the football game, because you always drank cold brewskies while watching and cheering on your team.  Or, let’s say you wanted to eat healthier this year, and you were at a party that served up some amazing food… you got it, triggered again.  Here is one more example, if the New Year’s resolution you set was to stop gossiping about others, and you were around your best friends during the party and this is typical behavior in your friend group, you had a trigger to engage in that unwanted habit of yours.  Now that we have lots of examples of what can trigger our negative habits, let’s try out some possible triggers for positive habits and making change really happen.

Just like the negative habits, your desired or replacement habits are going to need some antecedents.  So, how can you trigger yourself into doing what you really want to do now?  You can change your environment around, you can set things out where you will see them, you can add things in your calendar at certain times of day, you can have friends support you and hold you accountable, and you can pair new things with your old triggers.  Let’s say that you want to start taking a multi-vitamin but you are having trouble remember to take it each day.  You could try any of the above ways to get that trigger.  For example, you could change the environment by setting the pill bottle out on the breakfast table (if safe to do so for those in the home).  You could try setting a reminder on your alarm clock when you first wake or having a family member who already takes one a day to ask if you have had yours yet.  If you brush your teeth upon waking, you could set the pill bottle by your tooth brush (if safe again).  There are lots of ways to set the scene so that you can be successful with adding on new and positive habits.  Good luck in 2020 as you make those positive changes!