Find the Right Fit in Therapy

 

Written by: Shae Chisman, MFT-I

No, I’m not talking about skinny jeans. I’m talking about your therapist. Although finding the “right” therapist can be just as frustrating as finding that perfect pair of pants. No “sucking it in” should be necessary when finding someone to courageously share your shadow moments with. Feeling safe, accepted by, and challenged by your therapist are all essential to overcoming whatever ails you.

Those of us who have participated in some sort of mental health counseling know how important it is to actually like your therapist. Research shows that the client-therapist relationship is known to be one of the most important factors for contributing to client change (Blow and Sprenkle, 2001). So, if you find yourself feeling judged, unsupported, and disliked by your therapist – chances are you may not have a successful outcome in therapy.

 

Here are 7 signs that your therapist is right for you:

  1. Your therapist is warm, welcoming, and portrays what we call unconditional positive regard. This means that they should be accepting of who you are and what you bring to the therapy room.
  2. You feel safe being completely honest with them – no matter how shameful the truth may be. Therapists see and hear it all. Your story is unique and essential to your journey – and therapists are trained to handle your truth without judgement.
  3. You feel challenged. I know we just described a therapist who seems coddling and nurturing – but part of nurturance involves confrontation. Many of us have conditioned negative emotional responses to confrontation and part of your therapy journey must involve looking at yourself with clarity. Therapists are here to be a mirror to show how maladaptive patterns have prevented you from being your best self.
  4. All emotions are welcome. Laughter. Shouting. Sobbing. Your therapist should be capable of handling your emotions – as well as their own. In your most vulnerable moments, your therapist should remain supportive and open to whatever comes up. It can be messy – but that’s part of healing.
  5. They collaborate with you regarding your own treatment. YOU ARE THE EXPERT ON YOUR OWN LIFE. Therefore, you should be involved in creating your own long-term and short-term goals for treatment. If you have a therapist who has created therapy goals without your consultation – and they do not align with what you want out of therapy – RUN!
  6. They empower you to make decisions on your own. This is one of the biggest misconceptions about therapy – that therapists should be advice-givers. While at times, making referrals and resource suggestions are completely necessary – your therapist should not be telling you what to do with your life. They should be helping remind you that you have the capability to overcome your problems.
  7. There is an expectation that at some point in the near future, you won’t need therapy anymore. In the same vein as #6 – you should be empowered by your therapist to make change and eventually thrive with use of a natural support system. A good therapist does not want you to be reliant on them. We want to help you get un-stuck – not need us eternally. In the beginning stages of therapy – conversations regarding what it would look like to not need therapy anymore should take place. That way, you both have a picture of what needs to take place to get you back on track.

 

Bottom line : you should be happy with your therapist and if not – you have the power to let them know what you need out of therapy. And if they cannot give that to you – find another therapist.

 

Georgia HOPE offers in-home and online therapy (with AMAZING therapists) for a multitude of presenting problems including:

  • Anxiety
  • Depression & other Mood Disorders
  • ADHD/ADD
  • PTSD
  • Relationship Troubles
  • Substance Use
  • Eating Disorders
  • And more!

 

Carpe Diem or Seize the Day Before It Seizes You…

By: David Baker, LPC
Clinical Director
Georgia HOPE

 

As I’ve said before I realize this blog is available to anyone who wants to read it and I try to keep it relevant to anyone who reads it – helpers, people seeking help from helpers, the general public. Hopefully this post will be relevant to all those audiences as well, but it is admittedly focused more on helpers this time. However, keep reading if you would like a “behind the scenes” glimpse of a few of the challenges helpers face on a daily basis.

I would like to say this post is going to be about time management (and mostly it is), but in the interest of transparency it is really going to be about more than just that. You’ll see what I mean in a minute…

I think one of the most difficult challenges for me as a helper (and maybe for others of you as well) is being present when I am sitting with someone to whom I’m providing help or with whom I’m completing an assessment.  I often find that my mind is on a million different things like: “Did I get all the paperwork signed?”, “Am I late for my next appointment?”, “Was there an authorization for this appointment?”, “Will I have time to finish all my notes today if I try to schedule one more appointment?” etc. There are many obligations we face as helpers and they can often distract us from what we all want to do – provide help!

I am not the poster child for organizational skills and the concept of managing time in my mind is akin to trying to hold five pounds of loose sand in one hand without losing any. But I have learned a few things over the years about prioritizing the helping process which have improved my ability to focus on the person sitting in front of me who has come to me for help. The most important thing I’ve learned is that what I make my priority is what I will spend my time doing.

I have learned that there are three priorities I have to pay attention to every day. And if I pay attention to them every day, then at least my professional life as a helper stays mostly organized so that I am able to stay focused on the people to whom I am providing help. They are:

  1. I need to help the people I am supposed to be helping
  2. I need to document that I have helped the people that I am supposed to be helping
  3. And I need to make sure that my company gets paid for the help I provide so that I get paid for the help that I provide.

Let me tackle the third priority first because it is probably the most controversial. I like helping people. It is why I have spent a lot of time learning how to help and what kinds of help work best. This is why I got into this field in the first place. If I could do therapy for free (and without the paperwork…), I probably would because I like it. Unfortunately, like so many helpers, I have not had the financial freedom to do a lot of “pro bono” work. The truth for most of us, is that we need to get paid for what we do. More than that, we should get paid for what we do because we have put a lot of time and effort into learning what we know so that we can provide the help we provide.

Add to this that most companies who provide mental health services operate on very thin financial margins – reimbursement for services from insurance companies have not risen in many years, but service costs continue to go up. So being as efficient as possible in service delivery is really important so that we can afford to continue to provide help. And efficiency has some benefits:

  • Obviously, the benefit to a mental health services company is it helps the financial bottom line.
  • The benefit to helpers is that being efficient in providing help reduces the amount work hours staff have to put in outside the face to face help they are providing.
  • And finally, and most importantly, the benefit to the people we help is that there is very strong incentive to make sure that the helped are included in all aspects of the help they receive – there is a lot of research that supports the efficacy of this.

So helpers have to pay attention to things like whether the service they are providing has a payer and whether they are being efficient in scheduling appointments (more on that in a minute) and whether they’ve completed all the documentation needed for a payer to pay (more on that in a minute). We do all of this because we want to be able to keep helping people!

So with #3 out of the way let me go back to the first priorityhelping the people I am responsible for helping. Practically speaking this means every day I need to make sure that I have scheduled appointments with the people I need to see that day and that I have an idea of what I am going to do at each appointment. Sounds simple enough, but we all know that life is not always simple. There are always unexpected “fires to put out” that interrupt our perfectly laid out plans. That is why we need to schedule for the “fires” too. I can guarantee you that if you do not have a schedule for the day, than you will not accomplish that schedule. I will go even further to say that if you do not have a next appointment scheduled for all the people that you are helping, the likelihood is pretty low that you will see them as often as you want or need to. So if you want to make sure you are on time and have the time to “put out the fires” that invariably come up, then have a schedule which allows you time for your regular appointments and also for the “fires”. The best way to do that is to schedule so that you to get ahead and stay ahead. In the helping profession being ahead is a requirement if you want to stay caught up. Or said another way don’t put off till tomorrow what you could have done yesterday. Trust me, you are going to need any “extra” time you can get.

Finally (and sort of out of order), we come to the second priority – documenting the help that is provided. Some helpers may say “If I provided the help I was supposed to provide, why does it matter whether I write it down? I did my job didn’t I?Or Why is my helper so stuck on writing down with me what we did in our session today? Isn’t it enough that we did stuff that helped me today?” The most obvious answer to these questions is that if it is not documented, then (as I mentioned in the third priority) the provider doesn’t get paid for the help they provided – insurance companies need a record to justify payment. Put more simply if it did not get written down then it did not “officially” happen. But there are some other equally important reasons for documenting:

  • Documenting collaboratively between the helper and the helped ensures that the helper and helped are on the same page about how the helping is going and that the help is the right help.
  • It also removes the unnecessary “mystery” around what the helper is writing down and includes the perspective of the helped in their own record.
  • Documentation records the “story” of progress that is being made through the provided help. That’s important because the story of progress helps the helper and the helped to know when help is no longer needed.
  • And a final reason for documentation is that it helps both the helper and the helped remember what happened in the last session and what might need to happen this session. I don’t know about you, but for me without something like a note to jog my memory I have a hard time remembering the help I provided the previous session and how it was received. For me that difficulty is multiplied by the number of people I am responsible for helping each week. And we need to remember so that we know how to plan for the next session.

There are many other good reasons for documenting what goes on when help is being provided. The point of this post is that paying attention to documentation like the other two priorities should not be an additional “chore” to the help you provide.  It is an integral part of the help you provide. Paying attention to all three of these priorities is helping.

There’s no guarantee that if you to address each of these priorities everyday that you will live a stress-free professional life – I’m not sure if that’s even possible. However, if you give equal importance to each of these priorities every day, it’s very possible that you will find that most of what you need to get done each day is getting done and that the person you are helping is actually getting helped because you are able to the pay attention to them you should be paying. That sounds like a win-win to me!

Quilts, Cars and Integrated Care

By: David Baker, LPC
Clinical Director
Georgia HOPE

NOTE: You may have noticed that this blog seems to mostly be addressed to people who are providing helping services rather than on the people who receive the help. There are a couple reasons for that. The first reason is that I am a “helper” (in my case a licensed professional counselor) so in part that is the point of view I see the world from. As a clinical director for our company it is also my job to help helpers become better helpers.

The second reason my blog posts are focused the way they are is because I think it’s important for the professional process of helping people to be transparent. There shouldn’t really be secrets between those who help and those who are being helped about the process of helping.

So with that being said I do intend to address both the helper and helped points of view and I think this next post is sort of addressed to both helpers and the helped.


Here at Georgia HOPE we have really adopted the integrated care approach to providing mental health services because we believe that addressing the needs of the whole person is the best way to provide quality care.

We believe so strongly in this approach that, in 2016, we became certified as a “Patient Centered Specialty Care Practice” for Behavioral Health by the National Committee for Quality Assurance. We are very proud of this certification.

But what does it mean to be a provider of “integrated care?” Or, for that matter, what does it mean to be a client or patient receiving integrated care? I did a Google search on the term “behavioral health integrated care” and I came up with 1,930,000 + results. Clearly there’s a lot that’s been said about what integrated care means and there are a lot of different points of view on the “what” and the “how” of providing this type of care.

If you are like me, the wealth of information gets a little overwhelming. What sometimes works for me is to have a metaphor for what a complicated idea like this. So there are a couple pictures I’ve been thinking about that help me visualize what it means to integrate mental health help with other kinds of help. Maybe they’ll make sense to you also.

THE QUILT METAPHOR

A few years ago a friend gave my wife and me a video and a book about a group of women who make quilts in a place called Gee’s Bend in Alabama. (If you’re interested in their story, you can go here.) The amazing thing about how these quilts are constructed is that most of them took more than one person to make. That is because quilts require a variety of different skills to produce.

You need to have an eye for how colors and patterns work.
You need to know how to cut out the pieces of the quilt so that they will look right when they are all sewed together.
You need to have sewing skills
You need to know how to join the quilt together
You need someone who finds the materials out of which to make the quilt.

And I’m sure there are other skills I’m not aware of. The point is making a thing of beauty is not a simple process. While there are people who may possess all the skills needed for making a quilt, it’s often the case that a quilt is produced by a group rather than by a single person.

In similar fashion, the integrated care approach to providing help for a whole person builds on this idea that producing beautiful and satisfying help relies on more than just one set of skills. If I’m only good at cutting out the pieces of the quilt and not at the sewing together or quilting of those pieces, then the quilt I come up with on my own is not going to be very complete or satisfying. Integrated care recognizes the importance of making sure that all the right people with the right skills are present and working together so that the resulting help that is provided is complete and has as satisfying a result as possible.


THE CAR METAPHOR

For those who are more mechanically than artistically minded, think about integrated care in terms of maintaining a car in good working order. Like quilts, cars are not all that simple. There are a variety of different systems that all need to be working well together to make sure that a car gets us from here to there. If the engine is working well but the transmission isn’t, being able to get where you need to be is not going to be possible. Or if everything is working but the braking system, you may be able to get where you’re going but you won’t be able to stop once you’re there. As with quilt makers there are mechanics with special skills that specialize in different areas of car maintenance and repair. You probably wouldn’t take your car to the brake specialist to get your transmission fixed or to the oil change place to get new tires.  And if the care of any of those systems is neglected, you may have a car that runs but it may not run well and it may not run safely. And it may not be able to stop…

Again, the point is that as in car repair and maintenance, integrated care requires a variety of different skills sets to make sure that the right help is provided to address all the different parts of who a person is. If I am currently experiencing high blood pressure, can’t sleep at night and have depression and anxiety, I am not really going to get well unless I work on all those issues together. If I go to see my therapist and they only want to talk about my depression, then, while my depression may decrease, my overall health may limit how well I maintain my progress in resolving my depression. Or if my primary care doctor just wants to give me medication for my blood pressure and to help me sleep, then I am probably still going to have depression. And my depression will probably keep me from being as physically healthy as I can be. And if therapy would be helpful to me but I cannot get there because I don’t have gas for my car, then I am going to need help that gets me to therapy to have success in resolving my depression. Helping a whole person usually means that my therapist and my doctor and probably others may have to work together to help me be as well as I can be and continue to stay well.

Integrated care is about looking at the whole quilt and ensuring that all the skills and materials are there to make it beautiful. It is about making sure that all the systems are running smoothly so that the whole car gets where it needs to go safely and on time.

For helpers, this means that we need to make sure that we’re not only looking at the colors we’ve selected, but are also looking at how the colors are arranged and sewed together to make a whole quilt. It means that we need to make sure that in addition to having gas in the engine that the transmission will shift out of park into drive. We don’t have to have all the skills to provide all the help that’s needed, but we need to be aware that needs are connected and the best progress is made when all needs are addressed by the right kind of helpers who are working together.

It also means that we shouldn’t forget that there are more ways to approach a need than just those on which we usually rely. Therapy is proven to help relieve depression, but so is physical exercise because the mind and the body are connected systems which rely on each other to keep both working well. So just because I am a therapist, that doesn’t mean that every need should be addressed with therapy.

If you are being helped but the help you are getting only focuses on one part of your life and not all aspects of your well-being, then tell your helper(s)!

As humans, we are all made up of physical, spiritual, emotional, intellectual aspects.  The goal of integrated care is to support our overall well-being in all areas of our lives. The goal of integrated care is not just a quilt that looks beautiful, but one that also keeps us warm. The goal of integrated care isn’t just a car that stops, but one that also goes and gets us where we are going. And sometimes it takes more than one kind of specialist working together with other specialists to make sure that happens. That’s integrated care.


 

We’re Not Gonna Take It Anymore

Or, Why We Need to Stop Calling Clients

“Non-Compliant”

By: David Baker, LPC
Clinical Director
Georgia HOPE

I know it’s probably dangerous to quote the title of a song recorded in 1984 by a band called Twisted Sister in a blog about mental health related topics because 1) it certainly dates me a bit (though I promise you I wasn’t really a Twisted Sister fan in my youth) and 2) as a protest song (and I know you’ve probably heard it and maybe even sung along with it) it makes some pretty strong statements. But I think the title and the sentiment behind the lyrics of the song make a pretty good point about not trying to force people to fit into a box they don’t belong in.

I can already hear you asking “So what does that have to do with non-compliant clients?” My response is: “A lot!” Let me explain. Most of the time when we identify a client as “non-compliant” what we are saying is “They aren’t doing what I or someone else thinks they should be doing.”

For example:

  • “They aren’t keeping appointments”
  • “They aren’t taking their medicine”
  • “They aren’t returning my calls”
  • “They aren’t using the skills I’m teaching them”
  • “They aren’t getting anything out of the therapy I’m providing”
  • Or you fill in the blank

Usually “non-compliance” has more to do with what I think my client’s unmet needs are than with what my client thinks their unmet needs are.

At the risk of giving Twisted Sister more credit than they might deserve for brilliant therapeutic insights, think about these lines in the context of the clients you work with who you think of as “non-compliant”:

“We’ve got the right to choose it/There ain’t no way we’ll lose it/This is our life, this is our song”

and

“We’ll fight the powers that be just/Don’t pick our destiny ’cause/You don’t know us, you don’t belong”

While these sentiments may be somewhat overstated (and I’m probably stretching these lyrics way beyond their intended purpose…), I think these lines make the point that people have the right to choose their destiny and when this is challenged or disregarded the response is usually to fight or flee from whoever is trying to force us to do something we didn’t choose.

So when your client is “non-compliant” maybe what they’re telling you is there’s something about the help they are getting that they don’t want to “take.” If we are accurately reflecting in treatment the unmet needs our clients have asked us to help them to address, than “non-compliance” is a non-issue as a client can’t be non-compliant with themselves.

I think these lines make the point that people have the right to choose their destiny and when this is challenged or disregarded the response is usually to fight or flee from whoever is trying to force us to do something we didn’t choose.

So, what do we as therapeutic helpers do when we our clients become disengaged from treatment? I think the first and best thing we can do is to listen. Sometimes the listening is easy because our clients are singing as loud as Twisted Sister letting us know that they don’t want what they’re being offered by us – “We’re  not gonna take it!” More often than not though the listening requires a little more skill because the communication isn’t so “in your face.”

In an article on addressing resistance in therapy the following statement was included: “…resistance is a signal that the client views the situation differently.  This requires that [staff] understand the client’s perspective.  This is usually a signal for [staff] to change direction or to listen more carefully” (http://rssw705.tripod.com/id15.html).

The point is in order to better align treatment with the client’s unmet needs we need to make sure we understand our client’s unmet needs. For our clients to stay involved in treatment we need to create the positive motivation for them to stay involved in treatment. If we haven’t asked them why they aren’t engaged, we need to. If we haven’t given them the freedom to have a different point of view than ours and express that point of view, than we need to give it. If we haven’t put ourselves in our client’s shoes as best we can and tried to understand the challenges they are facing from their point of view, than we need to. And we need to be willing to acknowledge that while we may have a lot of experience and education in providing help to other people, our clients are still the experts on their own unmet needs even if they don’t always know it. So we need to make sure that we are developing the skills to hear in all the various ways our clients are expressing those unmet needs and then help our clients tell us how we can assist them to most effectively and positively meet those unmet needs.

And we need to be willing to acknowledge that while we may have a lot of experience and education in providing help to other people, our clients are still the experts on their own unmet needs even if they don’t always know it.

Finally, there will be times when our clients continue to tell us straight up “We’re not gonna take it anymore!” and our response will have to be “OK” because our clients have the right to make that choice. It’s their treatment. Hopefully that will be after we have made every effort we can to listen and have exhausted every possible avenue for creating motivation to access the help we have been trained and want to provide.

Oh and if you’re feeling lost without the word “non-compliance” in your vocabulary, I guarantee you if you put yourself in your client’s shoes and try to see things through their eyes you’ll probably come up with something more positive to use.

 


 

Dr. Seuss and the Individual Recovery Plan:
Oh the Places You’ll Go!
By: David Baker, LPC
Clinical Director
Georgia HOPE

When I graduated from graduate school a friend of mine gave me the Dr. Seuss book “Oh the Places You’ll Go.”  Some of you may be familiar with this book. The book is about a character who is at the beginning of a journey and it emphasizes the destinations on that journey he will reach and the experiences he will have along the way. The story is all about moving forward even if there are experiences like the “slump” and the “lurch” or places like The Waiting Place and The Alone Place that create problems or slow our hero down. The point of the story is that the character is moving forward toward a positive (and even exciting!) destination. The story ends with the promised excitement of what you’ll see when you make it to the top of the mountain you’ve chosen to climb.

Our job in working with clients is to help them identify the destinations they want to reach – the “mountains” they want to climb. Think of a time when you were planning a vacation or trip to somewhere. Usually when we do this we are thinking about the destination we want to reach – Bora Bora, Destin, the Smokey Mountains. Usually we aren’t just thinking about what we are getting away from. Ok, sometimes we are thinking “I just want to get away from it all” – work pressures, family pressure or some other discomfort. But we usually have a picture in mind of where we want to be instead – walking on a beach in Maui, sitting on your deck with a cool breeze blowing, curled up on the couch reading a great book, climbing a mountain with a Dr. Seuss character.

The role we can play with our clients is to help them identify those mountain summits they want to reach in life.

The role we can play with our clients is to help them identify those mountain summits they want to reach in life. They’re not usually physical mountains. Sometimes the “summit” is being able to get to the end of the day and say I’m proud of something or many things I did today. Sometimes it’s being able to say when I felt myself getting anxious today I knew what to do to return to my chosen sense of calm and peace. Sometimes it’s being able to say when I thought about the loved one I lost I was able to remember something positive about them and smile instead of breaking into tears. So while it may be very important for little Johnny to stop having temper tantrums at school or Sally to stop injuring herself when she feels afraid or anxious, it’s also just as important to help Sally and Johnny identify what they want instead. Maybe Johnny’s and Sally’s mountain to climb is developing a comprehensive sense of safety that they can call on when times are difficult.

Some mountains may seem big and some may seem small, but the thrill of getting to the top is usually the same and you almost always have a better view. Sometimes getting to the top of a small mountain gives a view of the next mountain you want to tackle. Not everyone wants to reach the same mountain top and not everyone climbs the same mountain the same way. So as tempting as it is for helpers like ourselves to think “I know the way to go and I’ll tell you how to get there” it’s probably more helpful for us to help our clients decide where they want to go and then help them decide what way there works best for them. Then our job is to simply cheer them along the way to the places they want to go.

So as tempting as it is for helpers like ourselves to think “I know the way to go and I’ll tell you how to get there” it’s probably more helpful for us to help our clients decide where they want to go and then help them decide what way there works best for them.

So the next time you look at or write an Individualized Recovery Plan see if it passes the Dr. Seuss test. Is it about “Oh the Places you’ll Go”? Do the “mountains” it identifies for climbing look exciting and positive? Or is it only about staying out of the “slump” or avoiding The Alone Place? And does it sound like something that your client thinks would be a good place to get to instead of the “slump” or The Alone Place? If it doesn’t pass the Dr. Seuss test, than have your client help you change it! As important as it is to prepare for the “slumps” and to know what to do about the “Alone Place”, it’s equally important to decide where you want to be once you get beyond those places. Our job as helpers is to keep that phrase in the back of our minds and to keep reminding our clients of it – “Oh the places you’ll go!”