Exploring Equine: Therapeutic Focus and Interventions

I have lived around horses since I was pretty young and have always been drawn to these magnificent animals. Their size alone fascinates me and the temperament of each horse is as unique as you and I. The relationships between our clients and horse therapist is something that we are not able to provide. Horses seem to have an extra sense when something is wrong or when a person needs a hug, a shoulder to cry on or just someone to walk with. These horses know when a person is struggling with traumatic incidents, self defeating behaviors, self control and low self esteem. 

We have all started to hear more about Equine Assisted Psychotherapy groups and other sessions that involve animals in our practices. The terms are somewhat new to the world and started getting more attention in the 1990’s- many years after we knew the impact on mental wellness that is provided in equine work. Horses are non-judgmental and will easily meet the client where they are at. The types of therapy that we provide at Peace Within Counseling and many other equine treatment facilities is extensive. 

• Ground work- grooming, leading, obstacles. These activities lead to a greater sense of relationship by being able to touch the horse, telling secrets to the horse and allowing the horse to get to know the human as well as getting to know what the horse likes or dislikes.  Matching the breath of a horse is very grounding. Connections are important, and at times, easy to gain with a trusting horse and companion. However, when putting a traumatized companion with a horse who also has faced trauma it can be a bit of a human challenge.  The person may have numerous hesitancies and extreme anxieties when facing this 1000 pound figure in front of them. However, most times the horse can sense the hesitancy and be able to pull in where no other human can emotionally touch. The horse can bring a comfort that the person may not accept from others. For instance, a young child who recently lost a parent was working with one of our horses. This child was shutting down and afraid to connect or accept others. The horse recognized this and pulled this child in for a huge hug. This boy broke down at this moment and was able to allow the touch and continued to work through his struggles and grief.
   
• Ground driving horses- a new phenomenon to me as of last month. We had a group of about 30 people join us in a group with 2 Percheron horses- each about 2000 pounds! The group had a chance to bond by brushing, petting, talking and even being able to sit on these gentle giants. Everyone faced a huge hurdle by walking behind these beauties while leading them around the round pen! These humans were able to control 4000 pounds of animals with a slight tug on their reins. We were able to fight the fear of the intimidation of an 18 foot horse that towered over everyone. This was a great time to understand the power that we posses and the control we can have if we allow ourselves to focus. 
   
• The horse can be another tool to add to ones toolbox. This is where people find total relaxation by being near to the horse. Energy work can be done at this point. We are able to lead the horses around the arena with our energy- no leads, no halter, no whips. Pure energy and pure exhilaration! We can gain a sense of accomplishment, leadership and regain lost self control when we are able to be at one with the animal. We teach the human companion to vision what they want the horse to do and the horse will follow. And when the horse does not listen to our desires, we have a great teaching moment with our humans as to how sometimes life doesn’t go as planned. We all struggle at one time or another and we incorporate these mindsets into our clients. Many times, people can relate to this and compare to a time in their life where things went wrong and maybe even notice the strengths that were gained from this. Then we try again with the horse- maybe some relaxation has happened through this acknowledgment and our horse will listen, maybe not.  
   
• Riding is another way to use horses in therapy. This is another fantastic opportunity for the human to feel the power and strength under their body. It can be a cathartic experience to be able to lead this horse around the arena with a small nudge or a slight pull of the reins. The movements that ensue are very relaxing and beneficial to those traumatized clients. I’ve known many people who trailride and end up being so relaxed that they have fallen asleep on their companion- not a goal we pursue in therapy, however.

This is just the beginning of understanding Equine Assisted Psychotherapy. Many people become certified in Equine Work through many programs. At PWC we have Equine programs where we ( the therapists) work closely with a horse handler or certified coach- someone to watch and  make sure the horses and humans are safe and to teach the do’s and do not’s of working with horses. Those certified in Equine Work as coaches are going to be able to share activities and sense things within the horses that most of us may not understand. Coaches can teach the roles of the horses in the herd and how we can relate this to our family, social and work dynamics. As a therapist, we are able to help relate to the dynamics that happens before our eyes to what the human is needing at the moment. We are able to focus more on leadership or focus more on boundaries with the obstacles that the coach can help lay out. We can fill in the clinical gaps that the coach may not be able to understand. By having a relationship with our clients, we can give them what they need through the relationships with the horses. It is a fabulous, amazing and miraculous bond to watch form in just moments.

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If you would like to learn more about our programs, please feel free to reach out to me at (303) 888-9042. We are offering Individual, Family, Couples and Group sessions this Summer and Fall. We offer kids and teen groups and soon will be adding groups for adults, cancer survivors and those struggling with PTSD and other traumas. We will also be hosting a brunch and team building morning in July for all therapists- watch for info soon.

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Guest post written by Nakoma Garcia, MS, LPC

Nakoma Garcia, MS, LPC graduated from Indiana Wesleyan University with a bachelor's degree in Social Work in 1997. She later went back to grad school for Professional Counseling at Grand Canyon University. She is a licensed professional counselor in the state of Colorado. She is trained in EMDR and also offers Equine Assisted Psychotherapy in her practice. She has worked with hundreds of individuals and families who have dealt with life changes and helped them find peace and strength. Nakoma is passionate about working with people who feel change is hard and helping them understand that it does not have to be.

Navigating the World of Public Schools

“Education is the most powerful weapon which you can use to change the world.”

-Nelson Mandela

As a therapist and school counselor, I would like to provide some resources for those of you who work with school-aged children. The main questions I’ll attempt to answer are: Why would you need resources; What resources might be helpful; and How would you access the resources available.

First, Why would you, as a non-school based therapist need to worry about what is happening for your client at school? Your child client likely spends a great deal of time at school. This is a very different environment from home, and children’s behavior sometimes looks quite different between the two settings. For example, a child may be described as displaying difficult, acting-out behaviors at home but quiet and well-behaved at school.

There are also plenty of cases where a child might not display any distressing behaviors in the home environment but is struggling at school. You may get children referred to you because of their school behavior, so in that case you would have an easier time treating your client by finding out first-hand about the school and child’s experience there.

Even if school does not appear to be the issue for your client, it can be helpful to find out about their experience of their school environment and what is working well. This gives a more complete picture for you as you set out to determine best practices for working with them.

Through my years of work in schools, I have seen a variety of behaviors. There are some patterns of behaviors to look out for because they happen more frequently for some individuals in schools. For example, staff tend to grow alarmed when they see children running out of the classroom, throwing objects (sometimes very large such as desks and sometimes in a dangerous way such as at other people), and yelling or causing general disruptions or defiance within the classroom. Other common concerns include children who do not speak at all, who sleep during the class day, and those who hide under desks. Social skills are put to the test in a major way at school, so this is another area where some children get identified as having concerning behavior. This could include sexualized or aggressive behavior towards other students.  

For middle school students, behavior may include a greater frequency or intensity of defiance and aggression within the classroom or with peers. Suicidal ideation and other mental health concerns may be noticed more as the child grows older. In high school, mental health concerns may become a more common factor causing children to seek treatment with you.  

At any level, children who act out and externalize their feelings with uncontrolled body movements and/or verbalizations will more likely get noticed. Adults may not so easily recognize the needs of students who internalize their feelings and do not act out.

When school staff or parents are at a loss for what to do, they often turn to therapy in the hopes that this could help change a child’s behavior. Sometimes, they are at a loss to explain the child’s behavior and are hoping the therapist will be able to uncover the true secrets as to what is going on with the child. This is where you might get involved.

As an outsider to the school community, there are some helpful things to keep in mind as you are working with the child and family. A child’s behavior is a function of his or her environment, so it will help you to get to know the child’s school for yourself. For example, some school staff or faculty have a pattern of engaging in power struggles with students, but this is likely not the information you will receive just by talking to the adults in the child’s life. You will have to dig deeper by looking at data or making your own observations at the school. Through this kind of investigation, you might find the true reason for the child’s behavior really has to do with someone else’s behavior. Finding out this information will give you a better chance at coming up with effective interventions that align with your client’s experience.

This leads us to the next question topic: what information might you look for within the school setting?  Some basic questions you might do well to ask include the following:

1. What is the child’s behavior at different points throughout the day? There are grids that staff use to denote what a child was doing every 5 or 10 seconds for a 20 minute period. That child’s behavior is compared to a variety of peers and what they are doing at the same time as the client. If this is done at a variety of times, subjects, and settings, it can give you good information about potential reasons for your client’s behavior. Ask someone at school if you can have a copy of this information or if the information hasn’t yet been collected, see if they would be willing to do so.
    
2. After identifying a particular behavior you want to learn more about, find out what happens just before the behavior occurs (antecedent) and what happens just after (consequence). This may inform you as to why the child is behaving as s/he is. For example, many times in school settings a child is inadvertently rewarded for behavior that the school staff actually wish to extinguish. Examples of this include when a child leaves the classroom, they might be allowed to go to a different setting, spend time with a preferred adult, or not be required to do the classroom work; or, if a child makes noise or otherwise disrupts in the classroom, perhaps they receive attention from staff or students.
    
3. What are the goals that the child has and how do those goals compare to the goals of school staff and caregivers? If you are able to speak to staff at the school where your client attends, you could learn a lot about what is working well and where some potential difficulties are arising just by talking to people and gathering anecdotal information.

If you work exclusively outside of a school setting, you may be wondering how you would go about navigating the system to get the information you are looking for. One good place to start would be with your client and/or their caregivers. Ask them to set up a meeting between you and school personnel so that you can begin getting to know the people in your client’s school environment.

Once you build relationships with some school staff, you could ask for some help gathering the more time-intensive data that is involved in tracking a student. If the student’s behavior is especially troublesome for the school, they likely will already have this type of data on hand as it is required for moving forward in a process of getting a student more intensive resources.

In your efforts to help a client make changes in their life, gathering more information about their experience in the school setting will better inform you and your practices. It will take time, but may well hold some keys as to what is really motivating your client’s behavior. In that way, learning more about your client’s school setting can be well worth the extra time and energy you put into it.

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Guest post written by Jenny Pelo, MA, LPC, NCC

Jenny Pelo, MA, LPC, NCC is a school counselor and community-based therapist in the Denver area. She has worked with children and adults at a variety of ages and developmental levels. She enjoys helping others heal from trauma and finding meaning in their lives. Spending time outdoors, rock climbing, and being involved with a meditation community bring her great joy in her own life. http://jennypelo.com

6 Reasons Highly Sensitive People (HSPs) Matter to Your Therapy Practice

If you aren’t familiar with the term Highly Sensitive Person (HSP) it refers to about 15-20% of the population who possess a unique sensory processing trait which allows them to pick up more on subtleties in the environment, resulting in deeper processing and often being easily overwhelmed with stimuli. HSPs are often gifted with having a rich inner life, complex imagination, and deep empathy for others.

Most HSPs exist on a spectrum of sensitivity, with about 1 in 5 HSPs who are considered High Sensation Seeking. High Sensation Seeking HSPs often experience life with ‘one foot on the gas, one foot the break’. Since they are often drawn towards stimulating environments, they often don’t appear as your ‘typical’ HSP. However they often need more time to recover from those stimulating experience than non-HSPs.    

As a therapist in private practice, you have plenty on your plate. Networking, continuing education, billing and insurance, not to mention the emotional work of hearing client’s stories of suffering and pain day after day. Given HSPs make up only 15-20% of the population, why should you care about them? And why do they matter to your practice? You might be surprised.  

1) HSPs Are Probably Already Your Clients

If you are thinking to yourself that you don’t have an HSP clients, think again! Remember that fun 80/20 rule? Dr. Elaine Aron (the official HSP guru) believes that, in psychotherapy, HSPs are the 20% of the population that make up 80% of your client base.  

I suspect you have at least one client on your caseload who is highly sensitive (or a high sensation seeking highly sensitive person). They may be aware of their trait and embracing it, aware of their trait and fighting it, or not aware of this trait at all.  

You already take into account many demographic details of your client, such as age, cultural background, gender identity, and trauma history. Why would you ignore your client’s innate temperament in the care you provide? Wouldn’t you want to know a critical detail about your client’s nervous system and adjust your treatment approach and expectations accordingly?

2) They Are Your Most Loyal Clients

When HSPs are receiving supportive therapy, in a setting where they feel valued and cared for, they will become your most loyal and dedicated clients. You may see them make progress fairly quickly. They probably will continue to see you even after the original issue has been treated.

One reason for this phenomenon is that many HSPs learn to view self-care not as a luxury, but as something inherently necessary for them to manage a delicate nervous system in a stimulating world. With their capacity for deep emotional and intellectual processing, therapy is a consistently needed outlet for their busy brain. If the client has the resources to do so, they may see seeking outside support from a therapist as a lifelong investment, not something that only occurs when they are in crisis or their needs are acute, although this may be how they initially come to your practice.

Even after their original issue has been managed, you can expect them to continue to support your business, either by continuing to see you for maintenance sessions, bringing their family and friends to you, or by sending clients your way who are also HSPs.

3) They May Be Your Most “Complex” Clients

When I use the term “complex”, I refer to clients with multiple concerns who appear to stall on progress despite long term or intensive support. They may also be the clients who you see frequently due to complex and challenging issues. They may be the client where you find yourself continually hitting dead ends or that feeling you are ‘missing something’.  

When treating HSPs, one must take into account how HSPs are impacted by differential susceptibility and vantage sensitivity. Simply put, these phenomena mean HSPs may have more long term negative effects than non-HSPs from adverse experiences or environments, but they thrive more than non-HSPs in enriching environments or relationships. Thus, HSPs who experience difficult childhoods are more likely to have anxiety and depression than non-HSPs.  They may even be mistakenly diagnosed with Borderline Personality Disorder.  

The key is not to use the HSP trait as the reason for all your client’s ailments.  It is to understand their susceptibility and take into consideration the delicate interaction between this trait, their environment, and whatever issues they are facing. For example, if your client is a person of color and/or part of the queer or trans community, you must also consider how the compounding impact of racism, oppression, heterosexism or cisnormativity, may impact HSPs vs. non-HSPs.  

When you take high sensitivity into account with your most ‘complex’ clients, you may need to reexamine and reframe your client’s past and current experiences. Stressor that may seem ‘minor’ to you or the client, but can actually have significant impact on an HSP’s psyche and physical health. You may need to support your client in reevaluating their past, lifestyle choices, and experiences with acknowledgement of their HSP trait. From there you may uncover some of the blocks to the client’s recovery and healing.

4) Awareness of a Client’s Sensitivity Can Improve Treatment Outcomes.

If your client is an HSP, you and your client have the potential to become frustrated or dishearten with lack of progress or barriers if you are not taking into account the client’s sensitivity. This may manifest as having the focus of treatment goals is in opposition of their innate temperament. You and your client may be frustrated because therapy goal’s are not taking into account your client’s finely tuned nervous system.  

You will never find a cocktail of medication that will prevent HSPs from processing deeply or being highly sensitive (although some clients report certain medications and supplements can help lessen sensitivity). You will never be able to ‘treat’ an HSP until they are no longer moved by others suffering or deeply empathetic. An HSP will never become ‘cured’ from picking up on subtle stimuli in their surroundings, but they can learn skills to manage overwhelm.

For example, most HSPs who work 40+ hours a week in a stimulating environment don’t have much energy left over at the end of the day. If your HSP client is wanting to be more social in order to meet more friends, but continually finds themselves not leaving the home after work, both of you may feel frustrated of their lack of follow through around social goals. You may see this as resistance, denial, or self-sabotaging behavior. The client may blame themselves for ‘lack of willpower’ or cite social anxiety. However, if you take into account the HSP trait, and the limitations around stimulation during the day, the goal may be to have the client instead look at adjusting their work schedule (i.e. working from home, scheduling more personal days) so that they have the energy to engage in social activity. You can help reframe their social anxiety as actually the anticipatory feeling of getting overwhelmed in certain social setting. Thus, you could encourage your client to attend social meet ups that are in less stimulating environments and help them distinguish between what is social anxiety and what is sensory overwhelm. You both can also reframe what is a realistic expectation around social engagement.   

If you are not able to educate and explore the possibility of your client’s sensitivity, you may continue to set your client up to be unreasonably distressed by something that is an inherent part of them. HSPs are susceptible to mental health disorders that require specific treatment and helping professionals must take into account an HSP’s basic temperament during their treatment process. It is possible for HSPs to learn skills so they do not become highly disregulated or overwhelmed, yet it is unlikely that their will lose their propensity for emotional depth and deep processing of the world.

5) Talking About the HSP Trait May Improve Your Relationship With Your Client

Often HSPs are relieved to understand that their trait is not something pathologically wrong with them. If your client is already aware of their sensitivity, even if they don’t have a name for it, they may be relieved to know their helping professional is open to talking about it.  Opening up the dialogue will invite a deep and meaningful conversation that can allow the client to feel valued and seen. This can result in your client feeling more motivated to engage in treatment and also deepen the healing relationship between you.

Keep in mind, it may be initially difficult for clients to hear about the HSP trait. Most HSPs have been shamed, ridiculed, bullied or even abused for their sensitive temperament. In turn, they will often internalize the devaluing of their sensitive nature, as opposed to seeing it as a strength.  

Be mindful of when to broach the topic. You can describe their sensitivity without naming it or without ever using the term “Highly Sensitive Person”. Consider using terms like: sensory processing sensitivity, finely tuned nervous system, or easily overwhelmed or overstimulated.  As you know, the best approach is to use the client’s own language.  

6) Discussing the HSP Trait Can Improve Your Client’s Relationships With Others

When clients learn they are highly sensitive, it can help them reframe their past experience and present functioning in a compassionate and new way. In my experience, once HSP clients really learn to embrace their trait, they often feel renewed energy and clarity around setting boundaries around their time, energy, and emotional labor. Many of my HSP clients have been able to finally make career decision that were more suitable to their temperaments, as opposed to what was expected from them by their family and culture. Other HSP clients have become able to frame relationship difficulties with their romantic partner as temperament differences (one is an HSP, one is not) as opposed to a fundamental flaw between them. 

Acknowledging the interplay between a client’s sensitivity and their personal relationships does not eradicate all problems, nor does it excuse legitimately harmful or abusive behavior. Yet, it can allow an increased clarity around the client’s true needs and the open the dialogue for your client to have relationships that are about honoring their innate sensitivity, as opposed to allowing it to be devalued. The first step might be exploring with your client how their sensitivity might show up in the therapeutic relationship.  

Moving Forward

If this article resonates with you personality or professionally, you might be wondering how you can continue to learn more about Highly Sensitive People or what your next steps should be.

Your first step is to do some self exploration. Are you a highly sensitive therapist? Are you a high sensation seeking HSP? It will be hard to truly understand the trait in your clients without seeing where you lie on the sensitivity spectrum. You can start with going to Elaine Aron’s website, where she has several self-tests around the HSP trait, including how the HSP trait might appear in children. You might also consider sharing these tests with any loved ones who are also curious about the trait.  

Should you want to incorporate knowledge of HSPs into your therapy practice, the next step is to educate yourself about this trait in the context of a clinical setting. Elaine Aron’s book Psychotherapy and the Highly Sensitive Person is an excellent resource for therapist who would like to start becoming knowledgable around working with HSPs. You may also want to pursue consultation and collaboration with therapists who specialize in working with HSPs.

Whatever path you choose, educating yourself around Highly Sensitive People will undoubtedly benefit your clients and your practice. Hopefully, this exploration will also uncover aspect of yourself and your relationships, bringing increased understanding and clarity to your own life as well.

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Guest post written by Arianna Smith, MA, LPC, EMDR

Arianna Smith, MA, LPC, EMDR is the owner of Quiet Moon Counseling in Littleton, Colorado. She specializes in working with Highly Sensitive People (HSPs) and LGBTQ survivors of trauma. She has a passion for helping HSPs learn to cope with overwhelm, find belonging, and craft their ideal life. She provides affirming therapy to LGBTQ survivors of trauma and abuse as they embark upon their healing journey. Learn more about her practice here. 

Bedroom Bliss: Have Better Sex Tonight with this Trick!

Now that I have your attention...

I want to talk about mindfulness. Not the sexy topic you may have expected, but bear with me, I promise I wasnt just teasing you with some clickbait blog title. 

Sex is pleasurable and fun and connecting and even spiritual at times. But F### what Cosmo or Maxim might say, the way good sex happens is not through circus act moves or potions or having the perfect body. Its by being mindful.

Mindfulness is paying attention and choosing your focus on purpose. You can have the best techniques and all the right moves, but if youre doing your taxes in your head or critiquing the size of your butt, you're missing out. You need to be mindful to fully be there to notice your own feelings and pleasure, and to communicate what you need, and to be fully present and connected with your partner. 

Now Cosmo and Maxim aren't totally wrong. New moves, exotic smells, and feeling sexy thanks to the latest health and fashion tips may help. But why do they help?? Because trying something new, using your senses, and feeling confident aid us in staying present and being focused on the moment. 

But you cant expect to go around being a mindless robot, thinking of the past or the future or not thinking at all, and then expect to suddenly be good at staying present for sex. That's crazy. We get good at what we practice. So practice being in your body. Notice when it feels good. Notice what makes it feel good. Get good at staying present with your self. 

Good times to practice tuning into your body are: 1. when you're getting dressed (notice what clothes and textures make you feel sexy and sensual), 2. when you're bored (often we self soothe when bored. Do you play with your hair or rub your neck or tickle your arm or ???), 3. When you dance or exercise (its a great opportunity to be in your body and pay attention to sensations in your body that give you pleasure) 4. When you masturbate (if you don't know how to turn yourself on, you will struggle to guide your partner)

Another quick mindfulness practice to jump start your practice. Do this as often as you like to use your five senses to be more aware of the present moment.

1. Notice 5 things you can see right now
2. Notice 4 things you can hear right now
3. Notice 3 things you can touch right now
4. Notice 2 things you can smell right now
5. Notice 1 thing you can taste right now.

So, since sex sells, heres reason #592 for practicing mindfulness consistantly: being more mindful will make you a better lover!

Namaste. Happy practicing!

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Guest post written by Erika Holmes MA, MFT

Erika Holmes MA, MFT, lead clinician at Colorado Couples and Family Therapy (www.coloradocft.com) is a  native Californian who now lives and works in beautiful Denver Colorado. With over 10 years of clinical experience both in agency work and in private practice, her work has included individual, couples, and family therapy, group therapy, parenting classes, behavioral assessments, and professional consultations. Her special areas of interest and training include working with 20 – 40-year-old sassy women, people in distressed relationships, people with mood disorders, trauma, eating disorders, and borderline personality disorder. She has also been privileged to contribute to "Rehab with Dr. Drew" and "The Mental Illness Happy Hour" podcast and "Paleo Baby" podcast. 

6 Steps to Engage New Clients in the First Session

When I first began in Private Practice, I noticed that new clients were not coming back for the second session. I knew I was doing something wrong in that first session (or free consultation) that wasn’t connecting with my clients. I started experimenting and tracking my conversion rate.

This is a rough guideline of what I have ‘fallen into’ over the years in private practice that has a very high conversion rate (rate of consults that turn into regular clients for me). I find this can be done in either 30 minutes or 60 minutes. Here are the major steps I do with some of the ‘scripts’ I find myself saying often.

1. Welcome/Orienting the client to the consultation session

The consultation session is a little different than a regular therapy session, so I make a point to tell the client what we are going to do, and what he/she will walk away with from our meeting.

Here’s a breakdown:

1. Greet them and normalize that it can be weird, awkward or anxiety-producing to meet a therapist for the first time (or meet a new one).
2. Tell them what we are going to do during today’s meeting. The important points to hit are:

• This is a time to get to know one another a little bit
• I’m going to be asking some questions to know what’s been going on for the client
• I’m going to be answering any questions that they have (I tell them it’s ok if they don’t have any)
• I’m going to share my thoughts and initial observations about what they shared with me, so that they know what I’m thinking and it aligns with their experience
• I’m going to share the general outline of what our therapy will look like (although we can pivot later if needed). This includes a preview of tools I will teach them, the order of things, how we will track progress, etc.

I know that’s a lot to get through, here’s a script:

 Hi Jane, thanks for coming in today. It’s nice to meet you in person. I know it can be nerve-wracking to meet a new therapist, and I’ll be asking some personal questions today, so I thank you for taking the step to come in. Today we have a little bit of a different meeting than a regular therapy session. Today I will ask some nosy questions so I can really understand what’s been going on. But don’t worry, you can ask me nosy questions right back if you want to. I’ll answer any questions you have today, but it’s ok if you don’t think of any. After I ask my questions, I’ll share with you only my thoughts and observations about what you’ve told me, so you always know what I’m thinking and to make sure I really understand. Then I’ll share with you my initial thoughts and plan for how I’m going to help you feel better. Ok? Great! Let’s start.

2. Super-Short and Focused Diagnostic Evaluation

I’ve found the key here is to not get lost in the weeds, but identify the main clinical concerns right away, then ask a few follow-up questions to understand the severity and symptom presentation of that clinical concern. I save a more thorough mental health evaluation for another time. I want the client to feel heard right away.

Here’s a breakdown:

1. Ask first about the main clinical concern by asking what brought them in, or how can you help?
2. Normalize and Validate that concern
3. Ask a few follow-up questions to get a broad understanding of the issue
4. Ask about previous therapy experiences, and what was helpful and not helpful about those experiences, so you can quickly learn how the client responds to therapy in general (I make sure to incorporate this into the ‘plan’ that I share towards the end of the consult)
5. Ask if there are any other major clinical concerns.

Here’s a script for a client struggling with Anxiety:

Therapist: Ok Jane, I know we spoke briefly on the phone, but I’d like to just start with a really broad question and go from there, so I will ask what brought you in today?

Jane: Well I’ve been feeling really anxious….

Therapist: I’m so sorry you’ve been dealing with that, it’s really hard. We see a lot of that here in the practice, so you are not alone.

*Now I ask some follow-up questions about this clinical concern, such as:

• When did it start?
• How bad does it get?
• Panic attacks? How many and when?
• How is this impacting your life right now?
• Medication? Helpful or not? Prescribed by whom?
• What helps it right now?
• Who knows about it? Support network?
• Family history?

Jane answers all these questions, and I normalize her symptoms along the way.

Therapist: Have you ever seen a counselor before for this or for anything? When was that? What was helpful about that? Anything about that not helpful?

*I’m listening for anything that the client found helpful in the past in therapy (if they have done it). Things like a therapist being directive, providing honest feedback, teaching tools, etc.

Jane answers….

Therapist: So I really hear you about the anxiety and am starting to think of some things we can do together that will really help that, but first let me ask, is there anything else going on that you think is important for me to know?

Jane answers…

3. Feedback to Client

This is where I thank the client for being so open and talking about difficult things, and provide feedback and a rough/initial diagnostic impression. I’m not rushing a diagnosis, and I don’t use that language (usually) with the client, but just like when you see the doctor, you want to know what they are thinking and that they understand why you came in. I emphasize that I hear them, reflect their own language back to them, and validate that their concern is not ‘just in my head’ but it’s serious enough that they came to a therapist about it, and that they deserve a professional’s help to feel better.

Here’s a script for our client Jane:

Thank you for answering all those nosy questions, Jane. I know this stuff is hard to talk about. It’s very clear to me that you have an above-average amount of anxiety and it’s really impacting your ability to sleep and your job. That must be so hard. You should know that what you have shared with me is not a normal level of anxiety that we all feel from time to time. I hear some markers of an anxiety disorder, and so you’ve been dealing on your own with a clinical issue. You can’t just make it go away by being hard on yourself, which I already hear that you are. If you could kick this by just telling yourself to calm down you wouldn’t be here right now. But you are, and I’m glad you are. You don’t need to be alone with this anymore.

In our next session I’ll ask some more about your symptoms and really make sure we get the right idea of what you’re dealing with, but I’m pretty confident in what I’ve heard that the focus of our work with be tackling this anxiety together.

4. Share Your Initial Plan (let the client know that you can help them)

This is such an important step. The client wants to know in a concrete way how you will help them with their issue. You don’t need to do an on-the-fly treatment plan, but as you listen to any clients, ideas pop into your mind of what may work well for the client. This is your time to share that, give examples, and give the client confidence that you are in control, that you ‘get’ them, and that you have a plan.

Things to keep in mind for this step:

1. Frame the work in terms of ‘we’ rather than ‘you’ or ‘I.’ You and the client are a team now.
2. Share an honest initial time-frame with the client. You’re not tying yourself down to that timeline, but you will have a sense of how ‘easy’ or ‘difficult’ the client’s issue is, so share that.
3. Incorporate what was helpful about previous therapy (If there was any)
4. Reflect the client’s own language in how they describe their symptoms to you, so they feel heard and understood. Don’t use overly-clinical or ‘jargony’ language.

Here’s a script for Jane:

I feel confident that we can get this anxiety under control and you can feel like yourself again. If you choose to work with me, I’m think that first we will jump right in to concrete and practical tools to help with your anxiety in the moment. I remember with your therapist back in college you liked having those tools you could turn to, so we will start there. We will also explore the causes and triggers of your anxiety so we can play offense, not just defense. We want to see those things coming, have a plan, and head them off. I will also work with you on some pretty easy tweaks to your sleep routine to get you some better sleep, which will help with anxiety. I think also, from what you have shared with me, that simply having someone to talk to about all of this will be helpful. You’ve felt alone and embarrassed about it, and I understand. But talking about it will help us move past the shame and implement these tools and strategies. I think we can really see a difference in around 3 months, based on my work with other clients who are going through what you’re going through.

5. Answer The Client’s Questions and Wrap-Up (giving them a choice to schedule for follow-up with you).

The last step is to ask if the clients have any questions for you. I usually find that at this stage, you’ve answered all of their questions. However, sometimes they have questions. I answer all of them as transparently as possible. Clients hardly ever ask a personal question. The most common question I’m asked is basically ‘Am I weird’ and ‘Can you help me?’ Those are easy times to validate/normalize and again reinforce your very rough treatment plan.

After that, we wrap-up and I see up the next session. I never want to pressure anyone, or assume that they feel comfortable being my client yet, so I give them a choice between scheduling our next session right now, or getting back to me after they think about it. Almost 100% of the time they schedule right then, but if they don’t, that’s ok too. I always remind myself that ‘you’re not for everyone’ and let it do. Oftentimes, the client that doesn’t ‘sign up’ right away will circle back to me in the future.

Here’s a script to wrap up:

Well Jane we’re almost out of time, I’m sorry to have to stop. We can do one of two things from here. If you feel comfortable that we’d be a good fit, we can go ahead and schedule our next session and I think it would be good for your progress to meet every week. If you want to think about it, that’s fine too. If that’s the case, I’d love your permission to follow-up with you via email in a few days so we can touch base before my caseload fills up again. What would you like to do?

6. The Follow-Up Email

I always send a follow-up email, no matter what (unless they tell me not to email them). This lets the client know that you’ve continued to think about them. It’s also an opportunity to offer something of value. I email with a short note saying it was really nice to meet them and, if they have ‘signed up’ to be a client, that I look forward to working with them. I say I have been thinking more about what they shared with me, and it make me think of this helpful article/book/podcast that I wanted to share and include a link. That’s it! Clients tell me they really love this follow-up.

This is also an opportunity to ask if a client wishes to meet again (if they didn’t schedule during the first consult).

Here’s a script:

Hi Jane,

I really enjoyed meeting you yesterday. We talked about some hard things, and I appreciate your openness. I was thinking further about that panic attack you had last week, and wanted to share this article about riding out panic attacks. It may be a good idea to share this article with your husband too, because I remember you mentioned he felt a bit powerless when that happens. Here’s the link to it. If you’d like to meet again and get started on the goals we spoke about, let me know and we will find a time what works with your schedule.

Warmly,

Erin

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Guest post written by Erin Carpenter, LCSW

Erin Carpenter, LCSW, is a therapist in private practice and owner of Thrive Counseling, a group practice in Southeast Denver. Find out more at http://www.thrivecounselingdenver.com

Staying Present: Finding Focus in Session

In my years in practice, I find building a rapport with the client and being able to stay present during intense moments are of utmost importance. In order to make progress, a foundation must be built where the client feels safe and supported. Below you will find useful techniques in building a rapport and staying present with your client during sessions.

Building Rapport

• Ask the client what specific goals they have for therapy.
• Make sure the client knows that you are there for them, so if perhaps they deviate from the goals they were working on and/or want to talk about something else during a session, allow them to so.
• Do not impose your views or beliefs on your client.
• Be nurturing, empathetic and non-judgmental.
• Ask how we will know they are making progress or have met a specific goal.
• Each session, ask what the client may need to explore how the session is productive for them.
• Encourage the client to voice his/her opinion in the session. If the client does not agree or like something you as the therapist says, make sure you create an atmosphere where they know they can bring that up without negative consequences.
• Stay present with the client during intense moments, and during all moments.

Staying Present

Helpful techniques in doing so include but are not limited to:

• Ask the client what it was like for them to say that (whatever it is they shared that was painful) out loud.
• Thank the client for trusting you with the information.
• Validate the client’s feeling during those moments. “that sounds so painful, sad, terrifying.”
• Be comfortable with silence.
• Allow the client to process through at their speed.
• Tell the client you are there for them, with them, that there is no judgment.
• Before the session ends, ask the client if there is anything they need to help them transition back into their day.
• Make sure you (the therapist) know what you need to care for yourself.
• Yoga, meditation, and exercise may help.
• In order to stay present, we need to be one hundred percent focused on the client; make sure you seek out your own therapist if needed.

I find these tools useful in my practice and hope you will too.

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Guest post written by Trisha Swintom, LPC, LMFT

Trisha Swinton, LPC, LMFT is a Licensed Professional Counselor and a Licensed Marriage and Family Therapist. Trisha is currently in private practice and has been practicing for about 14 years. She currently works with adults providing individual and couples therapy. Her educational background includes a Bachelor’s degree in Elementary Education, a Master’s degree in Special Education and a Master’s degree in Community Counseling with an emphasis on marriage and family therapy.

http://www.trishaswintoncounseling.com

Working It Out

“A sound mind in a sound body is a short but full description of a happy state in this world. He that has these two has little more to wish for; and he that wants either of them will be little the better for anything else.” 

- John Locke, Some Thoughts Concerning Educations

There is a profound connection between our bodies and minds. Despite our best efforts to help clients identify ways to increase their self-care, often getting a client to exercise on a regular basis is a tough sell. So, if you can’t get them to try going for a walk outside of session, why  not try a Walk+Talk session?

We know that one of the best methods to increase self-care is exercise. Its positive impacts on our clients is well documented:

The effects of exercise have been shown to contribute to:

• maintaining good health (feeling better physically)
• weight loss or maintenance
• healthy physical function (aiding digestion and metabolism)
• increased strength, stamina, and muscle tone
• improved sleep
• increased energy 

And while our clients likely know these benefits, they may  not realize how beneficial exercise can be to their emotional wellbeing as well as their physical wellbeing.  

Exercise has a positive impact on our emotional wellbeing by contributing to:

• powerful shifts of thought
• stress relief
• meditation
• a sense of calm
• an emotional release 
• peacefulness 
• mental and cognitive effects: 
  • cognitive clarity, a sense of control and a clearer head, self-esteem, optimism 

Walk+Talk Therapy

One service I offer is Walk+Talk therapy, where we go for a walk during the client’s session. Walk+Talk sessions have been an effective way for busy moms and working professionals to fit in counseling (while eliminating the need for a babysitter for new parents).  

Many people are drawn to it for convenience, but often Walk+Talk clients report that the movement during sessions has made them feel more comfortable, has aided in their memory, and helps them feel more creative and flexible in their problem solving.  

If you’re a runner or do any type of exercise regularly, you’ve likely noticed the same phenomenon: we often feel our best and have our best ideas while on the move.  

In “Working it Out - Using Exercise in Psychotherapy” by Kate F. Hays, he sums up this effect nicely:

“On long runs I seem to be able to pull together information in novel ways, by letting go of conscious linear thinking patterns.  On the surface, these may appear as random thoughts, yet they end up coming together in delightful and meaningful ways. … The extraordinary part of this is that it is so effortless and perhaps that it happens at all.  The kind of thinking that we spend years developing in graduate school is so taxing, time- consuming, linear. Perhaps Jung was correct after all. Rational, linear, conscious thinking takes effort and is not the way the brain naturally processes information. It is this dreamlike thinking—for lack of better descriptor—that is the way we usually process information. We’ve just learned to ignore and devalue it.”

The wonderful thing is, this dreamlike thinking, (otherwise known as a cognitive shift), that often leads to “ah-ha moments” and breakthroughs is available for the therapist and the client—leading to a productive session and further processing after a session.

Walk+Talk also lends itself to a plethora of therapeutic metaphors and symbolism regarding changes in thinking patterns, nonverbal communication, and empowerment.  

Research on Walk+Talk Therapy

Despite this being a unique way to offer psychotherapy, there has been research that has supported its effectiveness:  

• One researcher has consistently noted positive mood among active individuals and athletes. With exercise, negative moods (labeled as tension, depression, anger, fatigue, and confusion) diminish while positive mood states, such as vigor, increased.
• In a study comparing running with verbal therapy for the relief of depression, the researchers pointed out that “depressive cognitions and affect seldom emerge during running, and when they do, they are virtually impossible to maintain. 
• Therapists who have used Walk+Talk have suggested markedly beneficial effects on mood, sense of well-being, and self-esteem (Hays, 1994, Jongsgard, 1989, Sime, 1996).  
• Another researcher said, “even brisk walking seems to ‘loosen them up;’ they become less inhibited and constrained and more in touch with their immediate feelings and experience. He also observed that clients had more energy, were more aware of anger and assertive needs, talked about what they genuinely felt (in contrast to what they thought they should feel), and were more conscious of themselves yet less self-inhibited or self-conscious.
• In a study of the relationship between exercise and optimism, participants who engaged in aerobic or a combination of aerobic and anaerobic exercise experienced significantly lower levels of trait anxiety than those engaged only in anaerobic exercise.  
• Another study found that acute vigorous physical activity among women accustomed to exercise was associated with significant improvements in affect and feeling states, particularly feelings of revitalization, positive affect, positive engagement,  and tranquility. Measuring negative affect separately, they observed a statistically significant, although less powerful, decrease in negative affect.
• Jongsgard’s study showed: 
  • that exercise is a beneficial antidepressant both immediately and over the long term.  
  • although exercise decreased depression among all populations studied, it was most effective in decreasing depression for those most physically or psychologically unhealthy at the start of the exercise program
  • regardless of gender, exercise was equally effective as an antidepressant 
  • the most frequent form of exercise used were walking and jogging
  • the greater the length of the exercise program and the larger the total number of exercise sessions, the greater the decrease in depression with exercise
  • the most effective antidepressant effect occurred with the combination of exercise and psychotherapy 
  • Jongsgard concluded, “the magnitude of change which results from exercise therapy by itself is as great as that associated with a variety of standard group and individual psychotherapies, some of which, in turn, have been shown to be as effective as antidepressant drug therapy” (p.135, “Working it Out”). 

Exercise & Stress

Stress, something we all experience to varying degrees, involves heightened levels of both physiological and psychological arousal.  

Thayer has developed a theory of mood that focuses on the dimensions and interactions of energy and tension.  “Mood is assumed to be closely associated with central states of general bodily arousal with conscious components of energy (vs. tiredness) and tension (vs. calmness)”.  

The most negative mood states are those combining both low energy and high tension.  

Optimal levels, alternatively, are the result of activities that raise energetic arousal, reduce tense arousal, or affect both systems simultaneously.  

The good news?  Exercise serves to regulate exactly these functions. And going for a walk is accessible to many of our clients.  

What I’ve Learned

I’ve done Walk+Talk for a few years and have learned that with all of the above noted benefits, there are clearly clients and sessions where Walk+Talk isn’t the best option. In general, I’ve learned that:

• Walk+Talk isn’t appropriate for everyone, and especially not to process trauma
• Location matters - pick a route that isn’t brimming with people
• Eye contact matters - I alternate Walk+Talk sessions with in-office sessions to be able to increase eye contact and to be able to access pscyho-education tools such as posters and handouts
• A discussion of the limits of confidentiality is crucial

The Take Away

Walk+Talk may be a great option for some of your clients who feel stuck, need a change, or who need to add some light exercise to the self-care routine and learn well by example. At the same time, there are limits to Walk+Talk—but the good news is that all of the above information is applicable to our clients—and to us! Being able to go for a walk or run before or after a work day can be a wonderful way to get unstuck with clients and tend to our own self-care and wellbeing.  

References

1. Profile of Mood States, McNair, Lorr & Droppleman, 1971, Morgan (1985b)
2. Greist et al. (1979)
3. Berger & MacKenzie, (1981).  
4. Hays, 1994, Jongsgard, 1989, Sime, (1996).  
5. Jongsgard, 1989
6. Gauvunm Rejeski and Norris (1996)

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Guest post written by Brittni Fudge, MA, LPC, NCC

Brittni Fudge, MA, LPC, NCC owns Kindred Counseling, PLLC, where she provides counseling and parenting support for parents in all stages of parenthood.  Brittni specializes in healing developmental trauma, family of origin issues, and maternal mental health.  As a mother, mental health therapist, Love & Logic facilitator, parent coach, and former school counselor, her mission is to support parents in their own mental health to become Wholehearted so that the next generation can learn from their example.

http://www.kindred-counseling.com/services/

Strategies for Self-Care: Scheduling Intention

Self-care is a word we hear a lot in our industry, not just for clients but for professionals as well. How does one define self-care? Is it true that we need to implement self- care in order to prevent burnout? To better understand fatigue, burnout, and the concept of self-care, let’s take a closer look at each of these elements and how they contribute to wellness.

Symptoms requiring Self-Care

For many professionals, self-care becomes something to explore when functioning declines. Our clients come to us because their lives are being disrupted and self-care may be needed to recover balance. We are our own worst clients in the idea that we can talk about the importance of self-care to others, but don’t always put it into regular practice for ourselves.  The result of limited or absent self-care is burnout, and burnout can be long lasting or pervasive as it spreads beyond our careers into our personal lives and beyond. In order to explore the impact of burnout for ourselves and our clients, we may find the following list helpful (adapted from Vital Hearts).

• I don’t know how to relax.
• I feel irritable more than I’d like.
• I feel disconnected from my emotions.
• I’ve isolated from my family.
• Nothing makes me laugh anymore.
• I take comfort in sweets.
• I have no energy to listen to my family when I get home.
• I escape by sleeping more.
• I have no empathy at the end of my work day.
• I’m ignoring my relationships.
• I can’t seem to disconnect from work.
• I am experiencing more anxiety.
• I just want to get away sometimes.
• I’m angry at my clients for asking so much of me.
• I feel underappreciated.
• I can’t read or watch the news anymore.
• I don’t share my work with my friends, they just don’t get it.
• I don’t socialize with friends much anymore.
• I feel restless but don’t want to do anything.
• I have lost confidence in myself.
• I feel pessimistic as the result of my job.
• I feel sadness.
• I feel drained, I have no energy.
• I feel angry.
• My health has declined.
• I feel like nothing I do makes things better.
• I can’t concentrate.
• I cry much easier than I used to.
• My road rage has gotten worse.

For some, the list above starts the conversation about how much and to what degree life has been impacted by factors of our work as helping professionals.  Burnout untreated can lead to long lasting decline in quality of life and connection to others. Burnout can take away the passion of why you do this work. As we struggle to practice what we recommend to others, how do we change our patterns to support reduction of the negative impact of burnout? Below are some action steps.

Wellness Recovery Action Plan (WRAP)

Several organizations in Colorado see the importance of self-care, including the Colorado Mental Wellness Network. Selected by the Colorado Mental Wellness Network and endorsed by SAMHSA, the Wellness Recovery Action Plan (WRAP) is being utilized with various populations to support health and well-being. Colorado Mental Wellness Network supports change through peer to peer connection and wellness education. Through these efforts, they continue to implement WRAP plans within various communities, including those experiencing homelessness and within Department of Human Services caseworkers. What they found was that empowering individuals to notice wellness as well as health decline could support putting self-care into action. Below is an example of a wellness plan that can be used for both professionals and clients to best support their process of identifying and implementing self-care.

Building in Boundaries

In addition to exploring and customizing self-care for meaningful change, boundaries may need to be re-evaluated to prevent burnout. For many helping professionals, long hours, after-hours texts, emails, or calls, client crisis, and urges to help, prevent successful disconnection from work. Technology makes it easy to check work emails 24 hours a day and calls may come in from various parties regarding client care. If there is flexibility to re-evaluate the schedule of work versus home life, it is encouraged. However, the schedule assigned may not be in your control. If this is the case, other means of implementing boundaries may be needed and can include the following:

• Put an out of office message on email and voicemail to notify others of when you will respond.
• Separate work and home phones to leave the work phone off during days off.
• Identify a crisis coverage person to give to clients during vacations or other scheduled absences.
• Schedule time off in your calendar(s) to support appropriate boundaries.
• Schedule windows of self-care, even if just for 20 minutes, during your work week.
• Be concrete with hours for yourself and your clients as to when and how they can reach you.
• Find self-care you can commit to and put it in the calendar monthly or weekly.

It is with hope that we can create momentum from the talk of self-care into action steps as we continue in our roles as helping professionals. Modeling self-care is both in the benefit of our clients and ourselves as we navigate the busy world of demands in hope of positive change. May we all begin to develop quality self-care in order to find wellness in the path of hard work!

Adult Attachment: Creating Connections from Childhood

I panic when I don’t hear from them. I just want to be left alone. I want to reassure them that I’m here for them. These statements may capture several examples of responses from clients in your office engaging in work around their relationships. One powerful perspective on the functioning dynamics of intimate partner relationships is to look through the lens of attachment. In other words, by exploring childhood attachment and how it sets the foundation for interaction within relationships, we can experience an increased sense of awareness on how attachment translates to current relationships from needs being met or ignored in our early childhood experience.

Bonding Background

The study of attachment can first be linked to Mary Ainsworth and John Bowlby in the 1970s. Mary Ainsworth devised the Strange Situation, an experiment that placed babies in a lab with their attachment figure/parent and observed reaction in the baby as a stranger entered the room, as well as each baby’s ability to be soothed when the parent left the room and later returned. Based on Ainsworth’s research findings, we were able to identify three types of attachment: secure, anxious, and avoidant. Mary Main, another colleague, later identified a fourth type of attachment called disorganized to capture responses that were inconsistent and unpredictable when exploring a baby and their attachment figure.  

Attachment Attributes

Secure attachment in childhood looks like a distressed infant that is easily comforted when the attachment figure engages them, such as picking them up and soothing them with soft voice, physical touch, and proximity. In adulthood, the secure attachment individual is highly desired for their ability to reassure their partner and present as calm, grounded, and confident in the relationship. Anxious attachment in children can be portrayed as significantly distressed when the parent exits the room, with increased difficulty to receive soothing or reassurance when the parent returns. In adult relationships, the anxious attachment individual’s anxiety prevents them from feeling reassured in the relationship and can drive their behaviors to present as needy, anxious, and sometimes paranoid that the relationship will fail or that they aren’t “good enough” for the relationship to work.  Lastly, the avoidant attachment type in childhood will manifest in a baby as unaffected, cold, disconnected, and unconcerned with the parent leaving the room as well as an inclination to self-soothe, such as engaging in thumb sucking or playing with toys independently. The avoidant attached child has learned to rely only on themselves in not having the parent fully present, which can occur when parents are working long hours away from the child, are inconsistent in their reactions to soothe the child, or can occur in response to a parent’s mental illness such as depression preventing interaction and ability to attach in healthy ways.  In adults, avoidant attachment continues the theme of self-sufficiency and “not needing anyone” in a relationship, preventing them from connecting at a deeper level with others and can be portrayed as reluctance to commit to a serious relationship.

Linking to Literature

With John Bowlby’s Attachment Theory in mind, Amir Levine wrote an insightful book called Attached, that explores intimate partner attachment more deeply and offers examples of adult behaviors that can provide insight or identification of attachment styles. For client use, there are also helpful YouTube videos that can provide a brief overview of adult attachment such as the one found here. Another author, Stan Tatkin, took the idea of attachment a step further by providing symbolic representation of attachment that can also help one identify their attachment style.

Secure Attachment: An Anchor

Anxious Attachment: A Wave

Avoidant Attachment: An Island  

The imagery associated with attachment styles can help a client identify their reactions and resulting behaviors in intimate relationships, as well as assist them in identifying their partner’s attachment style and needs.

Creating Connection

In supporting your clients with exploring their attachment, you may find yourself pursuing additional training, such as Emotionally Focused Couples Therapy (EFT) that encourages vulnerable connection in couples and supports healing of attachment wounds. Or perhaps you link your attachment work to Gary Chapman’s The 5 Love Languages or communication and connection strategies from John Gottman’s training for couples’ work. Whatever means you choose to further dive into attachment needs, educating your clients on the possibility of positive shifts, such as moving to more secure attachment with their partners, can support movement towards healthier relationships. Levine and Tatkin emphasize that relationship attachment can shift and a person can present differently in each romantic relationship over their lifetime. With this in mind, exploring attachment can support your clients in discovering their own attachment styles as well as assist them in connecting and fostering healthy attachment in their intimate partner relationships.

Pursuing Purpose: Engaging in Exploration

Purpose. Impact. Fulfillment. All are meaningful words for a desired way of living your clients may want to maintain in pursuit of a quality life. Society may tell them to find what they love to do and do it for the rest of their life. Individuals tell your clients to never settle and keep pursuing their dreams. Regardless of how it’s described, pursuit of purpose, passion, or fulfillment can be seen as the driving force behind behaviors and identity within the world. And when it becomes hard to grasp or remains unfound, it can create distress that engages your client in seeking support to find answers. Influential author and speaker Simon Sinek calls this quest for meaning, “finding your why.”

Learning Through Literature

So how does one start the journey in finding their why? For some, it’s engaging in reading material such as Simon Sinek and David Mead’s book, Find Your Why: A Practical Guide for Discovering Purpose for You and Your Team, or exploring your leadership style with Tom Rath and Barry Conchie’s Strengths Based Leadership. Perhaps you explore your client’s personality through the Enneagram, which is increasing in popularity over the Myers Briggs Personality Test in its ability to develop insight into how one interacts relationally with others from reinforcement in childhood experiences. Any of these sources could support increased awareness not only of strengths, but awareness of the psychological driving forces behind motivation and resulting behaviors. A free version of the Enneagram quiz called EnneaApp can be found through the App Store with additional information and the formal assessment can found at the Enneagram Institute (enneagraminstitute.com). Engaging clients in processing the results of the Enneagram quiz can support insight into how they best relate to others when engaging in collaborative activity or to identify strategies for strengthening of their relationships.

Vetting Values

In addition to reading or other homework regarding the Enneagram, another approachable option for exploration of purpose and self-discovery can occur through values exercises. Ranking a series of values by level of importance can allow further insight of what motivates a person. By engaging in a values exercise, it allows one to check in on how important values are being experienced both in the present moment and how they can be improved in the future to support feelings of fulfillment.  A free, online resource to engage in exploration of your values can be found by completing the Life Values Inventory (lifevaluesinventory.org). As a helping professional, you may also invest in making or buying value cards that are easy to sort as part of therapeutic activity. The act of sorting presents as a low risk activity and encourages clients to remain aware of their gut reactions rather than finding themselves in analysis paralysis, which allows authentic processing outside of society pressures or others’ values influence.

Core Beliefs and Cognitions

Engaging in the progressive work of processing behavior patterns and values can also be explored through therapeutic work. Identifying negative thoughts or core beliefs can create new connections and awareness between actions and reactions. Core beliefs can be described as our deepest, sometimes darkest fears or beliefs about ourselves, usually focusing on negative traits such as feelings of unworthiness, being unlovable, or feelings of failure.  When experienced, core beliefs can engage visceral reactions in the body including intense feelings of shame and fear. When explored through trauma therapy modalities such as Eye Movement Desensitization and Reprocessing (EMDR), healing can be accelerated and supported to re-write client views of negative beliefs to something more positive, thus improving self-esteem, functioning, and relationships with others.

Career Counseling

One final therapeutic element that can support clients in pursuing purpose is career counseling. Career counselors, by trade, support individuals in discovering their strengths, possible career paths, and can support clients in preparing for career interviews, resumes, and choice of higher education if desired.

Whether you engage your client in the above-mentioned exercises to improve self-esteem, discover purpose, or develop new insight, reassuring your clients that self-discovery is an exciting, sometimes lengthy process to uncover passion and motivation can set realistic expectations for your therapeutic work.  However they go about engaging in “finding their why,” it is the hope that they enjoy the process and engage fully to uncover their recipe for success and achieve feelings of fulfillment!