Seven Tips for Building Rapport with New Telehealth Clients

Telehealth is a necessity in the face of COVID. Professionals and clients alike are feeling grateful to have this option to provide space for services and support clients with change, uncertainty, and the unknown. If you are like me, you weren’t fully prepared for the shift to telehealth back in March. Perhaps it wasn’t part of your business model as a therapist. Maybe it wasn’t an interest for you as a professional. Nevertheless, as we adapt to continue this meaningful work, let us take a look at some helpful tips for rapport and by-in when engaging new clients through telehealth.

1.     Look at the Camera Frequently. It’s hard not to feel self-conscious being on a screen. Invest in a light ring and elevate your camera so you are looking forward instead of down. Be sure to look at the camera directly when asking questions and when closing the session, as it encourages connection in feeling like you are truly looking at the client instead of looking at an image of you or them.

2.     Explain Loss of Eye Contact. You don’t have look at the camera the whole time. In fact, you need to be able to glance down from time to time to see how the client is presenting when it comes to body language. Be sure to name why your gaze is shifting, such as writing notes or referencing something in their initial paperwork.

3.     Review Documents. Review their initial documents beforehand and reference them in session. Not only does this show you are paying attention, it prevents your client from feeling like they have to repeat themselves.

4.     Obtain Consent for Telehealth. Engage your client in reviewing the telehealth software and protocols to obtain their consent. This includes emphasizing how their information will be protected and what to do when a call is dropped or requires another method due to connectivity issues.

5.     Encourage Questions. When building rapport via a screen, encourage your client to ask questions. This allows them to address any anxiety or worry about the work and permits them to feel like the conversation isn’t one-sided. Summarize goals and next steps for feedback and to demonstrate active listening.

6.     Explore Therapy History. A powerful question in building rapport can be normalizing that therapy is not a one-size-fits-all approach. Encourage your client to open up about what works for them by asking what they liked or disliked about past therapy experiences. Are they brand new to therapy? Ask how you’ll be able to gauge if something you say or do upsets them. This highlights our humanness as providers and encourages new clients to be honest and self-aware about triggers for upset as well as opportunities for therapeutic repair.

7.     Be Transparent. As the intake session comes to a close, summarize what you’ve heard them share, including what they want to work on and scheduling needs. Are they open to weekly therapy? Biweekly? Did you capture their initial goals? Scan and share your intake notes for complete transparency, inviting them to provide corrections or feedback as appropriate.

These tips are by no means an exhaustive list. However, the hope is that they compliment your own experiences as a professional adapting to telehealth. Allow these ideas to support your best work by providing a meaningful first impression. Your clients will be grateful for your attention to detail and your efforts will encourage their active participation in scheduled telehealth sessions going forward.

Exploring the Difference Between Sliding Scale and a Range of Rates for Therapy

In growing your private practice, it’s not uncommon to have questions about how a sliding scale works. In fact, for many clinicians, the concept of sliding scale gets confused with offering a range of rates for client services. We tend to use sliding scale and a range of rates interchangeably when in reality, they are very different approaches to running your mental health practice.

Sliding scale describes an income-based calculation to determining what the client will pay for each session. The client must report to you their income in order for you to set a rate they can afford based on that income. This is a clear-cut option in having the transparency of a table of rates and the calculations used to determine them in your state of practice. It demonstrates that there is no discrimination against clients of diverse backgrounds in having set rates that are predetermined. Take a look at the Khalil Center which shares sliding scale rates for their therapy services in Illinois, New York, California, and Toronto, Canada.

Although the charts are easy to interpret and are uniform to use, sliding scale does put you as the therapist in a position of asking the client to report on their income, which can make some people uncomfortable. Not only that, but what if they report an income that is incongruent with their reports of their lifestyle in sessions? I have seen colleagues struggle with unspoken resentment wondering why the client is taking vacations every other month but reports an income level where they can only afford $90/hour therapy sessions.  How often would the therapist re-evaluate the rate based on income changes for the client? Is the therapist prepared to offer the lower rate when the client comes in stating a change of employment such as a loss of job or layoff? Would the therapist introduce a re-evaluation of income and session fees when a client discloses a promotion or new job?

You can see why it can feel like a sticky situation to navigate client income as the fee determinant for private pay rates in private practice. It takes a lot of attention to detail to maintain a sliding scale. A second option to consider is a range of rates in your business as another viable option. 

Range of rates means that the business owner, in this case the therapist, identifies a range of rates they are comfortable charging for their services. For example, perhaps the clinician identifies that $120-$150 is an appropriate range that 1) feels fair to them as a licensed professional accounting for expertise and their current location and 2) feels accessible to the population they are trying to serve. Once the range of rates is set, the therapist can share it openly on their website and in initial calls with potential clients for client consideration. The client is encouraged to pick a rate that they feel they can afford, allowing the client to demonstrate financial autonomy. The agreed upon rate is recorded in the client file and both clinician and client are comfortable to move forward with sessions at that rate.

Similar to sliding scale, the range of rates may need to be revisited if the client experiences a loss of employment or other financial hardship. Recently, some of our colleagues have reduced rates to help individuals impacted by COVID-19. Others have had conversations with existing clients to adjust their rate as they look for new jobs or wait for news from their employer after being furloughed. Although these decisions can occur on a case by case basis, the biggest question that arises in private practice is what to do when you are ready to increase your rates.

Rate increases for private pay therapy are commonplace in January as the start of a new year. Will you raise your rates for existing clients? For new clients only? How will you notify existing clients of the change if the rate change applies to them? 

Some important elements to consider include:

1)    When and how current clients are notified of a rate increase. In writing is the ideal method.

2)    Documentation of the client decision including agreement to the new rate effective January 1st and beyond.

3)    Documentation of referrals provided within the client’s price range if the client is unable to continue with you at the increased rate.

As a business owner, you get to decide if sliding scale or a range of rates works better for you. As you move forward with your decision, clients will be deciding to either move forward with you in sessions at the higher rate or may require a transfer with referrals. Therefore notifying clients of the upcoming change 2-3 months ahead of time can be helpful to both the therapist and client in support of a seamless transition. My hope is that this blog will support therapists in exploring their options while encouraging them to navigate rate changes in ways that feel empowering and authentic. 

Estrangement Energy: A Cycle for Ruptured Mother-Daughter Relationships

It’s a pattern of devastating hurt. Safety and security are risked again and again. First introduced as the evil step mothers in Cinderella and Snow White, we have even more extreme portrayals of unhealthy mother-daughter relationships such as in White Oleander, Flowers in the Attic or The Sixth Sense where Mrs. Collins poisons her daughter Kyra to get attention from others. Characters we learn to hate due to their psychological and sometimes homicidal behaviors and repeated abuse of their offspring. These characters represent dramatic examples meant to produce an emotional reaction and feelings of protection by the audience for the daughters who are survivors of such abuse.

What about the real-life experiences of attachment trauma? The phenomenon we see for complex trauma survivors who open up about their experiences of their mothers being less than loving? In working with dozens of women over the years, it has become clear that the damage done in a ruptured mother-daughter attachment has long lasting effects. Powerfully captured in Dr. Karyl McBride’s book, Will I Ever Be Good Enough?, daughters go through patterns of grief and loss, questioning their own worth due to the spoken and unspoken messages of their mothers. If young children worry that their parents’ divorce is their fault somehow, it’s not surprising that an adult child of an estranged mother may also feel some sense of responsibility for the damaged relationship.

The responsibility and grief they feel may spur them to come to therapy to find some peace with the estrangement. Let’s take a look at several examples of adult women who are estranged from their mothers after the painful realization that the relationship was unhealthy, unsafe, or unable to shift in ways that felt empowering and worthwhile.

Kendell* has been estranged from her mother for more than 16 years. She left home at 15, got pregnant at an early age, and consumes alcohol daily to calm her nerves. Kendell is a committed mother to her four children, stating she wants to provide for them in ways her mother couldn’t. When engaging Kendell in her trauma work, she recognizes her mother’s mental health challenges prevented affection and her mother saw her as competition for the men she dated, leading to conflict and verbal or physical altercations until Kendell left the family home.  Kendell struggles with being gaslit by her mother who still tries to call her occasionally and has enlisted Kendell’s younger sister to convince her that it’s all “water under the bridge now.”

Nicolette* is celebrating seven years sober from heroin. She has identified her childhood consisting of her mom criticizing her looks, weight, and intelligence. Nicolette’s experience with her mom captures a pattern of manipulation through her teenage years which led her to believe she was flawed, unlovable, and mentally ill. She found herself marrying a controlling man and suffering from various addictions until she was able to get a divorce when the relationship turned violent. Although Nicolette entered substance recovery programs voluntarily to get well, her mom accused her of relapse throughout her sobriety, even physically assaulting her and getting Nicolette arrested under false charges due to her stigmatized label as a former drug addict. Nicolette struggled to release herself from family ties in spite of the abuse, believing she had to work harder to earn her mom and other family member’s love. She has been estranged for four years now and finds herself questioning the estrangement 1-2 times per year, asking herself if there was more she could have done.

Sophia’s* father reconnected with her as a teenager, dying of a rare cancer not long after. Raised by a mother who struggled with poverty, mental health, and substances, Sophia was left to take care of herself and her younger brother in their rural upbringing. Sophia was determined to find independence, moving out on her own and pursuing a career as a helping professional. Sophia currently struggles with high anxiety and demands for control. She doesn’t like change and finds herself on edge and reactive when anticipating outreach by her estranged mother every holiday. She struggles with perfectionist tendencies and rigid thinking. Sophia’s goal is to have stability for herself and her family and she maintains strong conviction to remain estranged from her mother. Sophia prides herself on building other meaningful relationships that feel supportive and loving. 

Each of these women’s stories is unique and their own yet they have something in common, the grief and loss patterns associated with the ruptured mother-daughter relationship. Some daughters are left wondering if they could have done more to salvage or repair the relationship with their mothers. Others hold anger and determination to be nothing like their mothers. Their therapeutic work could begin with questioning their own role or actions. Or perhaps they have concerns about other relationships present in their life. They may work through the core beliefs of feeling unlovable, unworthy, or a failure in believing they were unable to earn their mother’s love or affection. And eventually, with time, they may redefine their identity without a mother in their life, embracing their strengths and boundaries to support healthy, meaningful relationships with others. 

Estrangement Energy, what I call the process for individuals doing this deeper work, can feel exhausting. Here’s the pattern I’ve witnessed in many clients over the years. 

·      There is a cycle of abuse or patterns of negative behavior that have happened for years between daughters and their mothers.

·      The cycle of negative interactions contributes to how the daughter measures her self-worth.

·      There is questioning if this pattern will ever shift, improve, or change for the better, especially when the daughter is aware that other mother-daughter relationships look different than their own.

·      The relationship rupture happens when the daughter has had enough. She makes moves to distance herself from the pain or abuse experienced in the relationship. 

·      With space or at the urgings of others in her life, the daughter is prompted to remove the relationship, labeling it as “toxic” and estranged.

·      The daughter tends to pursue therapy after the estrangement has happened or is in the process of happening in response to immense hurt, pain, and grief reactions that result from the estrangement.

·      Grief and loss followed by new identity development is done in therapeutic settings or through self-discovery over time.

·      A new sense of self emerges, with deeper work on self-worth related to core beliefs of being lovable and worthy in relationships.

·      The Estrangement Energy Cycle can be triggered to continue if current relationships mirror the estranged mother-daughter relationship, leading to resumed questioning of self-worth.

As you can see from this cycle, it can be an emotionally challenging if not draining process to work through estrangement and what it means to an individual. It’s not an easy or fast process, so here are some ideas to help clients do this meaningful work:

·      What’s Your Impression? Understand that some clients will be worried what you think of them as they share their grief and loss of the mothering relationship. Remain curious and neutral, exploring how these worries can become part of the therapeutic process.

·      I’m Second-Guessing Myself. It’s not uncommon for a client to question if the estrangement is still valid after a period of time. Like Nicolette mentioned above, perhaps they find themselves checking in to see if the estrangement still feels right. Normalize the experience of questioning and hold space for them to evaluate the pros and cons of resuming contact.

·      Reconnection or Relapse? Some of your clients will move from thinking about rekindling an estranged relationship to giving it a try. As therapists, it is important that we do not force our own values on our clients, instead supporting them through the process of outreach and connection with their estranged parent while encouraging healthy boundaries, safety needs, and deeper processing in weekly sessions if needed.

The bravery of daughters and clients who choose to work on themselves in order to heal the attachment trauma they’ve experienced is both powerful and inspiring. My hope is that this introduction to theEstrangement Energy Cycle can support both clients and clinicians alike in the journey to being one step closer to healthy self-worth and a renewed, empowered sense of self.

*Client information has been changed to protect confidentiality.

“Don’t Just Tolerate Me, Love Me.” Love Languages in the time of COVID-19

Online for Love via Unsplash.com Images

We are more than four months into the pandemic and relationships are feeling stretched, like a too-small shirt across our shoulders, threatening to bust at the seams.  Perhaps you are separated from your loved ones, making the miles, restricted travel, and lack of contact feel unbearable. Maybe you or your loved one is an essential worker, choosing the difficult decision to distance from family and friends in order to reduce the risk of exposure. Or perhaps you’ve been following stay-at-home and safer-at-home orders with your partner or spouse, finding your relationship put to the test.

Some love languages are benefitting from the changes whereas others are being placed on the back burner. Folks with love languages of physical touch and quality time may be the lucky ones to benefit from unexpected, increased time together. Gary Chapman, Author of The Five Love Languages lists them as:

·      Physical Touch

·      Quality Time

·      Words of Affirmation (positive words)

·      Acts of Service

·      Gifts

So how have the love languages been stretched in the time of COVID-19? Quality time may be challenged because even though we are at home or in the same space working, it doesn’t mean it’s quality connection to one another. For physical touch, are we feeling the absence of platonic or comforting touch of others in having to self-isolate at home? Gifts may be limited, acts of service amplified, and words of affirmation may not come easily as we experience the brain fog and exhaustion of the pandemic. In fact, although couples are adapting to the changes, there are several challenges romantic relationships are facing under the strain of COVID-19.

·      Increased fighting

·      Too much togetherness

·      Feeling overstimulated

·      Feeling numb

·      Experiencing low libido

·      Increased stress and anxiety 

·      Difficulty separating work from home

·      Increased irritability

·      Feeling on edge or restless

·      Experiencing financial strain

These stressors don’t necessarily make or break a relationship by themselves, it could be that the accumulation of several factors like these would put a relationship at risk. Therefore it is important to attempt to adjust or adapt in an effort to keep the relationship healthy. Here are some ideas to try when your romantic connection is feeling itchy and uncomfortable.

·      Creative Quality Time: How creative can you get with quality time at home? A movie marathon in the living room full of pillows and blankets? Cooking a meal together? Taking a walk or a bike ride?

·      Rituals to Transition: What rituals are in place to help you both transition from work? Do you have a designated space to work? Can you change your clothes or walk up and down the hall to feel like you are moving from one role to another? Is it a matter of powering down your computer, closing the office door, or putting your laptop away?

·      Choose to Check-in: When do you like to check in on how things are going? Can you choose to check in during a meal or before the day takes off? Is there eye contact to support active listening? 

·      Communicate: It’s going to take additional effort to increase communication when you are already feeling stressed or overwhelmed. Share how you feel. Advocate for your needs. Ask for help. Partners can’t read our minds so it remains important to speak up.

·      The Art of Apart: Time apart can be good for the relationship if you feel like you are right up under one another. Is there a way to engage in hobbies or outdoor activity that gives you permission to miss one another? They say that absence makes the heart grow fonder, perhaps this is possible with a little time apart.

Relationships can grow leaps and bounds through hard times like these. The gratitude you can feel for being in this together is a powerful tool. Embrace new ideas to strengthen your relationship, knowing that blips along the way are expected and normal. The hope is with a little TLC and creativity, your relationship can move from surviving to thriving during COVID-19! 

What Pilots can Teach Perfectioneurs

Pilots and Perfectioneurs have a lot in common. Pilots can serve as examples of Perfectioneurs. The archetype of pilots is often one of confidence, charisma, attention to detail, and assertiveness, placing them one step away from the steamrolling potential of overworked Perfectioneurs. 

Pilot or Perfectioneur?

·      Maintains attention to detail

·      Works long hours

·      Defines identity by what they do

·      Prefers jobs where they are in control 

Make no mistake, we absolutely want people who are driven and have attention to detail flying various aircraft. It is directly connected to our well-being and safety as passengers. We also want to know that the people selected to hold this responsibility are performing at their best. Fit for duty. Therefore it’s no surprise that Aviation Psychologist Dr. Paul Dicken’s guide for pilots to re-enter the workforce during COVID-19 has been downloaded 65,000+ times since its release! 

Being a licensed therapist married to a pilot, I was excited to interview Dr. Dickens as one of 11 Accredited Aviation Psychologists in the EU. His passion for this work was palpable over Zoom and we found ourselves in easy conversation on the similarities between pilots and perfectionists. It’s not surprising then, to recognize that his suggestions in the areas of physical, cognitive, emotional, and relational needs compliment the work-life balance criteria for many other professionals attempting to adapt during COVID-19.

Some recognizable tips from Dr. Dicken’s guide Cleared for Take Off! A Pilot’s Guide to Returning to Flyinginclude: 

·      Set sleep patterns and sleep hygiene rituals

·      Adopt an exercise regimen

·      Gear up for work mode through reading materials and visualization

·      Practice self-awareness to identify how you feel about returning to work

·      Prepare your family for the transition back to work

Meaningful and relevant, these tips apply to entrepreneurs, first responders, and perfectionists as well. Let’s take it a step further to see how pilots address psychological safety at all stages of flight, captured in the acronym IMSAFE and created by the Federal Aviation Administration (FAA).

Illness- Do I have any symptoms?

Medication- Have I taken any over the counter or prescription drugs?

Stress- Am I under psychological pressure from the job? Am I worried about financial problems, health problems, or family discord?

Alcohol-Have I been drinking within 8 hours?

Fatigue- Am I tired or not adequately rested?

Emotion- Am I emotionally upset?

What if we modified the IMSAFE acronym for people during COVID-19 in order to capture what we are tracking as mental health and wellness needs during this challenging time?

Illness- Do I have any symptoms of illness?

Medication- Do I take prescription or over the counter drugs? Do they pose any risk to my functioning? Are they helpful to my functioning?

Stress- In this time of unknown, what’s my current stress level? Does it fluctuate? When?

Alcohol- Am I drinking out of a desire to cope or fight boredom?

Fatigue- How tired do I feel? Am I getting enough sleep? Too much sleep?

Emotion- Am I aware of how I feel? Where do I fall on the spectrum between anxious and numb?

IMSAFE poses some important questions to ask ourselves as we attempt to adapt and change during COVID-19. Change is difficult, especially for professionals that covet feelings of being in control. Therefore pilots and the FAA have a lot to teach us about the importance of checklists to gauge our functioning since it’s subject to change. Perhaps we can consider checking in on our functioning with the IMSAFE acronym. Maybe the tips from Dr. Dicken’s guide can help individuals preparing to return to work. Either way, pilots have a lot to offer perfectionists including disarming resistance and normalizing the vulnerability of adjustment. It’s possible that these resources will pave the way for additional conversations on coping during COVID-19, allowing perfectionist pilots to be the role models of adaptive functioning and pivoting during a pandemic.

Connect with Dr. Dickens on LinkedIn

Check out Dr. Dicken’s full guide here.

See more tips for pilots with the IMSAFE protocol here.

Efficient is not an Emotion: The Risk to Romantic Relationships

My husband was talking about the joy of driving a vehicle he really likes. The experience of a horse-powered engine that purrs, a smooth ride over asphalt, and a car that can make one feel confident when in the driver’s seat. In an attempt to further involve me in the pleasure of it all, he’d asked me how I felt when driving my car. “Efficient,” I said. I didn’t even have to glance at his face to notice the joy deflating.

“Efficient is not an emotion,” he responded, “you know that.” He’s right. As a therapist, that was not an acceptable answer. What about for the Perfectioneurs and entrepreneurs out there? The ones that value streamlined efficiency, momentum, and driven purpose? To them, an efficient vehicle is satisfying in getting them from Point A to Point B. It permits them the creative energy for other meaningful pursuits. In an entrepreneurial mind, it’s not about sheer pleasure in the drive, it’s about the purpose of the drive.

Efficient: Achieving maximum productivity with minimum wasted effort or expense

Perfectioneurs can’t stand idleness or wasted energy and I recognize I was speaking as a restless, irritable, and annoyed person that day. It happens, we all have moods. I’d crushed the conversation with my matter-of-fact tone and lack of enthusiasm. It wasn’t the nicest response I could have given to my spouse’s bid for engagement. Instead, I could have engaged more thoughtfully and with more heart.

I’ve come to realize that the more I embrace my identity as a Perfectioneur, the more I notice my edges, flaws, and quirks. I don’t always get joy out of the same things my spouse does. I find myself ten steps ahead in the future, plotting, planning, and anticipating victory energy. So finding myself in what I thought was a casual conversation, my reaction was to be efficient, answering to move the conversation in another direction.

It’s one of the risks of being a Perfectioneur, steamrolling over others in an effort to support our own agenda. And it that moment, I needed to check myself to not be hurtful to the person I love. How many people out there are aware that they do this same thing? That we steamroll and control at times? We’ve all been guilty of treating our loved ones poorly at one time or another, a subconscious expectation that they will tolerate our mood swings and poor behaviors because they love us or care for us and so we let them have it. The day’s frustration gets dumped on them. In this case, my spouse walked into a trap he didn’t even realize was there. And it was my responsibility to repair the hurt my clipped response had created.

Efficient is not a coveted characteristic of romantic relationships.  

How’s your spouse doing? Efficiently. How’s the sex? Efficient. 

Wouldn’t we rather celebrate unique characteristics of our relationships? Perfectioneurs must learn to lean in to vulnerability to show up more authentically in each relationship they have. Relationships are an important part of balance and connection, therefore they deserve our attention and efforts to strengthen them. Here are some tips I’ve learned along the way to be a better partner to my spouse.

• Importance of Eye Contact: If we aren’t looking one another in the eye, are we sure that we have each other’s attention? Are we truly listening?

• Routine Check-Ins: Having a routine supports us asking about each other’s day and solidifies plans for the next day. It’s a time where we can be present and make plans together during the busy work week.

• Don’t Fix or Freeze: We were taught by a professional once to ask what the other person needs from the conversation. For example, if we were seeking advice, naming it helped our spouse prepare their response. If we just wanted to vent and have them listen, it was helpful to share this up front so they could stay present in the moment without the urge to fix it.

However you choose to navigate your relationship, just know that efficiency is not the goal. Relationships are messy! If you are lucky, they are playful, passionate, and loving too. So strive to be the healthiest Perfectioneur you can be and show up for your relationships. Celebrate others interests, connect on a deeper level, and invest in solid communication. Relationships are the glue that pave the way for creativity, so elect to sit this one shotgun and let your loved one drive. 

Ready to Expand? 3 Things to Consider When Growing Your Practice

A natural next step for an established clinician in private practice is to consider bringing on other professionals as part of their growth opportunity. Therapists may consider this option for a variety of reasons, including a desire to address their growing list of referrals, utilize office space more fully, or reinforce their brand. Moving to a group practice model is a process that is not for the faint of heart, so let’s take a look at some important things to consider before embarking on the process.

1.     Do you wish to take on Independent Contractors or Employees?

This is a vital first question because it dictates how you go forward with the process. If you were to take on Independent Contractors (ICs) for example, your hiring process and formal contract would emphasize their defined commitment to the practice, payment schedule, and marketing or referral expectations that fall within IC guidelines at both the Federal and State levels. In contrast, if you were to go with an employee model, you would need to be prepared to pay salaries, maintain office space and supplies, and offer retirement or healthcare packages based on recommendations by your attorney and CPA for this model. By asking this question first as it applies to your vision for practice growth, you will be able to refine your plan of action when taking on professionals for hire.

2.     Have you set up a business name with tax ID and group NPI?

Another piece to the puzzle of private practice growth is moving from a solo practitioner to a small business model. This includes having a business name and TAX ID form which to operate from, most likely established when you started your practice as a sole proprietor. A next step for group practice designation includes applying for a free group NPI which will link back to your business for billing and insurance paneling if that is part of your larger plan and working towards updating your records to reflect both TAX ID and NPI going forward.

3.     Do you have plans to take insurance in your group practice?

Speaking of bigger plans, are you hoping to credential your new hires with insurance panels for the services you provide? Identifying the process of adding clinicians to your existing contracts for each insurance panel could impact your timeline for new hire on-boarding and adaptation. Some insurance panels may take 1-2 weeks to update their records with your new hire information whereas others may take longer, which could impact your launch date or growth opportunity overall if too many obstacles exist.

These are just three of many questions to consider when exploring if a group practice model is right for you. There are dozens of things to consider including office space, health insurance, contracts, fee schedule, staff, and billing needs. Lots of moving parts that feel rewarding to owners who have made the move to group practice. Consider investing in training, consultation, or group practice conferences to learn more about the pros and cons of group practice ownership and leadership as they fit with your future goals. 

My Wish for You is More Victory Energy!

Like several couples during COVID-19, my spouse and I have attempted to decompress by watching a show or movie at the end of our work days. Winding down, we happened upon Keeping the Faith (2000) with Edward Norton, Ben Stiller, and Jenna Elfman. Recognizing that neither of us had seen this movie before, it was Jenna Elfman’s character Anna Reilly that I recognized instantly as a Perfectioneur. Anna worked in a corporate office, had confidence and pleasure in her work, and was attached to her cell phone, even going so far as to carry it on a garter while in an evening dress! She was driven. She was respected. She had opportunities to excel within her company. As the plot of the movie advanced, Anna eventually questioned if she worked too much, recognizing that she wanted time for a career and time for quality relationships.

Spoiler alert! Anna, as a healthy Perfectioneur, found she could have both a rewarding job and meaningful relationships! It was reassuring. It was a happy ending. And it was one concept Anna spoke about that really resonated with me as a fellow Perfectioneur. She was talking to the mother of her then-secret romantic partner when she said she wanted someone to share it all with. Share what? Her victory energy. Anna stated she wanted to share her victory energy with a partner at the end of her day. The energy created by accomplishing something so satisfying, it leaves one on an emotional high. Giddy with accomplishment. Energized with enthusiasm. Anna wanted celebrate it and share it with someone she loved. 

As a therapist and entrepreneur, I too want more victory energy. I too want to share it with the person I love. As a therapist, I can’t always share the clinical victories in having to maintain confidentiality. However, I can share the victories of being an entrepreneur of several growing businesses, celebrating creativity with purpose.  

Experience the Victories

The first step in having more victory energy is noticing it. Notice the potential for victory energy, encouraging it to grow stronger. Be self-aware enough to feel the warm fuzzies of it followed by enhancing the way it makes you feel. Find yourself stoking the ember of excitement into a solid flame that warms you from the inside out. You’ve felt this feeling before. For some, it’s the victory of winning at a sporting event. For others, it’s the pleasure you feel after getting great feedback, a promotion, or a new opportunity. It’s euphoric. It’s a rush. And it feels amazing.  Engage your five senses to express victory energy fully. What visuals do you associate with it? What smells? What sounds? Elevate the feeling by noticing it fully, so you don’t miss the chance to feel the pleasure of it.

Understand your Baseline

The challenge of victory energy is that it doesn’t last forever. As humans, we don’t get to feel that high consistently. Our body is structured to return to baseline, representing an average emotional state when absent of stimulation. In other words, you eventually have to come down from the high of victory energy, which can feel disappointing or painful. In fact, author of The Big Leap, Gay Hendricks would say we are prone to subtle self-sabotage to maintain the status quo. If we find ourselves moving into our “Zone of Genius”, what Gay Hendricks describes as our optimal zone for fulfillment, purpose, and happiness, it can be expected that something happens to bring us back to our “Zone of Excellence.” Perhaps due to disbelief that we achieved this higher level of functioning, discomfort at the change, or core beliefs stating that we don’t deserve great things. Hendricks gives examples of sabotage like picking a fight with our spouse after receiving good news, or getting ill after obtaining the job of our dreams. Regardless of how it manifests, it’s important to understand your subconscious reactions to victory energy in order to navigate the challenges and embrace the benefits.

Build your Gratitude Practice

Now that you’re fully aware of the feeling and how fleeting it can be, capture your victory energy in words as part of a gratitude practice. What are you grateful for? What were the contributing factors to foster this feeling? How can you download the experience further, forming it into a pleasant memory to be revisited again and again if desired? Perhaps you engage in a writing exercise to capture the moment. For Anna Reilly, she wanted to share it with someone in real time when making the memory. She wanted to amplify the good feelings of victory energy by feeling the excitement and pleasure of sharing it with someone else. Who would you share your victory energy with? How could their participation assist in keeping the positive feelings flowing and growing?

Victory energy, like gratitude, has the potential to be life-changing. Celebrating success without fear of being cocky. Naming gratitude so we can fully download the experience at a cellular level. However you embrace it, I wish you more victory energy. The powerful practice of mindfulness, gratitude, and connection with others. I wish you more victory energy so that you too can feel the rush of excitement. To feel fully alive. I wish you a happy ending like Anna’s. May your victory energy be plentiful and celebrated with all whom you love.

Getting on Google’s Guest List: SEO Strategies to Be Better Seen

Imagine Google as an A-Lister putting on the party of the decade. 

The whos-who are all invited, rubbing elbows with one another amidst good food and drink. No one wants to be left out. To earn an invitation to this party, you have to be part of the ‘in’ crowd. So how do you move from fangirl to favored guest?

How do you get on Google’s Guest List?

Moving to VIP status on Google’s guest list is all about Search Engine Optimization (SEO). Recognized as a valuable online strategy for businesses, SEO can feel like a foreign language that is constantly moving and changing. Its purpose is to help businesses and products be seen by community members, identifying relevant information to populate higher on the list of search results over competitors. 

Private practice therapists are working hard to be discovered online in order to serve more people in their business yet the costs alone for SEO services can feel restrictive and intimidating. You don’t have to have it all figured out, this can be a place to start! Regardless if you are an SEO expert or novice, there are some great resources available to clarify marketing strategies that can otherwise feel lost in translation. I encourage you to research SEO companies out there and hire support when identifying how your business needs to grow.

Holding ever-evolving strategies and limitations in mind, I hope the ideas here can serve as a jumping off point in your own business journey with SEO, specifically focusing on what you can do with your professional website.* 

 Ready to find your name at the top of their list? 

 As the powerhouse search engine millions of people choose to use, Google’s pages represent the guest list that every business wants to be on.

 Google makes its own rules. It sets its own algorithms and expectations for how it wants to feature the billions of data points and businesses found on the internet. Winning Google over is a strategy worth considering. So what is Google tracking in website design that you can use to your advantage to become part of the ‘in’ crowd?

 Google wants to know that your website is active and up to date. Google doesn’t like websites that have been dormant for months, instead rewarding websites that have new information added or updated in a timely fashion. Here are some specific strategies that can help your website get one step closer to being on Google’s good side.*

Strategy #1 Update Videos and Pictures

 Google loves videos and pictures listed on your website. They don’t even have to be professionally done. Consider creating and updating media monthly, adding something new or rotating out featured videos and photos to keep Google and potential visitors interested. 

Pro Tip: Embed your videos on your website with links via YouTube and other video platforms to make changing up video content a five-second task!

Strategy #2 Have a Google Map and Business Listing

Google is the A-lister who holds all the meaningful connections remember? So give it something it likes in order to earn you an invite to rub elbows with other superstars—a Google Business Listing and Google Map location of your office! Create your listing with Google Business followed by creating a Google Map Link to embed within your website. This helps potential clients find you when searching your name or the name of your business online. You may have noticed that Google Business search results populate in the top right corner of the internet browser, including customer reviews, website link, and phone number associated with your business which can come in handy for people who want the at-a-glance view of what you do.

Pro Tip: Use this written tutorial to walk you through the steps of making your custom Google Map to then embed in your website.

Strategy #3 Post Blogs Regularly

In support of Google liking new content, consider writing a blog post at least once a month that is featured on your website. You can use your blog as a space for sharing new content and announcements about your business, distributing it on your social media for further exposure and visitor interest while encouraging them to click back to your website for more content.

Pro Tip: Use an eye-catching picture when sharing your blog post on social media, including the blog link on your post so they can easily find the full content on your website and check out more that you have to offer.

Strategy #4 The Contact Page is Necessary

 Yes, I know we’ve all been spammed when listing our email or other contact info on our website. Some therapists have gone so far as to eliminate ways to contact them via their website for this reason. But to eliminate it or not feature a “contact us” page is something Google doesn’t like, meaning it could hurt your ranking as VIP when it comes to the SEO game. So consider a contact page with set form fields and a captcha if necessary, recognizing that Google is still happiest when having your business name, address, phone number, and email featured.

Pro Tip: List your address, phone and email in the footer of your website so it populates on every page a visitor views.

Strategy #5: Links to Other Websites

Google likes your connections. Consider having hyperlinks to other webpages and resources on your website, encouraging visitors to participate in further clicks and engagement on your site. The longer the visitor is on your site, the better. Which is probably why people spend so much time writing and re-writing content for their websites. 

Pro Tip: When hyperlinking outside resources and referrals, be sure to change the settings so that each link opens in a new tab or window. You want to keep visitors on your page as long as possible, so a click that takes them completely away from your site isn’t recommended.

You did it! You are one step closer to being part of Google’s exclusive guest list! We looked at five strategies to improve your website’s performance with SEO to keep you and your business on Google’s radar. Next, you may want to consider hiring a professional to work on some elements that are a little more time consuming and complex, including:

·      Attach keywords and tags to your website that fit your brand

·      Complete coding on the back end of your website when using pictures or copy so Google can read it fully while limited errors

·      List your business within other search engines to make you easier to find

SEO can be seen as ever-evolving, requiring commitment to be named a VIP on Google’s guest list. Give yourself some grace, connect with colleagues, and recognize it takes patience to tackle this learning curve! You can be successful at being seen!

*These are tips and tricks I’ve learned from various marketing and SEO professionals and are subject to change. They do not replace formal consultation with a professional and are for educational purposes only.

Self-Harm vs. Suicidal Behavior: What Clinicians Need to Know

A common question in our community is about the connection between self-harm and suicide. Self-harm, also known as Non-Suicidal Self Injury (NSSI), is defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as relational and coping. Self-harm as a means for suicide can be described as one of eight possible reasons for engaging in self-harming behaviors. Dr. Jack Klott discusses the eight reasons in detail in his online series, Suicide and Self-Harm: Stopping the Pain as:

1.     Emotion regulation or coping-i.e. to calm the senses  

2.     Self-punishment- i.e. “I deserve to hurt.”

3.     Psychosis-i.e. command hallucinations to harm self

4.     Response to anxiety and depression- i.e. to bring back into body, to feel something, to express internal pain

5.     Peer influence- i.e. they said it worked for them

6.     Body dysphoria- i.e. I need to alter my body to feel more like myself

7.     Isolation and abandonment- i.e. expressing pain

8.     Suicide rehearsal- i.e. intention to die

For teens today, any of these eight possibilities could apply. Although each person has their reasons for engaging in self harm, more and more teens are going to their peers and the internet for answers on how to handle the stress they face in academics, relationships, and more. 

For 12-year-old Savannah, for example, self-harm patterns in her life are the result of a friend saying it helped them cope, therefore encouraging Savannah to explore if self-harm would have the same results for her as a coping strategy. 

What and Where?

 So what does self-harm look like for today’s youth? In the clinical arena, we are tracking trends in behaviors that have been socialized and publicized to some degree, like the Tide Pod Challenge of 2018 and the Salt-Ice Challenge of 2012. According to the Mayo Clinic, self-harm can be defined as any behavior that is self-inflicted, deliberate, and results in injury. Examples could be scratching, cutting, burning, hitting, and rubbing the skin until it’s damaged, as is the result of using an eraser on the skin. As more awareness is built around self-harm, the once typical locations of arms and legs may be seen as too noticeable to the public eye by individuals who feel a sense of judgement or shame after having engaged in self-harm behaviors. Therefore the clinical community is now tracking self-harm that appears more subtle when expressed on the human body, such as locations that are easier to cover up or hide from others, including but not limited to armpits, torso, upper thighs, and between toes. 

Curiosity and Compassion

Engaging youth in exploration as to what purpose the behavior serves can bring context and understanding to their reasons for engaging in repeat self-harming behaviors. It can also help professionals, family, and friends identify appropriate responses to self-harm in order to best support of the person they are trying to help. Asking questions from a neutral, curious place can clarify a youth’s choice for self-harm as it relates to risks for suicide. 

 Examples of how to ask:

“What purpose does this serve for you?” 

“What do you get from engaging in self-harm?” 

“What was your intention when engaging in self-harm?” 

For example, after being encouraged by her peers, 12-year-old Savannah states that she scratched her arm repeatedly in trying to cope with an internal, painful experience. This disclosure may feel very different in how a professional would respond to safety needs in comparison to the experience of 22-year-old Taylor, who reports he was hoping he would get an infection as the result of self-harm and die.

Harm-Reduction Model

Self-harm can be considered a precursor and risk factor for suicide, which is why it is important to explore a person’s experience and purpose for engaging in self-harm behaviors. Best practice continues to be a Harm Reduction Model when it comes to addressing self-harm behaviors, which means working alongside the person to identify other coping skills that could be utilized prior to self-harm with the hope of the urge dissipating as time passes and other strategies are utilized. The peak of strong emotions and stress is best described as the bell curve, where once a person in distress reaches the peak and start moving back to baseline—possibly out of fatigue or exhaustion—individuals who have historically engaged in self-harm report they are less likely to engage in the behavior in feeling less of a pull to do so.

Coping skills that can reduce the intensity and frequency of self-harm should be unique and individualized to each person. Returning to 12-year-old Savannah, for example, with therapeutic support, she has identified that she is looking for external expression of internal pain. Therefore, the primary theme for Savannahs’ safety plan would be to support her in identifying other ways to express that pain. For some youth, just the sight of damaged skin or blood is sufficient to shift or alleviate their current state of pain. For these individuals, a mental health professional might work with them to try fake blood applied to their body where they feel the urge to self-harm, or other expressions such as henna tattooing or doodling. 

For individuals who report that the pain response is the key element that quiets their internal system, other means can be introduced that reduce the risk of injury or infection. For example, perhaps a mental health counselor introduces a rubber band for youth to snap their own wrist, a frozen washcloth to pull apart that results in intense cold and stinging without injury, or introduces Icy-Hot for the tingling sensation on their skin. Again, each person’s Harm Reduction Plan should be catered to their needs in support of reducing self-harm behavior by means of how often they engage in the behavior and reducing methods that increase suicide risk.