Finding Yourself in the Fix-Its

It’s important to recognize that the therapy process isn’t fully predictable or formulaic. It’s a connection between two people, one with hurts, stressors, and needs. The other holding their own needs and biases in check in an effort to be helpful. Because of their limited time in the field, it is not uncommon to have a new clinician find themselves in an advice-giving role or “fix it” mode.

The perception is that the client is asking: What should I do? Help me. Tell me what to do.

Recognizing that a clinician holds some authority in the therapeutic relationship, we can easily find ourselves immersed in the urge to fix things. To reduce our client’s pain. To find a solution that would make both of us feel better. We’re human and want there to be hope and solutions.

But in an effort to make things better, the fix-it mode also comes with risks that the client could feel misunderstood, pressured to change, or pressured to adopt the perceived advice without a say in the matter. This can result in broken rapport, frustration, and possible disengagement from therapy if they don’t feel they can speak up or advocate for themselves.

So what can we do as clinicians to avoid the easy trap of wanting to fix things? Here are some ideas for therapists to remain present in a client’s pain.

1. Check Yourself – Practice self-awareness to recognize the warning signs that you are slipping into or existing within the fix-its. Are you noticing tension or discomfort in your body? Have you entered a pattern with your client where you offer an idea and they respond with the “yes, buts.” Have you talked with your partner about this? Yes but they don’t get it. Have you tried mindfulness. Yes but I have trouble focusing. It becomes a verbal tennis match where the client keeps returning the ball to you with no resolution.

2. Breathe – Once you notice you are in this negative volley of ideas being returned, take a breath. Pause and take a drink of water. Notice the frustration that may come up from your client declining your ideas.

3. Practice Self-Compassion – Engage in self-compassion to address the discomfort and frustration that may be brewing due to the fix-it exchange. An inhale with compassion for yourself, an exhale with compassion for your client. Inhale—It makes sense I’m frustrated, I’m trying to help—exhale—this must be so hard for them to feel like nothing could work.

4.  Name the Impact – A true practice of vulnerability is naming the impact of the negative exchange with your client. “I’m noticing some frustration in my chest in regards to what we are talking about. Is it possible you feel the same?” Sometimes modeling what it means to be human and own our emotions encourages the client to open up on what’s going on for them, allowing positive shifts in the dynamic out of the fix-its.

5. Ask What Would be Helpful – An important last piece of shifting completely out of the fix-its is to ask the client what could be more helpful in this moment. We’ve grounded ourselves through breath, we’ve practiced self-compassion, and we’ve modeled naming the emotions that are rising in the fix-it exchange. By asking for their feedback, we can repair rapport and engage in a new direction that might help them feel more seen and heard in the session.

Here’s an example from my own experience that illustrates how this process could look.

I had a client who was showing signs of frustration, responding to my questions in a clipped way that was not typical for her. I was trying to re-engage her at a deeper level, finding myself frustrated with the perceived withdrawal and surface level processing. It was necessary for me to check my own emotions and evaluate if I’d overstepped in some way before naming it to her. Once I named out loud what I was noticing, she confirmed she felt unheard and that we were moving too quickly into solutions, causing her to withdraw. Once I compassionately acknowledged her experience and thanked her for sharing this with me, I followed up by asking her what she needed more of in this moment. She reiterated that my ability to hold space for her pain would be most helpful, which we were able to do together for the remainder of the session.

I have to admit, some of my most powerful sessions come from exiting the fix-its or repairing a misunderstanding with a client in session. The ability to recognize the error, own it, and engage the client in compassionate collaboration can serve as meaningful examples of staying human and practicing healthy conflict resolution. To feel heard and get back on track in ways that feel supportive can be a powerful healing element all on it’s own. Finding yourself in the fix-its is a real possibility, for both green and seasoned clinicians alike. It doesn’t have to remain a frustrating experience for both you and your client, it can help you both grow.

Money Mentality in Mental Health

Mental health professionals are helpers through and through. Some would say our worth is wrapped up in what we do for others. We complete extensive training to provide professional interventions and obtain a license to practice, but for many of us, having a business degree isn’t part of the initial equation. Therefore it’s not uncommon to see the community struggling with how to navigate money matters in private practice. It could be considered a challenging rite of passage when becoming our own boss.

We don’t know what we don’t know. Thankfully, we can support one another in the process of creating a healthier relationship with money! Embracing our vulnerability by asking how to go about increasing our rates, move to a cash-pay practice, when to charge for no-shows, and throughout COVID, how to collect an outstanding balance from a client who is experiencing financial difficulties.

It’s the challenge of running your practice as a business offering a valuable service and giving back to your clients and the community at large. Because it’s such a delicate balance, there are times we receive judgement from our communities, questioning our motives, our focus or purpose, or believing we can’t maintain a thriving six-figure business and be a heartfelt professional at the same time.

A change in mentality around money is needed. Although we can’t make the bigger systemic change overnight, there are several things we can do as helping professionals to improve our mental health and relationship with money.

1. Read a Money Book. I appreciated the exercises exploring our relationship to money in Jen Sincero’s book, You are a Badass at Making Money. Writing a letter to “break up” with the unhealthy relationship with money was a meaningful exercise and can really highlight some themes of money for each of us as professionals.

2. Revisit Your Values. When exploring your relationship with money, it helps to know what holds the highest value for you. If one of your top values is stability, you may find yourself pursuing income streams to ensure stability within your business. If one of your top values is community, you may consider carving out a select number of reduced fee or pro bono spots to serve clients who couldn’t normally afford your services.

3. Complete a Money Course. Want to have the accountability and structure of a course that walks you through your relationship with money? Wendy Wright, a colleague and financial therapist in Denver, CO is offering several online masterminds in February to start you off on the right foot!

4. Work with a Financial Therapist. I was excited to discover a whole directory of financial therapists online who focus on helping people improve or heal their relationship with money. Find your best-fit professional by state and specialty!

Your relationship with money will evolve and change as you do your own meaningful work. 2021 is a new year with new perspective for all of us. Let’s cultivate a healthy relationship with money for improved mental health and work-life balance!

The Downside of Disney in Millennial Dating

I have to admit it’s been more than a decade since I’ve dated. With the Millennial generation being so large (people born 1980-1996, roughly), there are still people who are struggling to stay afloat in the ever-changing dating pool. They come to therapy to work on themselves, to address their loneliness, and to identify the characteristics of a supportive partner. They wonder if they should stick with someone who has a few warning signs—what I call yellow flags instead of red ones—or ghost the person. Choosing to ask themselves, am I settling? Is there someone better? Is there too much baggage? All which tie into a bigger theme of exploring how to have an authentic relationship when they feel pressure to conform to mind games, hookup culture, and fears of being hurt, cheated on, or tied down.

I remember showing my spouse an article last year about how hard it was to date in Denver. We were lucky enough to meet in Denver 10 years ago and man how things have changed! It appears that one the biggest factors for change in the past decade is related to social media. What it feels like to see someone we are starting to date posting pictures with others when we weren’t invited to join. How we might craft a negative narrative that they are avoiding us when we locate them on an app that says they’re at a downtown bar. What it means when they are talking to other people, going on various dates, still talk to their ex, or liking attractive strangers’ social media pictures and posts. To be caught up in our own attachment anxiety or trauma.

A professional I work with got me thinking when she said that we are all Disney characters trying to find our person, our purpose, and our happily ever after. Disney. Millennials were the Disney generation, we grew up on Disney! We also developed unrealistic expectations about finding our happily ever after. Expectations that the person must be perfect. Prince Charming. I can’t tell you how many conversations I’ve had with young adult clients who were worried that their relationship was too much work. That something was wrong if they had to put in effort or had counted one too many misunderstandings. Believing the alarm bells should be sounding if they aren’t having sex as often or if they’ve lost the butterfly feeling when they lay eyes on their person.

There is a lot of anxiety about what makes a romantic relationship healthy. Because let’s be real, Disney never showed the amount of effort needed to keep a relationship going. Characters would profess their love, kiss, feel euphoric, and the credits would roll. End of romantic imagery, end of invitation to highlight the challenges of relationship maintenance.

Disney didn’t give us the language to talk about our satisfaction in the relationship. Disney didn’t tell us how it’s predictable to have passionate love more into committed love over time. Instead, Disney gave us messaging about female characters needing to find their partner, their purpose, and their worth in others. So which Disney character are you?* And which Disney villain do you need to vanquish in order to feel whole and worthwhile, just as you are?

Are you Ariel, sheltered by a cautious father, who’s trying to find your voice in your relationship while battling the seductress/sea monster Ursula?

Are you Snow White, dating several (seven) different men while battling the Evil Queen, another woman who sees you as a young, beautiful threat to her happiness?

Are you Mulan, embracing your independence and not looking for a relationship, but wanting your family to be proud of you with or without a partner?

Are you Pocahontas, wanting to start your own family at the risk of misunderstandings, cultural considerations, and threats of violence?

Are you Merida, DunBroch princess struggling to balance your desires for adventure with your obligations to family tradition?

Are you Moana, married to your calling, the ocean being the focus of your affections in lieu of any interest in dating?

Thankfully, Disney has improved over the years, creating stronger, independent female characters for young girls to relate to. Gone are the days of girl-meets-boy-boy-rescues-girl-then-they-live-happily-ever-after-the-end. Yet Disney, combined with boatloads of romantic comedies and books, continue to make us question if we have it right. Are we dating the right person? Are we a worthwhile person to date? Is this how it’s supposed to be? Is this normal for how relationships work?

It’s time to transform your Disney character and relationship expectations, vanquishing your inner villain to show up authentically and whole-heartedly in relationships with others.  Brene Brown describes it as strong back, soft front, and wild heart. I’m not saying it’s going to be easy. It’s asking a lot of each of us to be vulnerable enough to find and embrace love and be loved. But like The Hero’s Journey, the hope is that you’ll come out of the dating pool transformed, embracing resiliency and finding yourself open to a quality relationship, feeling better about your own Ever After that exists on your own terms.

*This is a generalization and opinion based on personal observations and experiences, not facts or formal research.

Self-Handicapping is the Softer Cousin of Self-Sabotage

A colleague claimed they were self-handicapping in her new job to avoid feelings of inadequacy and I found myself intrigued.

According to Wikipedia.org, self-handicapping refers to a cognitive strategy to avoid effort in the hopes that it keeps potential failure from hurting self-esteem. What could this look like in real time? A student who performs well on a test attributes it to luck, believing it to be a fluke rather than the product of their hard work. A professional procrastinates on a project, thinking they may bomb the presentation the next day, anyway. An athlete skips practice, thinking it won’t matter to the match. A client puts off applying for their dream job because they’re convinced they won’t get an interview. It’s the pessimism mentality of,  “I’m going to fail, so why try?”

Self-Sabotage

With fear of failure in common, it’s important to take a closer look at self-sabotage as the more blunt, critical cousin in our analogy. Mark Tyrell, author of Self-Sabotage Behaviour Can Come in Many Forms, identifies four common reasons one may engage in self-sabotage.

·      Anticipatory Grief

·      Control

·      Boredom

·      Feeling Unworthy

Anticipatory Grief

For some of us, the familiarity of failure is a painful, somewhat predictable experience. We may go through our world anticipating loss or anticipating when something good is going to change, end, or fail. 

Perhaps you can relate to the following thoughts of anticipatory loss or end:

·      I’m waiting for the other shoe to drop.

·      This is too good to be true.

·      What’s the catch?

·      Nothing good lasts for me, when will this go south?

Because these thoughts have a lot of power, a client may be engaging in a belief that they don’t deserve good things. Or that they are doomed to suffer and that failing is inevitable. Similar to self-fulfilling prophecy, your client may find they are predicting a negative outcome. With these thoughts in mind, your client may also be subscribing to the second reason one can engage in self-sabotage.

Desire for Control

If we truly believe something good is going to end badly, we may want to be in control of the outcome. Have you ever found yourself thinking:

·      I’ll just end this relationship now, it’s less painful in this moment than when it ends months or years from now.

·      Better to leave this job before I get fired.

·      I know they are going to say our friendship is over, so I’ll just stop talking to them and get it over with.

We may convince ourselves that feeling in control of the failure in this moment can hurt less than something that comes on suddenly, out of the blue, or later when our guard is down. 

Boredom

The experience of our guard being down and everything feeling predictable can lead to discomfort as well. Predictability can lead to boredom, which can also be a reason to self-sabotage. If we go from feelings of chaos and excitement to monotony and boredom, Mark Tyrell states, as one example, we may find ourselves picking a fight with someone for no reason at all. Perhaps just for the alive feeling we get from adrenaline and excitement. 

Do you find yourself engaging in any of the following:

·      Picking a fight when you aren’t upset

·      Looking for trouble in new environments

·      Engaging in substance use

Feeling Unworthy

Self-sabotage can show up due to feelings of low self-worth. Maybe you feel you don’t deserve success or happiness and instead, engage by punishing yourself and setting yourself up to fail. This can represent the cornerstone of self-sabotage in wanting something and doing everything in your power to not achieve it, basically going the opposite direction of success. When explored further, many truly believe they “aren’t worth it” and engage in behaviors that prevent progress due to those negative beliefs.

Self-Handicapping

Based on what we know now, self-handicapping may be a softer, avoidant cousin to self-sabotage. Both are present when we are trying to protect our feelings or self-esteem. Both contribute to how we view ourselves and present ourselves to others. Self-handicapping just goes about it in a softer way, saying we didn’t prepare fully so we can’t be as upset with the potential failure or negative outcome.

How are you self-handicapping? 

·      Underachievement

·      Procrastination

·      Underpreparing

·      Pessimism

Self-handicapping may be a piece to the larger puzzle of recognizing the connections between our thoughts, feelings, and behaviors as they relate to self-worth and mental health. Therefore, I want to encourage deeper exploration into how self-handicapping may be contributing to our inner critic, self-sabotage, and imposter syndrome related to goal progression, not just for clients, but for ourselves as professionals as well.

Therapeutic Connection is the Key to Client Success

Research continues to demonstrate that the therapeutic relationship is the most important factor in client success. Therapeasy, a brand new therapist matching service, is actively thinking about this from the very beginning by exploring best fit criteria for successful matching of clients and therapists through their algorithm-based online platform.

The vision for Therapeasy was born because it's co-founders realized that the personal problems they each experienced in accessing mental health care were not unique to just them. Unfortunately, they share similar stories with frustrated people everywhere. Therapeasy's mission is to improve wellbeing by making connections, facilitate healing, and eliminate stigma in mental health care. 

Based on what we know now, I'm honored to have collaborated with Therapeasy to explore what clients are needing from professionals in order to find the best and most successful match! Check out my conversation with Therapeasy Co-Founder Jonathan Just.

What are clients saying they need from therapists to determine best fit?

Jonathan: “When we first started doing research for Therapeasy (it was only an idea at the time), we conducted a widespread market survey and were able to gather nearly 400 responses. This was extremely important to us as we began work to formulate the Therapeasy matching algorithm. 

What we learned is this: the number one characteristic considered when searching for a provider is area of expertise, which is an indicator of competency. But the number two characteristic considered is personality fit, which is an indicator of compatibility. Personality fit was indicated to be even more important than logistical factors such as location, price, and even appointment availability. This means that clients would be willing to drive further, pay more, and even move their schedules around in order to see a provider that they considered a "good fit " But as you know, especially if you have tried any online dating sites, personality can often times be difficult to determine and measure. This is why most therapist directories don't include personality fit, and why we made the decision to make it a priority for our algorithm.”

What do clients saying about the Therapeasy Profile that helps them find the best fit therapist? 

Jonathan: “I'd say that it's the interpersonal style preference that I mentioned previously that helps people find their best fit. Users have the ability to choose their preference between therapists who emphasize action and results, or are quiet and caring (as an example). Their preference is then matched up against the interpersonal assessment results on each provider profile, that helps contribute to each compatibility score. We also just recently added provider cultural competency to our algorithm. This option can be extremely important to underrepresented POC groups, LGBTQ+, and those with disablities who want to find a therapist who looks like them, or understands the community of which they are a part of. Since implementation, a full 1/3 of our users indicate that they are seeking a therapist who has cultural competency and experience working with clients of these backgrounds.” 

I've noticed therapists can get stuck in listing off their schooling and credentialing on a professional profile rather than speaking to their ideal client. How does Therapeasy help therapists capture the heart and authenticity behind their message? 

Jonathan: “I have definitely noticed that as well. It's understandable right? Many providers have put in a lot of time, effort, and money into their education so it's only natural for degrees and credentialing to be very important to them. Our market survey results however, indicated that certification and credentials were much lower on the list of search considerations. Of course I'm not saying that education is not important, but it simply isn't as important to many people seeking care as other factors. 

This is why Therapeasy profiles don't feature a list of what school you went to, when you graduated, or how many credentials you have. Instead, we highlight a bio section where each provider is encouraged to share a bit about what makes them and their practice special. It is often this message that people will connect with, prompting them to reach out and start a conversation.”

What tips do you have for therapists setting up their profiles that adds to success in matching with their ideal clients? 

Jonathan: “Great question. One practice that we started early was providing insights and tips to our providers to help with continuous profile optimization. The easiest and often quickest way to ensure a match turns into a client is to make sure that your profile photo is a good one. You might think that this is super obvious, but you would not BELIEVE the amount of profiles with below par photos. 

What I mean by that is: blurry/out of focus, low resolution, cropped, far away, or out of date (yes we can tell that the photo is 30 years old). Believe it or not, it makes a difference. My tip would be to use a headshot, taken in natural lighting, against a non-distracting background. If that sounds overwhelming, just find a teenager to help take it with their phone. No need to hire a professional these days! 

Another tip I'd give relates to the perspective and language used in the profile bio section. If the first place people look is at your photo, the next thing they will do is read your bio. I think that a well written bio speaks directly to the reader, instead of describing from a third-person. Using conversational language to describe what makes you/your practice special or unique is what can really help connect and attract clients who are looking for exactly what you have to offer. Instead of attempting to write something that will appeal to everyone, speak directly to your ideal client. These are just a couple of simple tips to help optimize any profile.”

This is all amazing! What else can we highlight in Therapeasy's efforts? 

Jonathan: “Therapeasy is currently and temporarily offering their therapist matching service to all Colorado providers, absolutely free. Due to the COVID-19 crisis, we understand that business this year has been challenging. Because more people now than ever are seeking mental health care, we want to make sure that providers in our communities have the ability to promote and connect with those who have a high compatibility to their practice. This means that it costs $0 to create a provider profile and start getting matched today. 

Therapy for me has changed my life and saved my marriage, which was only possible because I was able to find the right therapist. For anyone thinking about starting therapy for the first time or looking for a new therapist, I encourage you to log on to Therapeasy to find yours now.”

Thank you to Jonathan and the rest of the Therapeasy team for your passion and innovation in helping clients and therapists match successfully! Create your profile as a mental health professional at https://therapeasy.co

Therapy Graduation in a Pandemic? The Dos and Don’ts

It may sound odd to graduate therapy during a pandemic. In fact, it may be so rare and strange that there’s no protocol to be found! Maybe it’s because it sounds counterintuitive? Why would someone celebrate completing their therapeutic goals in a time of uncertainty? Isn’t most of the world in a mental health crisis right now?

Although unusual, I have several client preparing to graduate in the middle of COVID-19. I work exclusively with adults, so I also recognize this may be different for professionals who work with youth and families. For some, the pandemic has provided pleasant opportunities as well as the anticipated stressors. Therefore I feel it’s important to explore this topic for clients who are gearing up to graduate.

For the client who now gets to save time and a stressful commute in working from home. The parent who gets to spend more time with their kids. The single mom who received a promotion. The introvert who enjoys working on self-development projects in their living room. The person diagnosed with agoraphobia who just secured a job working remotely. The student who is graduating college with a job offer two months before he walks across a virtual stage.

Even with the heavy, there’s hope! I recognize that this can be privilege. Not everyone has their safety and security needs met to make this possible. Not everyone has the luxury of a two income household or the ability to work from home. So how does this impact individuals who were working on stressors in therapy that have been alleviated in some way thanks to COVID-19? Or for the clients who were in maintenance prior to COVID and remain in maintenance, reflecting ongoing stability through this pandemic?

Can we honor the client who states COVID saved their life? Acknowledge the parent who feels more authentically connected to their community than ever before? It’s a complicated dance of tracking the good, the bad, and the ugly while celebrating clients’ resiliency. For the folks who have experienced minimal negative impact or disruption to their lives, perhaps they entering a space of readiness and comfort with discontinuing therapy.

Recognizing this feeling as both foreign and exciting, let’s take a look as some things to consider when exploring therapy graduation in a pandemic:

1. Stability-Does the client recognize and regularly practice their own coping skills, feeling equipped to handle stressors that could come their way?

2. Resources-Does the client have access to other resources if needed? Personal and professional supports as well as additional tools? Can they return to therapy if needed?

3. Treatment Goals- Has the client completed all their treatment goals to justify a close in services at this time?

4. Medical Necessity- Is there evidence that continuing therapy is a clinical or medical necessity, justifying ongoing work?

5. Burnout- Is the client indicating they need some time to identify new goals or an opportunity to practice their skills without regular therapeutic support? As their therapist, are you also tracking their status in therapy maintenance, where continuing services might lead to client burnout because regular sessions are not feeling as necessary right now?

Graduation Planning

By considering the factors above, you may discover that having a conversation with your client about their readiness and comfort with graduating is an appropriate next step. 

A. Identify a Timeline. What kind of time frame does the client need to embrace graduation as a next step? Do they want several sessions to prepare? Is there a set date for the final session where you can both be intentional in processing their experience and identify a symbolic therapy graduation gift if appropriate? 

B. Celebrate the Successes. My favorite part of therapy graduation is celebrating client milestones and progress made towards their goals. I start by having them think back to the start of therapy and what was happening for them at that time. Then we walk together through a mental timeline of their successes, challenges, and goals accomplished, emphasizing their strengths.

C. Explore the Signs. The other piece that’s important to explore in a graduation session is the client’s awareness of warning signs that they may need to seek out support from you or another professional. I find it’s important to not only explore the signs, but also the length or duration of the signs being present for the client to practice coping skills on their own versus seeking additional support. This mental exercise results in having a future plan in place that empowers the client and can reduce some of the anxiety they might feel in ending therapy. 

D. Re-Engagement or Referrals. How can the client reach you if they need to re-engage in therapy? What referrals can be made available for other providers or specialties that could benefit their desired next steps? What resources can be given preemptively to support them in the transition?

Timing is everything. Graduation from therapy may feel like a far off goal for some of your clients, who are working hard through the challenges of COVID-19. For others, it can feel empowering to explore graduation, having a structured and supportive plan aligned with their long-term goals. After all, therapy is meant to introduce the skills and growth opportunities for clients to eventually try out on their own. A graduation session can serve as an important next step in closure and intentional transition in an otherwise unpredictable and uncertain time.

Vulnerability for the Wrong Reasons?

Vulnerability is powerful! Championed by heart-centered leaders like Brene Brown, Simon Sinek, and Michelle Obama, we’ve taken notice of how it can pave the way for authentic leadership and deeper connection. Vulnerability has its place in allowing people to feel seen. Learning to lean in to the discomfort to grow, It can serve as a catalyst for change. 

I myself have experienced the positive power of vulnerability as a leader. Yet what if there are times we embrace vulnerability for the wrong reasons? To manipulate others? Forced intimacy to get our needs met? Learned helplessness to be seen and cared for because we find we are unable to help ourselves? Showing up in the form of:

People Pleasing.

Co-dependency.

Manipulation.

It’s not uncommon to support vulnerability as a meaningful tool after trauma. For some, it starts with addressing the absence of vulnerability in a person wanting to feel strong, independent, and in control. For folks with mental health diagnoses of Complex Post-Traumatic Stress Disorder (C-PTSD) and Borderline Personality Disorder, vulnerability within relationships can feel even more complicated.  C-PTSD, for example, recognizes the impact of repeat relational trauma that challenges a person’s sense of safety and security. The unpredictable environment of not knowing if their needs will be met, when they will be met, or how often. Attachment trauma. Rupture with no repair. If vulnerability has the capability of bringing people closer together, can it manifest as a learned behavior with significant consequences? 

As a therapist, I find myself worried that vulnerability can be contrived in response to trauma, pressure, and pleasing of others. Concern that individuals who have had their boundaries violated will embrace vulnerability as a tool but not recognize the risks. What are the consequences of strategic vulnerability for agenda-driven reasons? Perhaps the person receiving the fabricated expression of vulnerability finds it draining or false. Individuals engaged in forced vulnerability to get their needs met may find themselves in burnout, resentment, or fatigue. By embracing inauthentic vulnerability, are we unknowingly elevating our risks of being physically or emotionally hurt again?

With these challenges in mind, I continue to engage clients in an energy wheel exercise in order to explore their relational boundary work each week. Presented as slices of pie, I ask them to map out their energy dedicated to various tasks each week, both personal and professional. Emphasizing relational energy, I encourage clients to remain curious by asking, “what’s my energy pie look like today?”

In the example above, the client indicates spending a lot of energy in Week 1 pleasing her father by spending time with him, meeting his needs, and putting out emotional fires. By actively practicing boundary work over the next several weeks, the client indicates a more balanced energy towards her primary goal of finding a job. By processing the shift in energy, the client recognizes an increase in self-confidence and improved well-being in not feeling as drained by the interactions with her father. This discovery not only reinforces her motivation to continue her important boundary work with family members, it also helps her explore her relationship with vulnerability.

As we can expect, boundaries and vulnerability go hand in hand. From a trauma lens, boundaries and vulnerability are equally challenged by the maladaptive coping skills we develop to survive a threatening experience. Therefore it is important to explore a client’s relationship with vulnerability, identifying how they feel about it, when they embrace it, and how it can serve as an opportunity to bring them closer to connection in healthy relationships while protecting them against unhealthy patterns.

Massage Can Be Messy: Considerations for Trauma Survivors

When we talk about self-care, massage may come to mind. Easily $60-100+ per session, we may also find massage to be a luxury. Some prioritize their service once per month with a membership. Others splurge for a special occasion. Understandably, the cost of a massage as self-care can be a barrier to scheduling and it isn’t the only one.

What is massage like for those who’ve experienced a physical or sexual assault trauma? As a therapist, I believe it’s important to recognize the significance of massage for someone who has had their physical space violated. To name how challenging it can be to trust a stranger to touch you and find it relaxing instead of triggering. To acknowledge the effort required to calm the fight or flight reaction with logic, wanting your body to recognize your consent. The involuntary emotions that can surface when a particular part of the body is worked.

It’s something I too can take for granted in embracing massage as part of my self-care. Therefore I want to share some strategies than could help clients find their massage experience healing and empowering in the aftermath of trauma.*

1.     Research the Options

Identifying a service provider with additional training related to trauma can be a helpful first step for trauma survivors. Is the massage therapist trained in Trauma Touch Therapy ™ or identifies as a Trauma-informed provider? Does your client feel encouraged to have a conversation on their needs prior to scheduling an appointment?  Do they feel open to exploring fit and expectations in order to reduce any anxiety that may be showing up? Additionally, reading client reviews can be a strategy for exploring fit along with asking trusted peers or friends who they recommend.

2.     Consider Provider Gender

For some trauma survivors, the gender of the massage therapist may be crucial to their level of comfort. As your client explores their options, can they consider the number of massage therapists available, including skill set, technique, and gender to increase possibility of best fit and feelings of safety?

3.     Have a Ritual

Several clients have shared the importance of feeling prepared for their massage experience. This may be as simple as knowing the date is approaching, getting into the right headspace the morning of the appointment, and positive self-talk or visualization to increase their sense of safety and security going into the appointment. 

4.     Find Your Voice

Massage therapists expect and welcome feedback on massage technique, pressure, pain, and comfort levels. Encourage your client to explore communication in your sessions so they can feel empowered to speak up if something isn’t quite right.

5.     Hydrate

Hydration is important for the body to feel more receptive to the massage experience as well as to reduce possible soreness after a massage. Additionally, drinking water calms the body by engaging the parasympathetic nervous system, which encourages the body to return to a calmer state of functioning after fight or flight systems have been activated.

Massage can be a powerful tool for healing and health for trauma survivors.* By exploring the strengths, challenges, and barriers, your client can feel more confident when deciding if massage is right for them.

*Clients have the right to determine what is best for them and should consult their professionals as appropriate.

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.