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Who Said: Removing the shoulds (and the stress) from our lives.

July 14, 2011 by

So often we get stuck in the shoulda, coulda, woulda trap without even knowing why.  Who said  you should have been a lawyer instead of a teacher?  Who said you could have been a millionaire, but instead you chose to be a cop.  What makes you thing that you would have done anything differently?  Shoulda, coulda, woulda, but didn’t.  Through listening to our parents, teachers, friends and the media, we develop a litany of “Shoulds” in our head.  Most of the time we take these things at face value without even asking ourselves if we believe it is something we should do, or if it is just something others are trying to convince us we should do.   When we start to get depressed or stressed out, often it is because of all of the things we are telling ourselves we should be doing, but are not.  For example, there used to be a commercial in which a very pretty woman sang about being able to bring home the bacon, fry it up in the pan and never let you forget you’re a man.  In reality, how many women can work a full time job, do all of the house chores, errands and cooking and handle the bedroom as well without getting stressed out?  Very few.  Unfortunately, many women in the 70s and 80s grew up believing that they “should” be superwomen, able to be everything to everyone all of the time.

There are times when we are unable to do things and we wish we could have.  However, many times these things we “should” have done are simply overly high standards or goals someone else has tried to convince us that we care about. If you are going to beat yourself up over something you “shouda” done, then at least make sure you are the one that believes that and why. Try filling in the following statements: “I believe I should have done this because ______.  The fact that I did not do it means that I am _________.”  If you can fill in that statement with something that is reasonable and true, then move to the next step.  If you cannot complete the exercise with reasonable answers, then you have to ask yourself why you are beating yourself up for something that really does not make that much difference anyway.

There is a basic principle that we do the things that are most rewarding (and least painful).  Sometimes there is something that you truly believe you “should” do, like going on a walk instead of eating another piece of chocolate cake.  If it is something that you really want (as opposed to something someone else tells you to do), then the challenge becomes figuring out how to make the desired activity(exercise) more rewarding than what you currently are doing (eating cake).

The first step is to do what we call a decisional balance exercise.  Identify the pros and cons of eating a second piece of cake and the pros and cons of exercise.  It is important to make the pros of exercise and the cons of eating cake strong arguments for exercise.  If you need to, add incentives.  For example, under the pros of exercise, say that you will get to go buy a new outfit every time you successfully complete 20 miles of walking (over multiple days of course).

So, to sum it all up.  Identify what is important in your mind to do and why.  Those are the goals you focus on.  The rest of it can be delegated, ignored or compromised.

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Responding to the Needs of Returning Veterans

July 6, 2011 by

Appropriate responses to the needs of returning veterans will include:
• A strength- and recovery-based focus
• An empowering, skill-training approach
• Careful, individualized, respectful, veteran-specific assessment and treatment planning
• A primary emphasis on stabilization and development of internal and external resources
• Education for veterans and families on the physical, cognitive and emotional aspects of trauma and substance use disorders
• Assertive linkage to ongoing support within the community—and in the larger military and veteran community nationwide
Effective responses to the needs of veterans with post-employment stress effects include a consistent approach that integrates trauma-informed addictions and mental health care, but what does that mean?  It means that when treating a veteran for mental and/or substance use issues the clinician must realize that the traumas experienced have changed how the person feels, reacts and perceives the world.  These changes are normal reactions to abnormal events.  Unfortunately, they often persist even when the danger is past.  This is the mind’s way of making sure the body survives. In order to help consumers to regain a sense of balance, we must create an environment of safety, trustworthiness, choice, collaboration and empowerment. 

Safety means ensuring physical and emotional safety not only in the treatment session, but also in veterans’ daily lives. Even Abraham Maslow believed that safety helped form the foundation of mental health and wellness.  When people do not feel safe, they are on guard, and they cannot rest well which negatively impacts their health, mood and relationships which could be supportive. So the next question I am often asked, is “What do they need protection from?”  They need places where they are not subject to judgement or evaluation, and are not concerned they will have to defend their actions or the actions of the military in general. If they have been deployed for a while, they need a community that can help them feel less like a stranger in a strange world.  They need places where people understand what they are going through, who have survived the nightmares, the insomnia and the feeling of utter isolation, not knowing who they can trust.  They need to learn the skills to deal with the flashbacks and the nightmares, and to relaxs at the end of the day.

Trustworthiness is developed in the process of creating safety by maintaining clear, appropriate, consistent boundaries and objectives.  Many people—veterans included—will not tell you everything until they believe you are trustworthy.  Those things that haunt them at 2am are not things they are going to tell just anybody.  Throughout the process that led to the PTSD–whether it be one single incident or years of traumas—the person regularly was stripped of their control, second guessed for every move and, often questioned on their decisions.   Trauma informed treatment not only relies on consumers learning to trust their therapists, but also on them learning to trust themselves.  Failure to keep promises reinforces the notion that the world is an unpredictable, terrifying place.  Failure to help consumers see the logic in what they did, or are doing, reinforces the notion that their behavior is unpredictable and they are out of control. Remember to ask yourself what the benefit is to any behavor. Our brains are programmed to survive.  How is the behavior helping the person survive. Substance abuse numbs pain and helps people survive until they develop alternate skills.  Fear reactions/fleeing protect the person from imminent danger.  Explosive anger can neutralize a perceived threat.

Choice means allowing consumers to prioritize what issues will be dealt with, when and to what extent. The caveat to this merges with collaboration.  While it is certainly advised to maximize consumer input and control, there are some things which may need to be negotiated. When consumers are putting themselves at risk, even before treatment starts, the chances of them engaging in highly dangerous behaviors when they are in the midst of a crisis is much greater. For example, if Johnny is drinking a fifth of whisky each night and chasing it with hydrocodone, I would certainly not recommend delving into deep, emotionally charged issues in a traditional outpatient environment.  It is likely when the pain increases, so will the desperation to stop the pain. Johnny first needs to get safe—mixing hydrocodone with whisky is just a slow way of committing suicide. If he can create a support plan that includes a drastic reduction in drinking (preferably 100%) and at least 3 people who will be there to support him, then I might consider working with him on the trauma issues in outpatient.  My preference is for people with dual disorders (i.e. PTSD and substance abuse) who live alone or do not have a strong support system to enter into either intensive outpatient or a 3-5 day retreat in which they can have 24-hour access to a therapist and have their medication and substance intake monitored. 

Finally, empowerment means providing consumers with the tools to help them create safety, trusting them to do the next right thing and encouraging them to make educated choices regarding their recovery and their life.  Empowerment means helping them find positive ways to use the energy they are currently using to try and contain their anger and devastation.  In PTSD, people often have a lot of “I should haves.”  They cannot change the past, but with the knowledge of what they believe they should have done, what can they do now?  That is to say, they cannot change the past, but what can they do to prevent it from happening in the future and/or make ammends if they believe they have done something wrong.

Trauma informed care identifies the trauma, and all of the associated mental, emotional, physical and social changes as the primary cause of people’s mental health and substance abuse issues.  Likely things will never be like they were before the trauma, but they can get better.  The terapists job is to help people define what “better” looks like, provide needed skills to help the person achieve their goals and empower them to start doing the hard work necessary to recover.

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Biological Needs: The Foundation of Mental and Physical Health

June 29, 2011 by

The quantity and quality of sleep people get each day significantly impacts their mood.  Think about the last time you were exhausted (maybe the last time the time changed?)  Did everything take a lot longer to get done?  Did you lack motivation to do much of anything?  Were you all but mainlining caffeine to stay awake?  Was it difficult to make decisions or remember anything?  Okay, point made. Despite the fact that it forms the foundation of our mental and physical health, all too often, the first things people forego are sleep, exercise and nutrition.  When people are awake, their energy is diverted across a wide spectrum of activities. When they sleep it is a time for their bodies to focus all of the energy on rejuvenation and repair.  Not only repair of things that are broken, but also restocking the supply of neurotransmitters that produce feelings of relaxation and happiness.

When people sleep it is also the time for the body to focus on building immunity.  When I was in college I used to stay up cramming for exams the entire week of finals.  As soon as finals were done, it seemed inevitable that I would be sick.  Coincidence?  I think not.  I don’t know about other people, but when I am sick, I am not so pleasant to be around, I lack motivation and feel like I am in a fog.  Sound familiar?  Yup, being sick and sleep deprived have a lot of things in common.

What about nutrition.  Did you know that the symptoms of dehydration and depression are very similar—fatigue, confusion, constipation, loss of appetite…  Similar things happen when blood sugar levels drop.  My husband is hypoglycemic, and I can tell when he has not been eating right.  He gets irritable, sluggish, has difficulty hearing and processing what I say and tends to seek caffeine and processed sugar to keep him going.

So what is the point?  Simple changes in people’s lifestyles can have a huge impact on their mood, motivation and ability to be on their game.   When they are rested and nourished, they will have more energy to be motivated, sociable and focus on the positive, and will need less energy to concentrate, make decisions and get things done.  All that combined can be a great stress relief.

TIPS for GOOD SLEEPING

  • Don’t eat right before bed.  Drink a small glass of milk or water if necessary
  • Keep a note pad, pencil and small lamp next to the bed.  When something pops into your mind, write it down
  • Keep the bedroom a comfortable temperature
  • Try to make it as dark as possible
  • Make a wind-down routine each day to cue your body to start releasing melatonin.  We do it for children, why not for ourselves.
  • Minimize annoyances.  One of our dogs licks the sheets incessantly.  She cannot sleep on the bed anymore.
  • Reduce (or eliminate) caffeine 12 hours before you want to sleep. Yup.  It stays in your system that long.
  • Try stretching, meditation or partner massage to relax your muscles and work out the tension knots from the day.
  • Drink plenty of water, but not right before bed.
  • Cammomile and lavender essential oils can help calm you.
  • Try creative visualization.  When I am trying to get to sleep, I plan my garden or some other interior or exterior decorating project.  It diverts my mind from stressful thoughts, and before I know it, I am asleep.

TIPS for GOOD EATING

  • Keep a water bottle with you
  • Eat small meals every 3-5 hours
  • Drink 4-8 oz of water before each meal.  It will help you get your water intake as well as fill you up a bit
  • Eat colorfully–at least 3 colors on every plate.
  • Fiber, protein and fats help slow down sugar absorption.  Try to combine foods to prevent a spike (and crash) in blood sugar.
  • Use a salad plate instead of a dinner plate
  • Put back half.  Only serve yourself 1/2 of what you would normally.  Often you will find that is just as satisfying, and it saves a bunch a of calories.
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Easing the Back-to-School Transition for Northern Virginia Students

June 15, 2011 by

August is Back to School which means back into a routine, back to struggles with homework and back to being sick every month.  Make no mistake, August and September are very challenging months for many families, but there are some ways to make the transition go a bit more smoothly.  Remember last month we talked about the basic needs: Food/Sleep/Shelter/Medicine, followed by safety and relationships.  The same principles apply here.

First let’s talk about the basics—primarily sleep.  Over the summer kids often get out of the school routine, stay up later and play more computer games.  When they go back to school not only are they in X-Box withdrawal, but they are also tired.  Not convinced?  Think about how just the one hour time change affects most people.  Couple all of that with the stresses inherent in being a pre-teen or teenager, and it is totally overwhelming. People’s natural response to being overwhelmed is to either get control of it or escape it. Children often try to get control by rebelling.  I remember, as a child, thinking that school wouldn’t come as quickly if I just stayed awake.  When I slept, time seemed to fly by, so I would do whatever I could to stay up later.  On the other hand, some children have just gotten used to a later schedule, so it is hard for them to get to sleep at 8:30 or 9.  Believe it or not, our bodies get into a rhythm, and certain environmental cues can help us get sleepy.  Think about how we help  toddlers develop good sleeping habits.  There is a routine—Eat dinner.  Take a bath.  Read a story.  Go to sleep.  Once  they begin the sequence, the brain  says “Oh, I know what comes next.”  Some children are more sensitive to changes in routine in others, however, if you start implementing the back to school routine at the end of July, August will go much more smoothly.

Then come the homework struggles.   Homework can be very difficult for kids after a long, tiring, stressful day at school.  For many children, it takes all they’ve got to behave all day, and they need a little while to wind down, decompress, or just be loud and get out energy.  Trying to get them to come home, eat a snack and do their homework is usually a losing battle.  Make sure they have a time limit though.  For example, they can have free time until 4pm, but from 4 until dinner they must sit at the desk and do their homework.   Some children also find it difficult to get back into the routine of being independent, and will lapse into “but it’s too hard,” or “I have too much homework. I’ll never get it done.”  This is when we, as parents, have to be coaches.  It is far easier just to give them the answer, or do it for them, and, after a long day at work ourselves, that is very tempting.  However, when that behavior is rewarded, it is very difficult to stop it. Create the safety for them.  Encourage them to try to learn the material.  Help them see that they are not stupid, and it is not hopeless.

Third, the sicknesses from the mutant bugga-buggas that all the other kids were exposed to over the summer/break/holiday.   Your kids are going to go to school, hug their friends, play on the playground and share not only their memories, but also their germs.  Our bodies are pretty adept at dealing with the stuff we encounter on a daily basis, but have you ever noticed how kids always seem to get sick right after a break.  And by sick, I mean really ill not just fake throwing up.  Well, there are a few things we can do to improve our odds.  First, wash your hands often.  Secondly, make sure everyone is getting plenty of rest, drinking plenty of water and eating plenty of fruits and vegetables.  Vitamins A, C and E can help people boost their immune system.  Third, and the one that people forget about is have fun.  When we are stressed our bodies release all sorts of chemicals to prepare us to fight or flee.  Why should we care about that?  Look at the presidents before they take office and after they have served 2 terms.  Most look as if they have aged 20 years, not eight.  Stress takes a huge toll on the body.  If you are having fun, you will be less stressed.

That leads me to my final point, all work and no play. . .  If families go from all play during the summer to all work during the school year, it is not surprising that children resist going back to school.  Set up one day a month that you can do something fun as a family.  Movie night with the grandparents?  Bowling?  Camping?  Cook out?  Whatever works for your family.  Try having each person write down what they like to do on a piece of paper and put it in a jar.  Then, before family night, draw from the jar to see what you will do.   Finally,  find one night per month that you can do something just with your partner.   Too often couples start having problems because they are too caught up in the day-to-day stresses of the family, housework and the like.  Have at least one night a month that you can go out and actually talk in complete sentences without interruption.

This is not an exhaustive list of things to do, but it gets you started and might spark some of your own ideas.  I would love to hear any suggestions you might have that makes back-to-school  not-so-cruel.

 

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Online Counseling for Anxiety, Depression and PTSD: Does it Work?

June 13, 2011 by

Over the past several years, online counseling has become more accepted in the mainstream counseling community.  Nevertheless, accepted does not necessarily translate to effectively used.  Let’s face it, some people just need to have the personal contact of being in a face-2-face session.  However, the vast majority of people are quite comfortable with video, phone or text chat.

 

Some of the benefits of online counseling for anxiety, depression, PTSD and addictions include:

  • Being able to connect with experts anywhere in the world
  • Access to services at the most convenient time for you (8pm on the East coast is 3 pm–still during normal business hours– on the West)
  • Reduced costs in terms of travel time, child care and waiting.  Instead of sitting in an uncomfortable waiting room, you can be watching ESPN in your living room.  This is especially important in areas like Atlanta, Arlington, Alexandria and Washington DC
  • Greater anonymity.  Some people do not want others to see them going in to see a counselor–for any reason.  Online counseling allows people to seek services for things like depression, anxiety and addictions in the privacy of their own home.
  • People with PTSD need to have a place they feel safe.  Practicing some of the exposure therapy techniques with an online counselor in the comfort of their own homes can help reduce their level of hypervigilence.
  • Does Fido make you feel more at ease?  Well, online counseling also enables you to have him in your lap.

 

What are some of the considerations for online counseling for people with depression, anxiety, addictions or PTSD?

  • Unless your issues are mild or moderate, many therapists will want to be able to chat with you via video such as Skype.  This allows us to better assess your mental status and level of danger to yourself or others.  In the case of addictions, video chat also allows the therapist to assess whether you are clean and sober.
  • For online video counseling you will need to have at least DSL internet.
  • If you select online counseling via text chat, it is important that you are able to type :)

 

What to expect at Gainesville-NOVA Counseling

  • Your first visit will consist of an intake assessment.  Your therapist will ask you a variety of questions to learn about who you are and what you hope to get out of counseling. She will probably give you three assignments.
    • Your first task will be to write an autobiography.  This will assist your counselor in understanding how you grew into the person you are today, when the problem started and what things make the problem worse and what things make it better. You will use a secure email account provided to you to email this to your counselor.
    • Your second task will be to keep a log of the problem (i.e. how many anger outbursts, how often you have flashbacks, on a scale from 1-5 what your average daily anxiety or depression rating was.
    • Pick on area of health to start working on: Getting sufficient, quality sleep; exercising, eating better or drinking more water.
  • During your second online counseling session, you and the counselor will review your autobiography, your problem log and the progress you have made in improving your health. Together you will develop a service plan to guide the online counseling process. This plan will use the knowledge-skills and abilities format.  Using cognitive behavioral therapy (CBT) you will be guided to learn more about the problem in general and specifically what triggers or improves your problem. Then you will identify skills that you already have which can help you deal with the problem, and enhance those.  Finally, your counselor will suggest some new skills to help you cope with or alleviate the problem.
  • Subsequent online counseling sessions will help you systematically go through the service plan, and make adjustments to it as necessary.
  • Our goal is to help you learn how to identify the root issues of your problems, increase your motivation to deal with them and use your current strengths and skills to achieve your highest quality of life.

In short, does online counseling for anxiety, addictions, depression or PTSD work?  It works if you work it.  If you just show up and expect the therapist to fix it for you, then I would not expect to see significant improvement.  If you treat counseling as a learning experience, to learn more about yourself and how people in general “tick,” then, yes, online counseling will probably work quite well.

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What Goes on Behind Closed Doors

June 12, 2011 by

Counseling can be very intimidating for people, so in the next few paragraphs we will take a look at what happens in the therapy room.

Okay, so first, there may be a couch, but that is usually to provide seating for multiple people (i.e. your spouse or family) if they come for a group session.   Most therapists these days do not expect you to lie down, nor talk about your mother.  Counseling in the 21st century usually involves one of two broad approaches.  The Rogerian approach is what most people think of when they envision counseling.  The thought is that if people are provided with a safe, nonjudgmental environment in which to explore their feelings, they will be able to identify and resolve their own issues.  This process takes more or less time depending on how long it takes to create that safety and how directive your therapist is.

The second approach is cognitive behavioral or CBT.  CBT is focused on 1) What is going well and not so well in the present, 2) What does the resolution to the problem look like, and 3) What steps need to be taken to get there.  While people’s past is important, because it has shaped who they are and how they view the world, the focus is on identifying (and maybe changing) how the past is impacting the person in the present.  CBT deals in facts, evidence and rational thought.  Many of the things we tell ourselves we must, should or can never do are good life lessons that have morphed into something irrational. To top it off, most people are depleting the energy needed for dealing with stress by not sleeping well, eating poorly and not exercising.  In most cases, the first steps are the most basic.  People need to start taking care of themselves and making one or two small changes in their attitude.

For example, Tom comes to counseling because he is totally stressed out and feels like he cannot do anything right.  Tom’s therapist might ask him what it is he hopes would be different if he were doing *everything* right.  She might point out that he seems to be holding himself to an unreasonably high standard, and would he hold his son to that same standard?  What would happen if his son failed to meet that standard?  Would it impact their relationship?  She might also ask him to identify one or two things that he feels he must be good at, and focus on doing those things right.  (Once that happens he loses the argument that he cannot do *anything* right).  She will probably also ask him to start trying to get at least 7 hours of sleep each night and walking his dog for 20 minutes each night after dinner.

Okay, so you get the idea, Rogerian tends to be more conversational and free flowing, CBT is much more directive, active and problem focused.  So why use one over the other?  Different people process things in different ways.  I am a therapist’s worst nightmare, because I need both.  When I am struggling with something, I want my feelings acknowledged, then I can go about the business of problem solving.  My husband, on the other hand, just wants to get down to business.   He figures the sooner the problem is solved, the sooner he will feel better.  Meanwhile, my best friend is one of those people who needs to talk about her feelings and use a therapist (or me) as a sounding board.

But is that all there is?  No, after all the talking comes the case notes.  You know, the secret stuff doctors write in people’s medical record that they do not think they are supposed to see.  Let me be the first to tell you that you have every right to see those.  I usually spend the last 10 minutes of the session writing them together with my patient.  Why?  Because it serves as a good summation of what we talked about, and then there is no mystery.  My job is to help people learn why they may be feeling or reacting in a certain way,  provide them the tools to better understand themselves and help them fix negative reactions/behaviors.  It is not magic.  Just like a mechanic can hear an engine hum and tell you volumes, so can a therapist hear what you are saying.  I could learn to be a mechanic, but I don’t really want to.  You could learn to be a therapist, but let’s start with listening to yourself first.

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Common Sense Wellness: Steps to Health and Happieness

June 8, 2011 by

Do you want to be happier, have more energy and less stress?  Awesome!  Each month, this column will present common sense information about how to get (and stay) happy and healthy.  I do not believe that any one piece of information or intervention will work for every single person.  We are all different.  What I do believe is that any positive change you make in any area of your life will create positive changes in other areas of your life.

So what are these areas? Well, I wish I could take credit for it, but, many years ago, a psychologist named Abraham Maslow said that humans have a hierarchy of needs.  At the foundation is our biological needs.  This makes sense right?  If you are exhausted, sick, hungry and homeless, you probably do not care very much about getting in shape or improving your self esteem.     Ironically, many of the people with whom I have worked over the past 15 years can trace many of the “roots” of their problems back to this first area.  Think about when you have the flu and an earache.  What happens to your patience? Concentration? Overall mood?  Impatient, indecisive and irritable right?  Let’s be honest, most people do not want to be around you when you are like that.  When you are sick, they can justify and overlook your disposition; however, if you are like this most of the time then it probably is starting to impact your relationships.  One of the first things I suggest people take a look at, is their overall health.   How well are they sleeping ? Are they eating a relatively nutritious diet?  How much exercise they are getting,  and are they in pain a lot.  When they make even small changes in one  or more of these areas, many people start having more energy, improving their concentration and generally being more pleasant to be around.

The second level of the hierarchy is safety.   When people think of safety, they often think of making sure they do not get robbed, but there is much more to it than that.  We need to not only have a sense of physical safety, but also psychological safety.   That is, we need to live in a world in which most people (including ourselves) abide by the principle, “If you don’t have something nice to say, don’t say anything at all.”  In many cases, we are our own worst critics.  People bombard themselves with negative self talk and, essentially, make themselves feel stupid, inadequate or less-than.  This often results in feelings of depression, anxiety and desperately seeking others (friends, relatives etc) to tell them they are okay.  It is easy to make your external environment a safe place to be.  It is much harder to make it safe inside your own head, but until you do, those negative messages are going to hold  you back from feeling truly happy and achieving your goals.

So what can people do?  Most people’s negative thoughts are so automatic, they do not even realize they had them.  I encourage people to focus less on trying to figure out what they thought, and more on trying to see the positive in every situation.  What did you learn?  What could have been worse?  What positive could come out of this? It is also helpful to start the day with a journal, meditation or list that provides an outline for all of the positive things they are going to accomplish.  Get pumped!  At the end of the day repeat the process and identify one or two things from the day that they are grateful for.  Example:

(Morning)  Today I am going to go to work, finish the monthly reports and then go workout with Tom.

(Evening) Work was okay.  I am grateful to just have a job.  I was kind of tired during my workout, but it was a great stress reliever and it was good to see Tom. (Isn’t that better than: “I hate doing monthly reports, my job sucks and all that stress made me have a terrible workout.”)

Once you are eating well, sleeping well and not so negative, irritable and distracted, then you can start addressing the next tier in the hierarchy: Relationships.  Believe it or not, these don’t happen over night or run on auto-pilot.  People have to work to keep a relationship going.  People need to know what makes their spouse/children/friends tick.  What are they interested in?  What is rewarding to them. Too often people choose gifts and rewards that they would like themselves.  For example, my husband is a reserved guy.  For his birthday, he is happy going out to dinner and spending time with the family.  I am a bit more outgoing.  I like big gatherings with lots of my friends.  What do you think I did for his birthday the first year we were together?  Yup!  I threw him a huge party—and a surprise one at that.  Not one of my better choices.  People should keep a running list on their iphone of what their friends like, so when it is holiday or birthday time, they will have something to reference.

But rewards are not the only part of a relationship.  Sorry!  The other big one is communication.  Tired, sick, depressed people are typically awful listeners.  They want their basic needs to be met, and conversation is simply extra noise.  Once people are out of the sleep-deprived, sluggish, stress-induced fog, they have more energy to do things like listening and saying what they need.  Unless I missed it in an RSS feed somewhere, humans still cannot read minds.  Figure out what your needs are, so your friends do not compare the relationship to herding cats.  Then—hold on to your hats—you must tell other people what your needs are.  Be clear, concise and specific.  Telling my 11 year old to clean his room is probably not going to get the job done.  Put everything back where it belongs on your shelves and make your bed.  Now that gets results.  When people are vague in their requests, then misunderstandings occur leading to tension in the relationship and a whole host of other stuff that we’ll discuss in future articles.

For now, eat, sleep, exercise, be nice, look at the bright side and say what you mean.  You might be surprised at how things so simple can make such a huge difference.

 

Dr. Dawn-Elise Snipes PhD, LPC, CRC, NCC is a psychotherapist and a nationally renowned speaker and counselor educator.  She recently moved to Northern Virginia with her 2 children, husband, 3 dogs, 3 cats, and 2 birds.  She uses a cognitive behavioral, reality-based approach to helping people find the happiness in their lives.

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Gainesville Counselors

December 6, 2010 by

Gainesville is one of those unique locations that houses a major university churning out counselors at the speed of light. Many (myself included) end us staying here for one reason or another. Why do you care? Simple. It means that there are more counselors than you can shake a stick at, and they all have slightly different styles. It also means that, in many cases, if you are willing to go “out of network” you can get an appointment rather quickly. (Most insurance provider panels have been closed in Alachua County for years.) Most counselors in Gainesville have sliding scale fees, or simply accept 50% of their customary fee if you are paying out of pocket. Why? Well, I can tell you that after many years of wrangling with insurance companies, I can easily spend a full hour trying to get preauthorizations and conform to each unique rule of each insurance company. I did not get into this business to get rich. I want to help people.

A couple counselors in Gainesville, such as myself and Meridian Behavioral Healthcare, also offer group counseling. This is a much more cost-effective way to get many of the same services. Groups usually cost about half of what individual services cost. Just like for individual counseling, you need to ask how the groups are run. For example, my groups are more “psychoeducational.” I open group by hearing how everyone is doing, any particular successes and struggles over the past week, and then move on to teaching a skill or technique that can help group participants better achieve their goals and deal with their stresses. The last half of group in spent applying this technique to each person’s unique situation. This is a very productive, cognitive-behavioral, nonthreatening approach to counseling.

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Face-to-Face and Online Counseling

November 15, 2010 by

Gainesville-NOVA Counseling now has counselors in Manassas, Tyson’s Corner and Fairfax who strive to make mental health and substance abuse counseling convenient, effective,  and even anonymous.   We understand your busy lifestyle may make it hard to go to a counseling appointment each week, or you may be afraid that your career will be jeopardized if anyone finds out that you are seeking counseling services.  DUI, DWI, Substance Abuse and Mental Health assessments can usually be done within 24 hours, and you can be enrolled in outpatient or intensive outpatient services that same day.

Our outpatient services are available six days a week, including Saturdays and evenings by appointment.  We address addiction, anxiety, anger, adult and child ADD/ADHD,  bipolar disorder, depression, eating disorders, grief, obsessive compulsive disorder (OCD), stress, and Trauma/PTSD.  Our clinical director, Dr. Dawn-Elise Snipes also specializes in working with persons in law enforcement and the military.  We use a solution focused, cognitive-behavioral approach to help you set goals, develop a plan and begin working toward a happier life.

Costs:

  • Assessment: $150
  • Individual Counseling Appointments (In the office or via video conferencing): $85/50 minute session
  • Intensive Outpatient Services $250 per week during phase 1 and $150 per week during phases 2 and 3.   IOP Groups meet on Monday, Wednesday and Thursday from 6:30pm-8pm.  If you cannot attend in person, you have the option of attending via video conferencing with Skype.
  • Written reports for court or probation officers: $30/per page
  • Court Testimony for sentence mitigation: $1000 per half day, includes preparation time.
  • Expert witness services: $1850 nonrefundable retainer.

Our individual, group and intensive outpatient etherapy/online counseling uses a secure, encrypted video stream to provide face-to-face services for addiction, anxiety, depression or PTSD within the comfort of your own home.  All you need is a computer with a webcam (it does not have to be an expensive one), and DSL or better internet connection.   Logging in is easy.  You go to a page on the internet and login using whatever screen  name you choose and a password that will be emailed to you when you sign up for the program.  Dr. Snipes and her staff look forward to the opportunity to help you!

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Welcome

March 3, 2010 by

At Gainesville-NOVA Counseling, our counselors use motivational interviewing and cognitive therapy to help people start to rapidly experience improvements.  We believe that each person’s thoughts, actions and physical health are all inter-related.  If you are sick, you are probably not interested in nurturing your friendships or trying to deal with you anxiety or depression.  People need to be physically healthy (more or less) to have the energy to nurture relationships, do pleasurable things and cope with the stresses of daily life.  Once you are rested, nourished and reasonably healthy, then you will be much more motivated to focus on the rest.   We encourage people to see their doctor to make sure that their anxiety or depression does not have a physical foundation such as hypo or hyper thyroid, polycystic ovarian syndrome or diabetes.  Our counselors will work with you to identify what you want to change…that is, what needs to be different for you to be happy?  From there, we will help you identify steps you might take.

Our counselors typically do not spend a lot of time focusing on the past. (Although in some cases that may  be appropriate).  Instead, we look at how the past has made you who you are and influences you today—for better or worse.  Then we help you turn those tragedies into triumphs.  During the first session, you will develop a service plan.  This will serve as the road map for future sessions.  Your initial course of treatment will last between 6 and 10 weeks.  At that point, you will reassess your progress and decide whether continued services are necessary.

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