Predictors of Positive Outcomes in Therapy and How to Get the Most Out of Therapy

What makes therapy effective? Can we predict if there are going to be positive outcomes in therapy? If so, what are the indicators? These questions have been asked by many a researcher, therapist, and client alike. So, if you are asking yourself these questions as you are looking for a therapist, you are not alone. If you had to guess, what would you guess? Would you guess, the experience of therapist, the theory or interventions used by therapists? Something else? Well, you might be wrong. Overall, the prevailing evidence shows that the number one predictor of positive outcomes in therapy is the therapeutic relationship. Therefore, the relationship between the client and therapist. Is that what you guessed? Let’s take a deeper look. 

As mentioned above, the most critical predictor of positive outcomes in therapy is a strong therapeutic alliance. This relationship needs to be collaborative, trusting, and empathetic. This includes having a secure bond and an agreement on the treatment goals. A mutual level of engagement is part of a strong therapeutic alliance. This means that both therapist and client are active and equal participants in the process. 

Let’s briefly discuss some client factors. Some factors that impact positive outcomes in therapy include the client’s motivation to change, openness to new information, and belief in the therapy’s effectiveness. Homework completion was another consistent predictor of positive treatment outcomes. What the homework looks like is something that is part of the treatment plan creation. 

Now some of the therapist qualities that impact the effectiveness of therapy include empathy, unconditional positive regard towards the client, genuineness, and the ability to adapt approaches. Empathy refers to the ability to understand another person’s perspective and emotions. It’s absolutely important that you do not feel judged by your therapist. Your therapist should treat you with unconditional positive regard, understanding, and affirmation. Keep in mind, depending on your therapy goals, a therapist may communicate perspectives you don’t agree with and offer challenges to your thinking. Typically, these practices are intended for growth, impact, and positive change. If you ever feel put off by something that your therapist has said or done, then it is encouraged that you tell them. 

Some other major indicators include positive feedback in sessions 3-5, client motivation, high outcome expectancy, goal consensus, and the therapist’s ability to tailor treatment to the client’s specific needs. 

Your therapy goals are more likely to be met if they are known to your therapist. It’s worth spending time clarifying and defining your therapy goals. This may be done before entering therapy, or alongside your therapist in a collaborative way. Goals may shift and adapt throughout the therapy. It’s also helpful if the therapist communicates realistic expectations for the process of therapy and mutual participation. 

 According the 16 meta-analyses conducted by the American Psychological Association (APA) Task Force, positive therapy outcomes can generally be predicted by three main factors (DeAngelis, 2019; Misic, Birkenbach, & Attia, 2023) which are therapeutic relationship, goal consensus, and empathy (discussed above). But an interesting finding is that the therapist experience had no bearing on the outcomes of the therapy. Therefore, therapists who have been practicing for many years were not necessarily more effective than therapists at the beginning of their career. 

Seven Tips for Getting the Most Out of Your Therapy 

Unfortunately, making progress in therapy is not as simple as just showing up. Therapy being another item on the ‘to-do list’ has the same effect as attending a workout class and laying on the mat the entire time. If you’re not working the muscles, you’re not building them.  

Below are things that you can do to help get the most out of your therapy sessions: 

• Show up on time, be consistent, and create an environment free from distractions. We’re more able to access our emotions and be reflective when we’re physically and mentally present. Do what you can to minimize outside noise and turn off notifications before a session. 

• Identify goals or think about what you want to get out of therapy. A therapist is there to help you clarify what is important to you and set realistic, meaningful goals. Don’t be afraid to consult with them or explicitly tell them, “This is what I want.” 

• Be willing and open to receiving new information and reflective when presented with new information. A sense of curiosity, willingness, patience, and openness go a long way in creating meaningful change. 

• Be honest with your therapist. Any good therapist welcomes feedback and questions about the work that you do together. If you’re concerned about something, or frustrated with progress, you can talk about it with your therapist. Therapists are not mind readers; they cannot help you with something that you have not told them. 

• Put in the practice. Real change happens between sessions. It’s when you take what you experienced or learned from a therapy session and contemplate it or apply it in your life. Trials and errors are common and normal parts of learning. 

• Be willing to feel your feelings. A therapist can help you develop safe ways to feel your feelings and contain them. Processing painful events oftentimes requires you to make room to feel and thinking about your feelings is not feeling your feelings! 

• Acknowledge the reality that there is no magic wand “fix” for feelings. Therapy and learning how to think differently, responding differently, and feeling is a process. Change is most often non-linear and subtle before it becomes significant. 

Now, hopefully, you can put some of this into action in your own therapy and experiences. This is meant to be a starting point but change and therapy is a process and work. Please be patient with yourself as you try to make long-lasting changes.  

https://actionpsychotherapy.com/psychotherapy/3-strong-predictors-of-positive-therapy/  

https://www.sciencedirect.com/science/article/pii/S0272735824000849 

*This article is meant to be informative and not a replacement for treatment. Please consult your provider for treatment recommendations. 

How Does Music Improve Your Mental Health?

I have always loved music. Growing up, I would spend hours on end shut in my bedroom listening to my CDs on repeat (yes, I’m that old!). Music was my escape and way of understanding the world. It still is today, only I now understand it and myself on a deeper level. 

There have been numerous studies on the benefits of music. Here’s what some of the research has found regarding music. Research supports that engaging in music-making activities, such as drumming circles, songwriting, or group singing, can facilitate emotional release, promote self-reflection, and create a sense of community. A 2019 study found that college students who listened to classical music every day for two months had significantly lower levels of anxiety. Although, I don’t know many college students that generally listen to classical music on their own. And some research has found that even listening to “sad” music can make you feel some pleasant emotions, which might lessen the pain you are feeling or allow you to more safely feel sad feelings we sometimes try to avoid in life. Research into music therapy for people who are deaf and also have mental health disorders is more limited, but case studies suggest, just as in hearing people, music can help people with hearing loss to express emotions and improve cognitive abilities. I've always said that if I go deaf, I’m going to listen to music really loudly and just feel the vibrations because that’s healing as well. 

Considering the healing effects of music, it may seem backwards that musicians may be at a higher risk of mental health disorders. A recent survey of 1,500 independent musicians found that 73% have symptoms of mental illness. This could be due in part to the physical and psychological challenges of the profession or that they are drawn to music due to its healing nature. Researchers at the Max Planck Institute for Empirical Aesthetics in Germany found that musically active people have, on average, a higher genetic risk for depression and bipolar disorder. 

Benefits of Music 

There are so many benefits regarding music, mentally and physically. Today, we are going to focus on the mental health benefits. 

Stress & Anxiety Reduction: Promotes relaxation while lowering cortisol (stress hormone), heart rate, and blood pressure. Music therapy decreases anxiety levels and improves the functioning of depressed individuals. 

Mood Enhancement: Upbeat music triggers a dopamine and serotonin release, making you feel happier. 

Emotional Regulation: Music helps process emotions, manage feelings, and can transform negative moods into positive ones. “Listening to music that does not have lyrics attached to it lets the listener project their personal feelings and their personal struggle into the music,” Dr. Cook recommends. 

Cognitive Function: It improves memory, focus, and mental alertness, activating multiple brain regions. 

Social Connection: Group music activities (singing ensembles for example) build community, empathy, and social bonds. Music can serve as a catalyst for social connection and support, breaking down barriers and bridging divides. Emerging evidence indicates that music has the potential to enhance prosocial behavior, promote social connectedness, and develop emotional competence. Music has a rich history of being used as a tool for social advocacy and change.  

Self-Expression: Music offers a powerful way to express feelings, cope with anger and other emotions, or find hope. If you don’t have the words to explain what you’re going through, or if you don’t feel comfortable talking about it, song lyrics provide another way to express yourself. 

Trauma & PTSD Relief: Music therapy provides a safe space for emotional release and healing, reducing symptoms of trauma and PTSD. Music therapy has shown promise in the research for providing a safe and supportive environment for healing trauma and building resilience. 

How it Works (Brain Chemistry) 

Neurotransmitters: Releases dopamine (pleasure) and serotonin (mood), while lowering cortisol (stress). 

Brain Activation: Engages the neocortex, improving calmness, and activates emotion centers like the amygdala and nucleus accumbens. 

How to Use Music for Mental Health 

If you would like to explore using music to help you feel better, here are some recommendations:  

 -Sampling different types of music to expand your horizons and find what you like  

 -Using music as a stress reliever when you are feeling anxious  

 -Discussing meaningful song lyrics with a friend  

 -Trying an instrument  

 -Talking about why you love a particular song with the adults in your life (or, if you’re a caregiver, with your teen)  

 -Listening to classical music when you have confusing or difficult emotions  

- Creating playlists to match or inspire different moods 

-Going to a concert to connect with other people 

-Join an online community with other music lovers-band specific, genre specific, etc. 

-Put music on to motivate you to do a task you are avoiding, such as cleaning or working out 

Music Therapy 

Music therapy is a structured, evidence-based use of therapeutic interventions where music is used to promote health and wellbeing. In music therapy, sessions may include songwriting, active music making (ex. Playing instruments), singing, and receptive music listening, often followed by a discussion. To provide music therapy, therapists have to complete an accredited program. Music therapy is used to treat individuals struggling with depression, anxiety, dementia, and chronic pain. It promotes wellness, manages stress, alleviates pain, expresses feelings, enhances memory, improves communication, promotes physical rehabilitation, and more. Clients receiving music therapy do not need musical skills to benefit.  

To learn more about music therapy visit the American Music Therapy Association at https://www.musictherapy.org/  

As you can see, music has many benefits and it’s really up to you about how you want to utilize it in your life.  

*This is for educational purposes only and should not replace treatment. Please reach out to your practitioner to discuss your treatment.

Everything You Need to Know About Couples Therapy

What is couples therapy? 

There are some similarities between couples therapy and traditional talk therapy, such as the ultimate goals being to relieve people’s distress and improve their functioning in an important sphere of life. But unlike other forms of therapy, there are typically three parties in the room in addition to the therapist. There is each of the partners in the couple, and there is the relationship itself. In a very dynamic high-wire act, the couple's therapist impartially balances the needs and interests of all three. Meaning the therapist’s “client” in this case is the relationship, not a person. This means that the therapist doesn’t take “sides” between partners but has a neutral stance in session and offers guidance in ways that are best for the relationship, not a particular partner. 

The couple therapists help romantic partners improve communication, resolve conflicts, and strengthen their relationship by providing a neutral space to address issues like disconnection, infidelity, or stress. It teaches skills for healthier interactions, understanding each other's perspectives, and finding constructive solutions, applicable to any stage or marital status, whether for major crises or preventative "tune-ups". 

What can you work on in couples therapy? 

There are many issues, problems, or concerns that can be addressed in couples therapy. The list can go on and on and can be as unique as every couple. But here are some common issues and struggles that couples come to therapy for.  

Communication breakdowns where couples struggle feeling understood and connected with each other. It is very easy to get into unhealthy and problematic communication patterns. Couples therapy can help couples learn new skills and how to talk and listen more effectively. 

Recurring conflicts where couples struggle with having the “same” argument over and over. It is not uncommon for couples to have conflict patterns that are repetitive and problematic. Couples therapy can help couples understand their conflict patterns, break them, and create new, healthier ways of disagreeing. 

 Infidelity is another common reason that couples come to therapy. When one person cheats, the other is likely to feel betrayed and hurt. But an affair doesn't have to spell the end of a relationship, provided both people want to improve the situation. Couples therapy can help heal the relationship and rebuild the broken trust after an affair. 

Intimacy issues are another thing that can be worked on couples therapy. Working on both or either emotional and/or sexual intimacy. These issues can impact the quality of the relationship as a whole and can sometimes be difficult to talk about. We sometimes struggle with shame or struggle finding the right words. Having a trained professional help remove judgement and guide healing conversations. 

External stressors, such as financial problems, parenting, or health issues can be addressed in couples therapy. Money can be a source of stress and conflict for many couples. One partner might want to save while the other partner likes to spend or might not have the same financial goals. Our views and beliefs can go back to childhood and how our parents taught us about money. Relationship counseling can help couples gain understanding of the other’s perspective and come to a compromise. Disagreeing on parenting issues can cause issues within a relationship as well. Couples therapy can help couples communicate their perspective clearly and understand their partner's perspective as well. When a partner gets a diagnosis of a physical or mental health condition, it can strain an otherwise healthy relationship. One person might take on the responsibility of caring for their sick partner. Meanwhile, the partner with the illness might feel like they've become a burden. The sick person could be an outside-related person, such as parent, and the added stress could impact the relationship. Couples counseling can help couples who are dealing with ill health find a path forward. 

When couples decide to start a family, it can add stress to the relationship. Deciding to have a child with another person is a milestone that brings many other choices. If infertility is an issue, you might need to decide how you'll have the child, such as whether you'll go through IVF, work with a surrogate or adopt. You'll also have to agree on how to raise the child. Couples counseling can help guide these conversations, so they happen effectively and with empathy. 

Feeling disconnected from your partners. Couples therapy can help re-establish emotional closeness. It can help couples who wish to strengthen their bond and reconnect. You don't need to be struggling to benefit from couples therapy. Sometimes every day stress takes priority over the relationship, and you just want to feel renewed in your relationship. It can be helpful to work on some communication skills in order to nip small, minor issues in the bud before they become issues that cannot be overcome.  

Can you work on more than one issue in couples therapy? Of course! You can work on more than one struggle or issue. You and your partner can work with your therapist to come up with a treatment plan that aligns with your personal and relational goals. 

Benefits of Couples Therapy 

Restoring affection is a benefit and outcome of couples therapy. Feeling more affection towards your partner and receiving more affection from your partner when there has been a decrease in affection is a benefit. When you work through your struggles, you feel more connected to your partner, and you can learn ways to show each other affection. 

Building respect is a wonderful benefit of couples therapy. Couples therapy teaches you how to communicate respect. 

Increasing intimacy is another benefit. Whether you are working specifically on intimacy or another issue, increased intimacy can be an indirect outcome. 

Rebuilding trust after a trust breaking incident such as infidelity is a benefit of couples therapy. It can be helpful to have a professional help a couple navigate the intense emotions of a trust breaking incident and couples therapy can help restore trust.  

Helps you work through life's challenges: Even the happiest couples will face challenges in life, such as infertility, mental health concerns, traumatic events, and financial issues. A therapist can guide you through these obstacles, helping you develop the skills to work past them. 

Creates a safe space: Every time you and your partner attend a couples therapy session, you enter a safe haven. You know that everything you share with the counselor will be held in confidence. You also can rest assured that the therapist will remain neutral during the session and won't side with one partner or the other. Both people will have a chance to express themselves during the session. 

Builds understanding and empathy in your relationship: Going to couples therapy can help you understand your partner better. Over several counseling sessions, you might gain a new perspective on their world. Likewise, your partner can develop a better understanding of your thoughts and experiences. 

Helps you resolve conflicts: Conflict is part of life. Knowing how to work through and solve disagreements is another secret to a sustainable and fulfilling relationship. Resentment can build when you and your partner struggle to move past issues or if you decide to sweep concerns under the rug. Your therapist can help you develop conflict resolution skills you can use during your sessions and later in life 

Improves communication skills: Communication is essential to a healthy relationship, but not everyone knows how to express their thoughts and feelings appropriately. Working with a counselor, you and your partner can learn how to share your concerns and emotions effectively. Some of the skills include learning how to communicate effectively, active listening skills, and how to disagree healthily.  

There could be many other benefits, but these are just some of the common benefits. 

What is a couples counseling session like? 

Most couples therapy is conducted conjointly, meaning with both partners present in sessions. Seeing or contacting one member of the couple separately is occasionally warranted but mostly done to gain information important to the relationship and with the permission of the other. The therapist is likely to ask many questions, including some about each partner’s family of origin and some that challenge an individual’s beliefs or perspective.  

Couples' therapists do not take sides in disputes, but they may call out individual behaviors that contribute to joint problems. This is called neutral facilitation. The therapist will guide discussion and ensure that both partners feel heard and understood. Relational science has firmly established that both partners play a role in most couple problems. 

The content of the session might vary but could include skill building, such as where the partners learn strategies like fair fighting, “I” statements, emotion regulation, and empathy; identifying patterns, such as uncovering deeper issues and dysfunctional interaction patterns that fuel conflict; or uncovering values and beliefs that impact behaviors and emotions. 

Types of Couples Therapy 

The Gottman Method: It was developed by psychologists John Gottman and his wife Julie Gottman, and is therapy emphasizes the outsize power of negative emotion to harm a relationship, the importance of frequent bids for connection or response, the vital need for repairing the damage done by missing those bids, and the value of sharing their inner worlds. Partners learn how to express affection and respect as a means of building closeness and make “love maps'' reflecting their partner’s psychological world. 

Emotion-Focused Therapy regards the restoration of a distressed couple’s physical and emotional bond as the best lever for change in the relationship. Drawing on attachment theory, the therapist encourages partners to access and express what lies under their anger or alienation. That disclosure of vulnerability becomes a powerful means for stirring the responsiveness of a partner. With contact restored, couples have a renewable source of mutual comfort, allowing them to jointly solve whatever problems they face. 

Imago Relationship Therapy has as its theme “getting the love you want.” Its goal is to enable partners to fulfill the ideal of love they developed early in life through attachment to caregivers. Partners take turns listening and speaking; repeating or mirroring what the other says to demonstrate understanding; validating their partner’s perspective; and tapping into their feelings. 

There are other methods or types of couples therapy, those are just a few popular and some couples therapists use a blend of multiple theories.

Some takeaways are that couples therapy; it’s not just for crises but can be used to maintain or build on a healthy relationship, not just fix a broken one. It requires commitment as best results come when both partners are invested in making changes.  

*This is for educational purposes only and not meant to replace treatment. Please consult your practitioner for treatment planning. 

The Skinny on New Year’s Resolutions

With the new year just a couple days away, I thought it would be a great time to discuss New Year’s Resolutions. First, let’s start with the history of them. According to history.com, the ancient Babylonians are said to have been the first people to make New Year’s resolutions some 4,000 years ago. They were also the first to hold recorded celebrations in honor of the new year, although for them the new year began in mid-March, not in January.  

 The Babylonians would have a massive 12-day religious festival called Akitu where they crowned a new king or reaffirmed their loyalty to the reigning king. They would also make promises to the gods to pay their debts and return any borrowed objects. These promises are what are considered the precursors to modern New Year’s resolutions. Babylonians believed if they kept their promises, their gods would bestow favor on them for the coming, but if they didn’t, they would fall out of the gods’ favor. Luckily, we do not have that much pressure to keep our resolutions. 

Some common New Year’s resolutions center around categories such as health (exercise more, eat healthier, lose weight, sleep better), finances (save money, budget, get out of debt), personal growth (learn a new skill, read more, get organized), and relationships/lifestyle (spend time with family, travel, quit smoking, be happier). These goals often focus on self-improvement, whether physical, mental, or financial, with a strong emphasis on better habits. 

According to recent research, while as many as 45 percent of Americans say they usually make New Year’s resolutions, but only 8 percent are successful in achieving their goals. 

Things to Think About When Creating a New Year’s Resolution 

There are many reasons that individuals are not successful with their New Year’s resolutions. One, they don’t create goals and a plan around their resolutions. Vague resolutions are not helpful and do not set one up for success. Another reason is that they don’t set them with intention. Setting a resolution just because you feel like you need to set a resolution isn’t helpful. If one is not fully invested in the goal, one is not likely to follow-though. Another one that I’ll get into farther down is the timing; January might not be the ideal time to start setting new goals.  

The first thing to think about when deciding on a New Year’s resolution is if you want to set one. I would never tell someone to set a New Year’s resolution, if they are not fully invested in the idea of it. Personally, I’m not one to set New Year’s resolutions as I don’t feel like I need a New Year to set goals and work on growth as I believe it should be constant. But if you find setting New Year’s resolutions helpful, that’s great. 

Next step, decide if you want to set a resolution or set an intention. Here’s the difference. Resolutions are concrete goals or standards you would like to achieve. Intentions are flexible goals or growth edges that you’d like to put more energy and actionable steps into. They both center around self-improvement and ways you’d like to create meaningful changes in the New Year but differ in structure. Some examples of resolutions are “I will read 2 books a month.” or “I will go to the gym 4 days a week.” Some examples of intentions are “I will start to carve out more time for myself to read.” or “I will put more focused energy into my physical health." 

One is not better than the other; there is not a right way to engage in self-improvement and growth. If you have tried one way and it hasn’t worked, maybe try another way. Being flexible with the approach could be helpful. Even if you struggle, you can always restart, thinking in absolutes is rarely helpful.  

If you need help coming up with ways to create specific goals or resolutions, make them SMART goals, meaning; Specific, Measurable, Achievable, Relevant, and Time-bound (SMART). 

Additional things to think about and include in your resolutions and/or intentions.  

Define Your "Why": Understand the core motivation and values behind your goals (e.g. if you want to go to the gym more, why? To be healthier? To lose weight? To keep up with the grandkids?) This can help with your motivation on days when you are struggling with keeping it up. Why is this important? Why is this your goal?  

Engage Supportive People: Who can you reach out when you are struggling to maintain? Do you and someone else have the same resolutions and/or intentions and support each other on the journey? You are more likely to not be successful if you go at it alone. 

Create Micro-Habits: Break large goals into small, manageable daily actions to build momentum. 

Monitor & Adapt: Regularly track progress and adjust strategies as needed, using indicators to measure success. Be flexible with the strategy.  

Is January the best time to make a new resolution? 

Some research states that January may not be the best time to make a new resolution or set a new intention. This could explain the small percentage of successful people. 

One reason that January is not the best time is because of the post-holiday slump. You're often tired, low on Vitamin D, and recovering from financial stress. Another reason is unrealistic expectations. The "new year" mindset encourages overly ambitious, impulsive goals that are hard to sustain. The final reason is out of routine. You're still adjusting from the chaotic holiday period. 

 If you find that you struggle to be successful with your New Year’s resolutions, March might be a better time to set new goals. March marks the beginning of spring in the Northern Hemisphere, a season synonymous with growth, renewal, and beauty. The days grow longer, the weather becomes milder, and nature comes alive with colorful blooms. 

In spring, you’ll likely have a clearer perspective. You've seen what actually happened in January and February, allowing for more realistic planning. With spring, you have renewed energy. Spring brings longer days, more sunlight, and warmer weather, boosting mood and motivation. There is reduced pressure. The pressure of "New Year's Resolutions" fades, allowing for a more genuine, less overwhelming fresh start. There is also seasonal alignment. Spring is symbolic of growth and new beginnings, making it a natural time to implement change. As the seasons change, it’s a natural time for reflecting and refocusing. It's an ideal time to reassess failed resolutions and create a more sustainable plan for the rest of the year. 

Whatever you decide to do regarding New Year’s resolutions, make sure you reflect and be intentional with your decision.  

How to Cope with Seasonal Depression

What is seasonal depression?

Seasonal depression, or Seasonal Affective Disorder (SAD), is a type of depression that occurs at a specific time of year, most commonly during the fall and winter months due to less sunlight. 

There are multiple causes including reduced sunlight, mood regulating chemicals, genetics, decrease in vitamin D, and demographics. The main trigger is the decrease in sunlight during fall and winter, which can disrupt the body's internal clock and affect mood-regulating chemicals like serotonin and melatonin. Vitamin D, which we naturally get from the sun, also plays a role. Family history of seasonal depression can increase susceptibility. Seasonal depression or Seasonal Affective Disorder is more common in women and in people who live farther from the equator.

Symptoms for seasonal depression are those commonly associated with other depressive disorders. These symptoms include feeling sad, empty, or hopeless. Many who struggle also feel a loss of interest or pleasure in activities and struggle with fatigue or low energy. Oversleeping or difficulty sleeping can often occur. Carbohydrate cravings, overeating, and weight gain are common during the winter months and can be attributed to seasonal depression. Other common symptoms include difficulty concentrating or making decisions, agitation, restlessness, or social withdrawal.

Ways to cope with seasonal depression

Now, how can you cope through the tough cold, winter months with seasonal depression? There are definite things that you can do that can make seasonal depression more bearable. As we see less of the sun, light therapy can be helpful as well as time in saunas. Since we have less access to natural vitamin D, making sure that you get enough vitamins and taking supplements if necessary. It is also important to make sure you move your body and not just rot on the couch, whether that is regular exercise or walking outside, if it’s safe. Because spending time outside is still important with the fresh air and natural sunlight. Making sure you are taking care of yourself, not always giving in to your cravings and eating a balanced diet is important as well. While it might be tempting to just hunker down and live on your couch, reaching out for support and maintaining those social connections is really important, because depression thrives in isolation.

It’s always helpful to reach out to the professionals if you are struggling and there’s no shame in it. Medication can be very helpful in treating depression as well as therapy. Please do not take anything in this post as a substitute as medical advice or a replacement for therapy.

How To Have Boundaries Through The Holidays

There are some people that look forward to the holidays and find it to be the most wonderful time of the year but there are many others that dread the holidays. If you are one of those who do not think the holidays are the most wonderful time of the year, you are not alone. Although, it can feel that way with all the commercials and pressure to make everything perfect. You may have past trauma related to the holidays and this time of the year is triggering, you might have lost someone close to you so the holidays trigger grief, you may not have the same beliefs, or there is just too much pressure to do everything and make everything special. Whatever the reason, you are not alone in feeling this way and your feelings are valid. 

So the question is, what do you do about this?

One big thing is boundaries. Boundaries are the lines and limits you create between yourself and others. 

The basic steps for setting boundaries are: Define where you want the boundary to be. Communicate the boundary. Follow through with the boundary. Sounds easy, but it’s not because you are dealing with your emotions, other people’s emotions, and breaking old habits and patterns.

Define where you want the boundary to be. Where your boundaries should be is a very personal decision. Because every person and situation is different, everyone’s boundaries are different. Some examples you could have as boundaries is picking and choosing the social gatherings you attend instead of just automatically saying ‘yes’ to every single one. You don’t owe anyone an immediate answer or the answer ‘yes’. Take your time to decide if this is really an event you want to attend and then if you do, fully commit without resentment. Another example is going but leaving early or when you are ready instead of staying until the end or if someone crosses a different boundary. Say, you are an introvert and instead of feeling like you have to stay until the end, leave when you are done socializing or if you are around people drinking and that makes you uncomfortable, leave before anyone gets drunk. Or if you know a specific topic such as politics will cause conflict, decide to leave if that topic gets brought up. These are just a few common examples and are far from all of the boundaries you could possibly have during the holidays. But having a plan beforehand can be really helpful for your ability to follow through with the boundary. 

Communicate the boundary. For a majority of situations, communicate your boundaries. If you don’t communicate your boundaries, how are the other people involved supposed to know what your boundaries are. There are situations where no explanation is needed. It is also up to you how much information you give. If you decline an invitation, you don’t have to give a reason. But if you are leaving a function because someone brought up politics, it could be helpful to communicate. Also, if you don’t communicate your boundaries, your reaction to your boundaries being crossed could be seen as an overreaction to others and as if it came out of nowhere.

Follow through with the boundary. This is likely the most difficult step. Our emotions get involved and we might not want to hurt someone else’s feelings. It is the most active stage in the process and therefore, the hardest. Just because you have established the boundary and communicated it, doesn’t automatically mean people will respect it. You cannot control people, therefore, it is up to you to enforce it by following through on what you said that you were or weren’t going to do. If you said that you were going to leave if politics was brought up and it gets brought up, leave. If you declined an invitation and someone tries to guilt trip you into going, hold firm on your original answer. It is hard to change our patterns and habits, so be kind to yourself if you struggle with this step.

Boundaries are hard, especially if you are new to setting them. It is always helpful to have someone such as a therapist guide you. There’s a saying “people go to therapy to deal with the people around them who won’t.” I think this is especially true around the holidays. Don’t hesitate to reach out for extra support during what might be a difficult time of the year.

What are superbills? Everything you need to know!

What is a superbill?

A superbill is a detailed, itemized receipt from a healthcare provider that patients can submit to their insurance company for reimbursement. It is generally used with regards to out of network benefits. It works when you as the client or patient pays your healthcare provider directly for services and then submit your bill directly to the insurance company for reimbursement. Some information that is important for a superbill to include is patient and provider information, dates of services, diagnosis, procedure codes (CPT), and charges. You would receive a superbill from a provider who is out of network from your insurance company.

But first, what is the difference between in network and out of network (OON)?

In network refers to a provider who has a contract with the insurance company. They have negotiated a price per service. When a provider is in network, they “bill” or submit a claim to your insurance directly on your behalf to get “paid” for services.

Out of network (ONN) refers to provider who does not have contract with insurance company. Therefore, the provider does not have a set price for the service. Because there is no contact between the provider and insurance company, the provider does not submit a claim directly to the insurance company, but can provide the patient/client with a superbill in order to get reimbursed directly from the insurance company for service rendered and paid.

Many insurance plans have both in network and out of network benefits. It is best to contact your specific insurance company to find out your specific benefits.

What are some benefits of superbills and/or utilizing out of network benefits?

It provides you, the client, access to more providers as you are not limited to choose only in network providers. You’ll have greater opportunity to find a great fit in a therapist that you may never had the opportunity to utilize. It gives you the freedom to choose from more therapists, including specialists. It provides you cost transparency as you know the cost of therapy upfront and do not have to guess if or how much insurance will cover. How frustrating is it to think that your service is covered only to find out that it wasn’t? And because you receive a breakdown of the costs, you can have a clearer understanding of the financial side of your therapy costs. You will meet your deductibles quicker by utilizing your out of network benefits. Submitting every superbill will help you meet your deductible quicker. You will have clear documentation of your medical expenses and evidence for insurance claims. There is greater transparency in costs and better understanding in the financial side.

Are there any downfalls to superbills?

With anything there are downfalls and the main one with superbills includes that you have to front the money initially. It does place a financial burden on you initially and you don’t know if or when you’ll be reimbursed by the insurance company. There is also the administrative complexities of having to deal with the insurance company directly.

How do I get started with superbills?

The first step would be to understand your out of network benefits. To do this, you should reach out to your insurance company and get clarification of benefits and the superbill submission process. Then you would ask your provider for a superbill and they would provide you with one, usually monthly. You would then submit the superbill to your insurance company for reimbursement. The insurance company could request additional information. 

There is no one size fits all when it comes to deciding if to utilize your out of network benefits. It is a wholly individual decision, but hopefully this short summary gives you clarity on the complexity of superbills to help you make the decision for yourself. Please reach out with additional questions!

*This is meant for educational purposes. Please contact your insurance provider for clarification on benefits.

Learning All About Trauma Therapy

What is trauma?

A common definition of trauma is “when we experience very stressful, frightening or distressing events that are difficult to cope with or out of our control. It could be one incident, or an ongoing event that happens over a long period of time.” There is what is called big “T” and little “t” trauma. Big “T” trauma includes what is stereotypically considered trauma, such as major life threatening events, physical, emotional, or sexual abuse, experiencing a natural disaster, war, or experiencing or witnessing a violent crime. Little “t” trauma are not the things that are typically thought of when we think of trauma, but still have a negative impact such as chronic stress, bullying, emotional neglect, or witnessing a car accident. Both little and big trauma have a negative impact on one’s wellbeing. But some key differences include severity and impact. Big “T” are often life threatening and more severe. The impact is also more immediate and more symptoms.

How does someone respond to trauma?

There are many responses to trauma. Some emotional reactions include, anxiety including panic attacks, fear, numbness, dissociation, detachment, anger, irritation, rage, guilt, shame, self-blame, sadness, grief, and/or depression. Some physical reactions include hypervigilance or heightened sensitivity to stimuli, difficulty sleeping or nightmares, changes in appetite or weight, physical pain or aches, and/or fatigue or exhaustion. Some cognitive or mental reactions include confusion or difficulty concentrating, memory problems or flashbacks, difficulty making decisions or taking action, avoidance of thoughts or feelings related to the trauma, and/or intrusive thoughts or images. Some behavioral reactions include withdrawal from social activities or relationships, substance use or other unhealthy coping mechanisms, changes in sleeping or eating patterns, difficulty trusting others or forming new relationships, and/or increased aggression or impulsivity. These responses vary on the person and situation. Depending on the responses and mental health disorder could develop including but not limited to depression, anxiety, and Post-Traumatic Stress Disorder (PTSD). Just because one experiences some of these responses after a traumatic event, it doesn’t mean it will develop into a mental health disorder.

What is trauma therapy?

Trauma-informed therapy is a type of psychotherapy that recognizes and responds to the impact of trauma on an individual's life. It is based on the understanding that traumatic experiences can have profound and lasting effects on a person's mental, emotional, and physical well-being. So what does that mean? Short answer…it means therapy that takes into account the trauma someone has experienced. Long answer…it includes a deep understanding of trauma on the individual, family, couple, and societal level. It creates a safe and supportive environment for healing to take place while empowering the client. It focuses on strengths and resilience of the client while avoiding re-traumatization. 

Types of Trauma Therapy

There are many times of trauma therapy. Some include:

Cognitive Behavioral Therapy (CBT): Focuses on identifying and changing negative thoughts and behaviors associated with trauma.

Eye Movement Desensitization and Reprocessing (EMDR): Uses eye movements or other bilateral stimulation to help process and desensitize traumatic memories.

Prolonged Exposure Therapy (PET): Involves gradually exposing individuals to trauma-related stimuli in a safe and controlled environment.

Dialectical Behavior Therapy (DBT): Teaches skills for managing emotions, improving interpersonal relationships, and developing distress tolerance.

Somatic Therapy: Focuses on the body's experience of trauma and uses techniques such as mindfulness and movement to facilitate healing.

Internal Family Systems (IFS): Views the individual as a system of different parts, and helps them integrate the traumatized parts into a more cohesive self.

Narrative Therapy: Helps individuals make sense of their trauma by constructing a narrative that gives meaning to their experiences.

Psychodynamic Therapy: Explores the unconscious motivations and conflicts underlying trauma and helps individuals resolve them.

Brainspotting: It is based on the premise that the brain stores traumatic memories in specific eye positions

Other Therapies: Hypnotherapy, acupuncture, yoga, and other complementary therapies may be used in conjunction with traditional trauma therapies.

*This is not an exhaustive list, but gives a general overview.

My Approach to Trauma Therapy

I take things slow when it comes to trauma therapy. First, focusing on building the therapeutic relationship, because if you can’t trust me there’s no way you’ll feel comfortable processing through your trauma with me. I meet you where you are. I also will not make you tell me your trauma as I believe that we can work on trauma without you telling your story and re-living the traumatic experience over again. 

I conceptualize cases through a CBT lens so there’s lots of CBT interventions but will borrow interventions from different theories and modalities as needed to meet my clients’ needs. For example, I might utilize mindfulness or narrative therapies if I think it would be beneficial for the client. I am a Certified Clinical Trauma Professional (CCTP) so I have the training to treat trauma clients. 

Please reach out with additional questions regarding my therapeutic style and approach to trauma therapy. Take advantage of the free 15 minute consultation!

What Am I Like As A Therapist?

Some words that have been used to describe me as a therapist are authentic, collaborative, laid-back, honest, straightforward, understanding, empathetic, and humorous/sarcastic. If these are words that you would want to describe your therapist, keep reading.

The first session is a get to know you session. I’ll try my best to get to know you as a person and try to understand your situation. I also understand that some things take time to open up about and will not force you to talk about something that you are not comfortable talking about. I understand that this is the first session and trust takes time to build. I’ll also provide you the opportunity to ask any questions you have for me, regarding my therapeutic approach or treatment.

Therapy with me is collaborative, which means we will come up with the treatment plan goals together. I don’t want you to be wanting to work on one thing and I have a completely different idea in mind. Therapy would not be successful and you would not find it helpful if we do not work together. Because of the collaborative nature, if you are ever unhappy with your sessions or treatment, please bring it up to me and we can discuss what you dislike and are wanting from therapy.

I consider myself a laid-back therapist, meaning I let you lead the session. You can talk about whatever you want, whatever is on your mind. My reasoning behind this is if you have something on your mind and I come to session with a specific agenda that is different from what you want to talk about, you are not going to pay attention to me, you are going to be focusing on what you want to talk about. If you are struggling to come up with things to talk about, I have no problem asking questions to guide the conversation. There are no right or wrong topics or things to talk about. There’s not one size fits all to therapy. I also understand that you may need different things from your therapist from session to session and try to be flexible to accommodate. 

I believe that the therapeutic relationship is the most important thing in positive outcomes from therapy. Because of this, I make it a priority to continuously work on the relationship with all of my clients. I do this through displaying empathy, understanding, being my authentic self with humor, and providing honest, straightforward feedback. I understand that healing, growing, and wanting to become the best versions of ourselves are all extremely difficult things and being a part of someone’s healing and growing journey is not something I take lightly. I am honored to hold that safe space, be that listening ear, celebrate the wins, and everything in between for you. 

My goal for you is that I become someone you trust to confide in and you can appreciate the ways in which therapy can challenge you, heal you, and help you grow in ways you never thought possible. I want you to help you grow and realize the person you’ve always dreamed of becoming. It is possible and you can become that person!

Benefits of Private Pay Therapy

You are probably wondering, what are the benefits of private pay therapy as opposed to using insurance to pay for therapy? That’s a valid question. There are actually many benefits to private pay. Have you ever thought to yourself, wouldn’t it be great if insurance didn’t dictate my therapy treatment, if my diagnosis wasn’t on my permanent record, if I didn’t have to worry about what insurance was or wasn’t going to pay, or if I didn’t have to wait until insurance approves my treatment to start. If these are some of the thoughts you’ve had then private pay might just be for you. Below are some of the wonderful benefits for private pay therapy. Check them out!

One benefit is greater confidentiality and privacy. Because with private pay therapy, since there is not a third party paying for your treatment, they are not allowed access to any of your records, which increases confidentiality. This can create a safer space to share vulnerable topics without fear that anyone else will ever read the notes. You have complete control over who has access to your records, so that can create additional peace of mind.

Another benefit is greater autonomy over treatment. Without insurance involved, they cannot dictate treatment, including length or type. This grants you more control over the length, frequency, and type of therapy, including alternative or holistic approaches. It also gives you the freedom to choose the therapist you wish without the worry of being in network with your insurance company. It provides you more flexibility and control over treatment. It gives you the opportunity to take your time to work on your goals at your own pace. You can move slowly and you have the opportunity to get to the root of an issue without feeling rushed. You are truly in control of your treatment.

You’ll have faster access to treatment with private pay as you don’t have to wait for insurance to pre-approve your therapy treatment. There are also often waitlists associated with insurances. This is something that you can bypass with private pay. Therapists who do not accept insurance can often dedicate more time and energy to each client because they are not burdened by excessive paperwork and low reimbursement rates from insurance companies. Therefore, they will be able to get you in sooner and be more present during sessions.

With private pay therapy, insurance doesn’t dictate it, therefore, a formal diagnosis is not required. You can focus treatment on whatever you desire including stress management or relationship issues without a formal diagnosis. With private pay, you can bypass a diagnosis being placed on your formal record. A mental health diagnosis on your permanent medical record can potentially impact future life insurance or health insurance application. With a diagnosis comes stigma which you may want to avoid. You can avoid feeling the impact of having a label placed on your health record and feeling as though it’s following you around.

Another benefit with private pay therapy is no surprise bills, you’ll know what you are paying upfront. With insurance it can be a surprise if they will or won’t pay and you can be left with a huge unexpected bill. With private pay, you can plan for the payments without a surprise. In some cases, the out-of-pocket cost may be lower than using insurance, especially for individuals with high-deductible plans. You’ll have more control over your finances. There are so many things that can happen and surprise bills that can come, you don’t want therapy to be one of them.

Overall, private pay therapy offers many benefits and can be worth the cost for many. Private pay therapy might just be the way to go for you! Whatever decision you decide, it is very personal and this article was intended to educate only.