A Therapist's New Year's Resolution

By Concentric Owner & Counselor Jennifer Larson, LCPC, NCC

In only a few more days, 2017 will come to a close.  It will be a time to think ahead – many will ignite their New Year’s resolutions.  While I may not routinely come up with New Year’s resolutions, I do think about and write down my personal desires and goals throughout the year.  And, I have decided that I will come up with a New Year’s resolution for 2018.  Before I share my resolution, I would like to share part of my roadmap that has led me to this juncture.

As I have engaged in reflection, I found myself returning back to a perpetual theme that would emerge and re-emerge over this past year.  One particular theme is what I will name as the ‘non-self-disclosing' therapist vs. the 'self-disclosing' therapist wrestling match.  I have no idea when the sport of wrestling season begins and ends, but I can tell you this particular wrestling match has persisted season after season. And, my hope for 2018 is the self-disclosing therapist will take the lead and possibly bring the wrestling match to a close someday soon.     

Let’s start back when these 2 wrestlers first met.  Perhaps they were both first introduced way back when, before the days of graduate school as 'non-self-disclosing' me vs. 'self-disclosing' me.  In my formative years, I grappled with how much to disclose and how much not to disclose my vulnerabilities. And if I did, I chose wisely with a very select few.  Some would say this is normal as we need privacy and boundaries while others may offer a difference of opinion.  Now, let’s fast forward to when I enter into graduate school where I am confronted again with choosing and deciding on how much to disclose.  This time it is focused more on me as an emerging therapist, not me personally.  In the earlier stages of education, students learn about various theoretical orientations and the relevance and implications of non-disclosing and disclosing to one’s clients. 

Just after the start of the millennium, I recall being enthralled with the tug-of-war game that was played during a semester course on ethics.  Our instructor was instrumental in leading the charge on getting all of us graduate students to really explore how to handle ethical dilemmas that can and will mostly likely confront a professional counselor, social worker, or psychologist.  Depending on the topic, some students would sinuously form into 2 teams, tugging and vying for one end (yes, it’s okay to self-disclose to a client; yes, it’s okay to hug certain clients upon closing a session), while the other group pulled and vied in the other direction (no, it’s not okay to self-disclose and hug a client). It was one of my favorite graduate courses as our professor and the course curriculum gave us the space and freedom to think critically and to share our perspectives and beliefs.  Some topics called upon us to unequivocally unite together whereas other topics had students participating in the game of tug-of-war, and well some (ahem) left all of us pooling together in the middle, gray area -- scratching our heads saying, “It just depends, it’s not so black-and-white.”    

Does a therapist merely act as a ‘blank slate’ allowing for one to free associate more easily? Or does a therapist offer some disclosure about their experience and feelings in relation to one’s client (countertransference)?  As therapists, do we divulge some our personal, relatable experiences, such as, “I share the same fear of heights as you do – here are tools that have been helpful to me.”  To disclose or not became even further embedded post graduate school during professional training courses and consultation. And for good reason, this particular topic warrants so much attention in the world of psychotherapy.  I understand the clinical relevance and implications – I get it. 

Over the past 15 years with greater professional and personal life experiences, I have found myself continuing to think about the inquiry of the self-disclosing therapist. At times, I have put forth a tidbit of self-disclosure when I believed it to be ‘clinically appropriate’ or when it simply felt right.  The self-disclosing therapist is not uncommon for some psychotherapists, and it's probably still one of the more debated issues in the field.  Over the past year or so, the inquiry in my mind has expanded beyond the closed doors where therapist-client, supervisor-supervisee, and consultant-consultee relationships are formed, maintained and evolve.  

Questions continue to knock on my door, such as, do I as a therapist share my story (or stories) with others publicly?  Is there value in therapists who choose to open up in a more public forum?  How about us therapists taking our practice even further by exercising vulnerability and using our voice through other outlets?  Are age and credibility in the field some of the salient determinants when choosing to publicly divulge as a professional?  What is too much to self-disclose in written form? Could casting a wider net be detrimental to a therapist’s profession?

While these particular questions have lobbed around in my head for just over a year now; admittedly, they have not been all ‘heady’ taking up rent in my mind.  Sometimes (and many times), I would simply experience this feeling inside of me – near my heart or gut – nudging me to share more and to share with more people.  Stop thinking so much and just take action.  Take the leap and have faith.  Even a call to duty would emerge from within as well.  But why and for what purpose?  The answers didn’t seem readily available to me.  And then over the past few months, it all became clearer.

Earlier in 2017, I learned about On The Table and the #BreakTheSilence initiative by The Kennedy Forum.  I was immediately pulled in as I loved the mission and purpose of this initiative.  Bring people together to give people an opportunity and space to talk about mental health in effort to reduce the stigma that still hovers around and shrouds the already cocoon existence of mental health. The idea is that when more people talk about a topic – in this case mental health and addiction – a positive rippling effect can ensue. 

The more people talk about mental health…

• The easier it will be for all of us to talk about it.

• Better yet, the easier it will be for all of us to talk about it without feeling shame, crazy, or embarrassment.

• The more we will feel safe and free of judgment.

The more people talk about mental health, the more…

• People will seek out help.

• We will honor and view mental health as another facet of humanity and life, just as we do with other areas, such as our physical health.

• We will advocate for change across cultures, families, and even within the helping professional field.

• Opportunity for positive changes within the health care insurance industry.

The continual, cascading effect.  The more people talk about mental health and addiction…

• The more we will become intimate and experience love.

• The more we will be empathic and compassionate.

• The more we will be more understood and connected.

• The healthier we will all become and the more lives will be saved.

Who doesn’t want to experience these things for themselves and others? 

Concentric Counseling & Consulting hosted its first On The Table Discussion on May 16, 2017.  The turn out and experience was inspiring and moving. We even shared people’s stories, experiences and solutions for people to read in our blog.  However, the Concentric’s therapists served as hosts and guides – we were not active participants in this discussion.  No self-disclosing.  This is not a terrible thing, but the knocking on my door didn’t go away.  Should we have re-considered actively participating in this dialogue?  Sharing would mean ‘more people’ talked about mental health and addiction, right? 

There have been other initiatives and movements this year, including one of the more recent ones that started in October 2017. The #MeToo movement gained momentum and traction which has given people collective permission to break free of the shackles that have promoted and reinforced silence, inequality, sexual harassment, discrimination, and assault, shame, and for some, the cocoon existence of mental health. The #MeToo movement encouraged women to share their stories in effort to give people permission to break their silence to unite and to bring greater awareness about the prevalence of sexual misconduct.  The more people talk about their experiences and hardships, the same effects will occur as with the more people talk about mental health and addiction.  Movements like these promote the cascade effect which in turn promote movements – a positive feedback loop. 

All of these experiences along my personal roadtrip have touched and impacted me.  And, while I recognize that I am helping people, I have also recognized that choosing (more times than not) the non-self-disclosing therapist may just not be as helpful.  I believe in the importance of using one’s voice, honoring one’s experiences with integrity and respect, and I want to help become a part of the bigger picture.  I want to talk more about mental health and addiction publicly in effort to help achieve with many others a positive cascade effect.  It won’t be easy for me, that I know. Truthfully, I am not quite sure where to start, what I will disclose about and which platforms to traverse.  What I do know is I now have a clearer understanding of the persistent themes that knocked on my door.  My deeper desires and hopes for all by talking about mental health.

So, my New Year’s resolution for 2018 is for me as a therapist is to start leaning in, to become more of a self-disclosing therapist by sharing more publicly some of my own mental health challenges and triumphs.  Happy New Year Everyone! 

Simple Meditation Steps For All Ages

By Concentric Counselor Michelle Taufmann, LCSW

These are the instructions for the basic meditation on the breath that I teach clients. Meditation on the breath is a simple, classic form of meditation that has been used for thousands of years to strengthen one’s focus and ability to sustain full awareness.

First, sit on the floor on a meditation pillow, or in a chair. Sit in a comfortable position with your back straight, but not rigid. If you are sitting in a chair it is best to sit forward with your back away from the back of the chair (rather than leaning back into the chair). You want
to assume a posture that facilitates being alert, yet relaxed. Next, close your eyes, or if you prefer, lower your to a gaze about a foot in front of your feet on the floor. The purpose of closed eyes (or lowered gaze) is to remove visual distractions from the field of perception. Now, take a moment to relax your head, neck, shoulders and arms by rotating them, tensing and releasing them, and/or shaking them out; these parts of the body tend to hold a lot of
tension.

You are now ready to begin the meditation on the breath. Start by noticing your breath as it comes into and out of your body. The experience of the breath coming into or out of the body is most noticeable in the following areas of the body: at the nostrils (the sensation of the breath going into and out of the nostrils), at the chest (the sensation of the chest rising and falling, and at the abdomen (the sensation of the abdomen rising and falling). Choose one of these areas on which to observe the breath. It usually works best to choose the area of the body where the sensation of breathing is the strongest for you. Now, simply attend to the breath. Think of it as being present to the experience of breathing. Your attention on the
breath should be light; you do not want to concentrate or think about the breath.

Once you have stabilized your attention on your breath, sit in this way for the designated amount of time. Ten minutes is the recommended amount of time for beginners. If you are like most people, you will fairly soon notice that your mind has wandered. When you notice
this, gently let go of the distraction, whether it is a thought, sound, or  internal sensation, and bring your attention back to your breath. Continue in this way, returning your mind to your breath each time you become aware that it has wandered. Remember to do this with
patience and gentleness.

Try not to become frustrated or judge yourself if your attention wanders frequently. Frequent mind-wandering is normal and to be expected, especially for beginners. Becoming frustrated or judging yourself for not being able to sustain attention on the breath is simply further distraction from your meditation practice and should be dropped as quickly and gently as other distractions are dropped during your practice. 

With practice, mediation of the breath will strengthen your focus and ability to sustain full awareness.

Your Voice Matters: Honest Discussion about Mental Health and Addiction

By Concentric Counselor Jennifer Larson, LCPC, NCC

It’s been about 3 months since Concentric Counseling & Consulting hosted its first On The Table 2017 conversation, and I am still impacted by the experience.  First let me backpedal to how I first learned about The Kennedy Forum, one of the co-sponsors of On The Table. 

It was the Fall of 2015 and I was having a conversation with my friend Caroline McAteer about various social issues and she had asked me if I heard of The Kennedy Forum.  Much to my chagrin, I had sheepishly told her that I hadn’t.  She told me about The Kennedy Forum’s mission and details of their annual meeting.  I was instantly intrigued and had to dig in.

Of the many things learned, one of them was Patrick Kennedy of The Kennedy Forum and his involvement with The Mental Health and Addiction Parity Act of 2008; he is still putting forth advocacy efforts to have The Act enforced on a national level.  I remember the buzz just before The Act went into federal law as I knew all too well the red tape and consequences people, including my own therapy clients, faced with limited mental health sessions imposed by insurance companies.

Fast forward to Spring 2017, and I learned about On The Table initiatives (co-sponsored by The Kennedy Forum and The Chicago Community Trust). Once again, I was intrigued.  On The Table initiative is about having people host open and honest conversations about mental health and addiction in effort to #BreakTheSilence and eliminate the stigma around mental illness and addiction that still greatly exists. 

As a counselor, I regularly encourage my clients to use their voice whether it is to share, increase vulnerability or intimacy, honor or advocate for oneself, and to work through the shame that often plagues people with mental illness and addiction. 

The focus of psychotherapy with my clients typically entails understanding and resolving challenges with one’s intrapsychic and interpersonal relationships (represented by inner concentric circles, hence the name Concentric) versus the larger, social systems (outer concentric circles).  Participating and joining forces with other hosts to help end the stigma associated with mental health and addiction while giving people an opportunity to use their voice fit Concentric’s mission with helping others to your their voice – but this time on a macro level.    

On May 16, 2017, the therapists at Concentric Counseling & Consulting hosted its first On The Table 2017 conversation in Millennium Park, across the street from our office.  It was an unseasonably warm and windy day, and our topic was "Your Voice Matters: Mental Health and Addiction.  Honest Discussion About Why More People Don't Seek Out Help." 

We had an incredibly diverse group of people who actively participated.  It was such an honor to hear people’s stories and ideas about why more people don’t seek out help.  So many stories and barriers were shared.  Common themes emerged and were extracted.  Follows are some of the common themes people described that either prevented them or others they know from seeking services:

• Stigma, embarrassment, and shame. Seeking help is seen as a weakness. What will my family and friends really think about me? Will I be seen as a ‘nutcase?’ Denial about having a problem or my ego getting in the way.

• Financial burden and obligations. Lacking financial resources all together. Treatment is a privilege for only those who can afford it. Lack or poor insurance coverage. All of the convoluted layers to insurance coverage.

• Lack of information and available resources on how and where to find mental health and addiction services. Example given was local university offered free counseling services to its students but was not aware of services until his senior year of college. Not knowing how to access services or where to start. Location and other barriers to gaining access to solid services.

• Cultural barriers and roadblocks, including families of certain cultures not supportive of mental health services. Experience with providers who lack cultural, gender identity, and sexual orientation competence. Religious barriers and lack of supports within religious communities.

It is a reminder to all of that us that suffering from mental illness and/or addition is hard in of itself, not to mention having to endure additional barriers that get in the way of seeking and accessing help.  Some of the solutions shared were not only to address or remove the aforementioned barriers and roadblocks, but to focus on the equity of mental and physical health. 

People remarked how it is much easier and more acceptable to talk about their physical ailments, but not their mental health.  Let’s look at people wholistically and give the mental health side the same due attention and respect.  Another solution shared was to target childhood prevention. 

One of the guests remarked in early childhood, we learn the importance of daily hygiene, such as brushing our teeth daily.  Why not introduce conversation around mental health care at an early age or make mental health education mandatory in schools.   Also, when providing education on mental illness and addiction, don’t use extreme or scare tactics, such as the “This is Your Brain” drug campaign did in the 1980s.  Guests remarked it only silences people more. Instead, provide a spectrum of information that can resonate with or speak to a variety of people across all ages and cultures.

My hope is that the information shared from our diverse group in Chicago can continue to be shared with others. And importantly, inspire all of us to participate in more active conversations about mental health and addiction whether it’s in your home, at work, in your community or as an On The Table host.  Because Your Voice Does Matter!      

Is All Drug Use Created Equal?

By Concentric Counselor Myron Nelson, LCPC    Edited by Concentric Counselor Jennifer Larson, LCPC, NCC

All drug use is not created equal.  Take a look at that statement again and see if it contradicts or confirms your views on substance use.  I hope by the end of this post you feel it does both.  As a country, we are simultaneously experiencing an opioid heroin epidemic and progression in the legalization of marijuana. Clearly, drug use is not so black and white.  I aim to gray the edges and disrupt some of your beliefs because critical thinking is needed in these cacophonous times.  

We often tell kids to beware the slippery slope of drugs.  As if smoking marijuana is a banana peel slide away from cocaine or criminal behavior.  Not only does that argument neglect to account for alcohol (being many adolescents first introduction into mind-altering substances), but it also purports that all drug use is inherently related or equal.  To say that one drug can lead to the use of another may be true, but that is because things kept hidden away in the dark tend to be hidden together.  Research debating the effects of the slippery slope can teeter in either side's favor but both sides would agree that every individual person's path does not neatly align one way or the other.  That point should not be ignored.  

If you are concerned about someone's drug use, talk with him or her about it.  There may be underlying mental illness issues or some form of trauma that is being treated by the effects of substances.  Many will turn to substances to self-medicate symptoms of mental illness, neglect or trauma.  Additionally, experimenting with drug use can be a normative behavior for certain subgroups.  That does not mean it is safe or healthy, but it also does not mean its intent is malicious.

When you talk with someone about their behavior, be sure to not talk at them.  Be mindful that attacking or judging their behavior typically is not going to lead to a productive conversation.  Come to them seeking to fully understand them and what is going on.  Coming down with an iron first also spreads the message that substance use is only dangerous.  To pretend that substances or drugs do not produce a euphoric or calming effect creates misconceptions.  

If I were to cite research and share stories about the detriments of TV and forbade you from ever watching it, what might happen if you finally caught a glimpse of some TV show?  You might find it enjoyable and then seek out other people who like to watch it too.  You may then find yourself containing this information for fear of being criticized by others.  So it becomes one of your secrets.  Likewise, what if all you heard about alcohol was that it causes hangovers?  

If you inform people about the benefits and consequences of substance use then they can start to formulate the foundation of decision-making and choices.  If you think it is too dangerous to expose them to that knowledge, you may need to think again.  You cannot stop it as images and scenarios of people enjoying being high on some kind of substance are constant in the media.  Plus, putting up walls of censorship in the Internet era can be futile with certain people.  You do not have to fight a battle against people discovering drugs can have positive effects; you can incorporate that as part of your conversations.  Conversations with a 's' -- it is plural for a reason.  No topic as big as substance use is going to be covered in one sit down.

Given what I've written so far you may imagine that I am an advocate in a way that I am not.  When it comes to most substances and drugs, I take a firm stance that substance dependence is unsafe with detrimental consequences.  I do not think someone's only way to relax after a long day at work should be to drink a beer and I do not think someone who is constantly depressed should seek to escape with substances, such as ecstasy.  How someone is using should be discussed as well as what they are using.  Certain drugs are more associated with images of horror or suffering, sometimes rightfully so, but do not let the name fool you.  

This blog post is one part informative, two parts inquiry.  It is a questioning of the commonplace idea that we have to draw deep lines in the sand about what drugs are not okay and when.  We would all benefit from looking at all use in more detail.  Parting words -- Experimentation is not addiction. Information is not dangerous (taking into account age and other factors).  Open up the conversation and have many of them.  Seek professional help if you believe you or a loved one struggles with substance abuse or dependence.

How to Bring Up an Important or Sensitive Topic to a Person?

By Concentric Counselor Jennifer Larson, LCPC, NCC

It’s been six months since my last blog post, so it’s much overdue.  There has been no shortage of topics to write about as they perpetually swirl around in my head – it’s now just a matter of carving out the time to be intentional about writing again.  So, here I go. 

This is one of my favorite topics as it comes up fairly regularly in sessions, not to mention I love helping people to learn how to establish and maintain boundaries while learning how to be a better communicator. Please know this blog just scratches the surface as there are many facets when it comes to boundaries and communication, but at least these pointers can be the launching pad you need to start. 

People consistently ask how to bring up an important or sensitive topic to a person while at the same time not hurting their feelings, making the situation worse, or coming off as a jerk.  While we cannot ultimately control the outcome of the interaction or the other person’s feelings, we most certainly can prepare and use an approach that can increase the chances of a better outcome keeping in mind integrity, respect, and boundaries. 

For some, it takes a lot of courage and strength to confront a person. So, if this is you, give yourself a pat on the back for taking this difficult step.  Some people may feel somewhat comfortable or even enjoy confronting, but may neglect to do it somewhat well.  Whatever your situation is, just remember it may be awkward to learn something new, it’s okay to make mistakes along the way.  You will get better with further learning and practice.  As we therapists love to say, “It’s a process.” 

One of the first things to consider is what is your intention (or goal) for bringing up an important topic to another.  Is it to clarify a situation, better understand another, ask someone if they can meet a need of yours, or come up with a solution?  For purposes of having this conversation, try to clearly define your intention(s) coming up with only one or two.  If there are more areas to cover with this person, you can parcel out over time with several conversations.  But for this initial conversation, you don’t want to fire off a litany of items all at once. 

Ok, so you now have your 1-2 intentions.  Next, you will want to ‘invite’ the person to have a conversation with you.  You do not want to spring it on this person when he or she least expects it.  You want to be mindful of not only when you are available to provide your full attention, but also when the other person is completely available.  The invite can be, “I would like to talk to you about something that is really important to me, are you around to chat tonight over dinner or tomorrow morning?” 

The day, time and possibly place have been pinned down.  Next is the anticipation of actually having the conversation.  You may be fraught with anxiety, fear, or other unpleasant feelings.  If this is the case, it’s perfectly normal and okay.  Keep in mind, the other person may be just anxious.  Just remember this person and topic are important to you, and you are approaching this person with your best intentions and method of communication. 

The time has come to engage with one another.  You can warm up the interaction by either acknowledging or thanking the person for being open to talking or you can briefly state something that is positive about that person or the two of you.  This warm-up can help ease both of you into the conversation while setting a positive (or even neutral) tone.

After easing in, you will share your thoughts and feelings by speaking from an “I” position versus opening the dialogue with “You.”  Speaking from an “I” position shows accountability and ownership whereas entering the conversation with “You” can put the person on the defense.  For instance, “I have been bothered lately by the lack of connection or sex between us”, “I have concerns about our how you address disciplining our child and want to learn more about your position on this”, “I am feeling overwhelmed and would like some support from you with the household chores" or "I would like to talk about the restaurant incident the other day.”  Remember you are the one who ultimately wants this conversation, so it is up to you to share you (your thoughts, feelings, behaviors, and beliefs). 

Try your best not to blame the other person, be critical or judgmental, talking down to the person or going into demands and commands.  Also, try your best to suspend those pesky loaded terms, such as “always”, “never” or “should."  Use these words judiciously as they often do not depict complete accuracy (e.g. You never compliment me; You are always rude) not to mention these words can convey judgment and criticism (You should want to be a better partner to me; You should know what I want). 

Also, be mindful of your tone, choice of words, body language, including facial expressions.  Eye-rolling, using offensive language, speaking in a patronizing tone or yelling, sitting with your arm crossed are some examples that will undermine the conversation.  You want to work towards conveying both verbally and non-verbally openness, equity, and respect. 

So, you’ve shared your thoughts keeping these key items in mind, now what?  Depending on the topic or person, the conversation can go in a variety of directions.  For brevity sake, let’s say worse-case scenario is this person reacts negatively to you.  Depending on the type of negativity, you may need to remove yourself from the conversation, pause the conversation until both of you are in a better spot to chat constructively or you can redirect the interaction by expressing your overall intention and that you would like to reciprocate by also fully listening and understanding the other person.  You can ask for a commitment that both of you will try your best.  It’s okay if the two of you may not agree or feel the same way.  For you, you are learning how to bring up an important topic to another with a few tools in your bag.  

Go ahead, and give it whirl -- you're on your way to learning how to approach people with topics that matter to you!      

Ask The Therapist? What Does ADHD Typically Look Like in an Adult?

By Concentric Counselor Ashley Allis, LCPC, NCC

We continue the Ask The Therapist? series for people who attended a Small Business & Eco Fair and popped by our table to meet us and write down an anonymous question related to mental health and well-being issues that they or a loved one may be facing.  Over the next weeks, we will continue to post anonymous questions and our answers. So, feel free to re-visit this blog to see what others had to write.

Ask The Therapist? is to provide some helpful information, guidance, and resources only.  This information is not intended to give a diagnosis, provide treatment recommendations for a mental health disorder or to replace individual therapy. Make sure you see your doctor or mental health provider if you think you or a loved one may have symptoms of a mental health disorder which warrants professional help.

WHAT DOES ADHD TYPICALLY LOOK LIKE IN AN ADULT? 

Many are surprised to hear that adults can be diagnosed with ADHD.  ADHD symptoms can look (or manifest) different in adults than in a child where usually the underlying causes (etiology) are similiar. Some typical symptoms for adults are:

Disorganization:  Someone diagnosed with ADHD may struggle with time management and staying on top of certain tasks.

Forgetfulness: We can all be a bit forgetful at times; however, adult with ADHD forgetting routinely happens. 

Lack of focus:  Being easily distracted, difficulty listening to others in conversations and work settings, and overlooking details.

Hyper-focus:   On the flip side of ‘lack of focus’, there is hyper-focus. Sometimes a person with ADHD can be engrossed in an activity that is of interest to them. 

Poor listening skills:  It is not uncommon to hear reports from their partner or family member that they have to repeat themselves often. 

Impulsivity:   This means interrupting others, blurting out thoughts without thinking, and suffering from addictive tendencies. 

Emotional problems:  Adults with ADHD can feel their emotions are up and down. This can be caused by feeling bored by a lack of stimulation, sense of underachievement, and/or trouble staying motivated. 

Restlessness and Anxiety:  Feeling like you can’t shut off your motor or constantly feeling you need to move or be on the go.  Difficulty staying still in meetings, at work, dinner, or other situations which may require sustained sitting. 

For more information on Adult ADHD, check out:  http://www.adultadhd.net/childhood-vs-adult/ and http://www.mayoclinic.org/diseases-conditions/adult-adhd/home/ovc-20198864

To learn more about our specific services, check out: Individual Therapy and Teletherapy and Online Counseling