Choosing a Therapist: Red + Green Flags

As a therapist it is easy for me to share with you how to select the right therapist for your needs. However, when i went through the process myself, i was able to experience the process from a client’s perspective. I firmly believe that every therapist needs their own therapist. Regardless of who you are, the supportive people in your life, it’s so rewarding to have a truly objective person in your corner. If you have a current therapist, are looking for one, or helping someone else with finding one, read on for some tips in choosing a therapist.

Just as you would watch for red flags and green flags in a relationship, friendship or business partner, you can look for signs in a therapist. The flags listed below may not apply to everyone, so take what you need.

Red Flags

1. Unreliable. A therapist that is unreliable can make it difficult for you to find appointments consistently. The unreliability may also lead to poor follow up of services.

2. Insincere or Judgmental. One of the reasons you want to see an objective person is to avoid judgments from others. Being able to freely voice what you are thinking and feeling is essential to building rapport and feelings of safety within the therapeutic process.

3. Talks about themselves too much. A therapist may occasionally share some minor details about their lives with you during a session. But the rule of thumb is that it mustn’t derail the focus from the client to the therapist. Too much self disclosure means that they are either shifting their relationship to you from professional to personal, or they have poor boundaries.

4. Other red flags include: makes you feel uncomfortable or unsafe; engages in unethical behaviors; shares information about other clients with you; overly focused on billing/financials; imposing their values onto you; telling you what to do (therapy is not advice giving). If any one of these red flags show up, and you feel safe and comfortable to do so, bring it up to the therapist. Ask to speak to their supervisor. File a complaint with their licensing board. Do not feel obligated to return to therapy if you feel unsafe working with them.

Green Flags

1. Attentive and Attuned. A therapist’s role is to pay attention and listen; a.k.a. be an active listener. Listening to the words, the tone, the timber, the body language, the emotion expressed. All these are ways that the therapist should be engaging with you. You should feel ‘heard’ and safe in the sessions. Sometimes though a therapist may be distracted; it happens because we are human too. If your therapist reflects on something incorrectly, speak up and correct it.

2. Have skills that meet your needs. There are three kinds of therapists. The kind that niche down into working with clients on a specific need (e.g., sex therapy), the kind that are generalists and work briefly with all need areas, and the kind that say they are experts in everything. A great therapist is the first two kinds. You don’t necessarily need a specialized therapist for your needs. But if they are accessible to you, you may want to check them out as an option. Steer clear of the “expert in all” kinds of therapist.

3. Use evidence based techniques. Every therapist has learned in school a variety of interventions and modalities to help their clients. Some common ones include CBT, EFT, EMDR, Solution focused. If this is your first foray into therapy, you may want to read up on the techniques and see which feels right for you; talk to friends about their experiences. If you are more experienced in therapy, using a keyword of what is effective for you, say CBT, can help when searching.

More Green Flags

Other green flags to look for include: they want therapy to end because you have worked through the initial concern, not because they want to keep their caseload flush; they work with you on goals because they want what’s best for you; they are a strong communicator; they educate themselves continuously; they earn your trust; and they challenge you- respectfully- so that you begin to see a change in yourself.

When looking for a therapist, personal preference is important. Know what you are looking for, do some research. The biggest practice in town may not be your best ally for your needs; small solo practices are very powerful. Always ask for a free consultation; this is your chance to interview the therapist and make sure you like them. Ask questions, be clear that their values or mission statement aligns with your goals and values. Take the time to find the right one at the start, and you’’ll find your best match.

Be Well.

What I learned AS a sex therapist

I haven’t always been a traditional therapist.

My early career was spent working with the justice involved population. From roles of monitoring and supervising, to assessment and treatment. Years later I became your typical therapist; sitting in a comfy chair empathetically listening to clients. My role as a sex therapist ranges from topics regarding sex play, building desire, and healthy self pleasure, to compulsive sexual behaviors and sexual offending treatment. In my over 20 years I have discovered a lot about people, and a lot about me. Here are some discoveries i’ve uncovered while working as a sex therapist.

Leave you at the door

When entering the field of counseling and therapy, just as in any field, you need to be sure this is what you want. Admittedly there are a variety of potential career paths to take as a therapist, so the options exist if you need a change. As a grad student a few of the tenants of therapy is to be nonjudgmental, nonmaleficence (do no harm) and create beneficence (do good). I like to think of this as leaving ‘me’ outside so that I can create space for the client. The less I bring me in, the more I am able to listen openly and with genuineness. As a sex therapist, i am to listen.

Expect the unexpected

I recall people being surprised that I would be working with the justice involved population, let alone people convicted of a sexual offense. Maybe it’s because i was so young? Whatever the reason, guess I just didn’t match their expectations. The point is that the same idea applies to my clients. I can’t have a preconceived idea of who they are or what they represent. Whether they are involved in the legal system or want hotter sex with their partner. I don’t know their story. I don’t know their needs and goals for therapy. As a sex therapist, I am to be a compassionate ally.

Learn to laugh

Yes, really. Therapy isn’t always serious. Laughter sometimes is the best medicine and it can be very therapeutic when talking about sex. Clients bring in their embarrassing stories, learn a new term or slang, share a meme. As a sex therapist, i am to balance levity with lightheartedness.

Choose knowledge

I am a firm believer that therapy is a place of education just as much as a place for healing. So let’s talk about sex, baby. Let’s talk about anatomy and desire. Let’s talk about fantasies and sex toys. Let’s talk about learning to create plans that prevent future victims. As a sex therapist, I am to educate.

I’ll admit that when i graduated I didn’t envision myself being a sex therapist; I have no regrets!

A Few of My Favorite Things

How many of you are now humming that song from the Sound of Music? I may have done that intentionally because it is one of my favorite movies this time of year (White Christmas starring Bing Crosby is the other). Read through to the end to learn why the song and movie is associated with Christmas. I know that you are so eager to learn about some of my favorite things, so here goes.

Therapy

Okay okay, i’m not biased on this I promise! Participating in therapy is a great tool for so many to find healing, solutions, restore confidence and learn new skills. According to a NAMI report 21% of U.S. adults experienced mental illness in 2020; that’s 52.9 million people, or 1 in 5 adults. Of those adults 46% received treatment. We can undoubtedly guess that during the global pandemic of 2020 these numbers in mental health and therapy needs increased from 2019. What was once very taboo has become a bit more normalized. Thanks in part to the Gen Z-ers who are very vocal about participating in therapy, to the influx of social media posts by lay persons and professionals related to therapeutic benefits. Here’s a tidbit that you may not know; even therapists have therapist. It’s our role to leave our worries outside the therapy room door so that we can be fully present for you. But that means we need someone to helps us process it all too.

Supplements

Let me be very clear before I start talking about this. I am not a licensed medical practitioner, but I am a certified health coach, so always consult your medical practitioner before starting a new supplement. If you want more information about the health coaching I offer, check out the page on my website. Based upon my own experiences using supplements paired with my training as a health coach, there are a few supplements that have proven to be valuable in improving moods, maintaining a healthy brain, and healthy lifestyle.

First up is omega fats. I am not a fish eater; in fact my motto as a child was ‘nothing from the sea.’ This has since changed and I now love mollusks and shellfish. However shellfish does not offer me the healthy omega 3 fats that come from cold water fish (e.g., salmon). Other healthy fats in the omega 6 + 9 variety are more prevalent in my daily diet. So I supplement with omega 3-6-9 pills. This article provides more details on the differences, sources and importance of taking omega fats in supplement form. Other supplements I highly recommend is magnesium and turmeric. Turmeric has many health benefits, the most notable is that it’s a natural anti-inflammatory and antioxidant. Additional benefits include improvements in brain health related to depression and prevention of Alzheimers (source). Lastly is magnesium, essential for brain and body health. It’s the most abundant mineral found in the body yet you’re likely not getting enough through your diet. Check out Dr. James DiNicolantonio’s videos on magnesium here and here.

Pets

If you’ve sat in my office or been in my virtual office, you’ve likely seen my cat. As ornery as she is, my cat is a calming force when I come home. She loves snuggles, has anxious attachment tendencies (is that possible in animals?!) and is a big talker, as are most Siamese cats. Owning a pet certainly comes with disadvantages (financial cost or clean up), yet more and more people own pets. Over half (57%) of the population owns at least one pet (source) which tells us there’s got to be something good for us about owning a pet. One study in particular looked at the wellbeing of owners, conducting 3 separate studies to find their conclusions. Improvements were more significant than originally proposed proving that owning a pet increases the social support aspect of the owner. Consider how many people you have become close with at the dog park because the dogs are playing together! Other benefits more commonly discussed from pet ownership include, reduction in depressive and anxious symptoms, improved self esteem, and increased physical activity. Considering getting a pet? Be sure to do your research on all the expectations and responsibilities of pet ownership. Plus there are opportunities for interactions with pets without the ownership responsibilities through volunteering at a shelter, working with therapy animal trainers, etc.

Laughter

You’ve heard the saying, laughter is the best medicine? And I’m guessing that you’ve even experienced the perks of laughter after a game night with friends. But just how good for you is it to laugh? The idea that laughter as medicine became a subject of interest in 1979 when Norman Cousins spoke about it’s analgesic effects on his own illness is his book An Anatomy of an Illness. Since then multiple studies have shown the psychological benefits of laughter; improving affect, reduction of depression and anxiety symptoms to name a few. In more recent years however there is growing evidence that laughter even has physiological benefits. This article outlines more of the details of the studies conducted. Suffice it to say that you could prescribe laughter for yourself and reap the psychological and physiological benefits. Creating a new weekly habit for 30-minutes belly laughing, a great way to share!

Looking ahead

Now that you’ve had a peak into a few of my favorite things, let’s return to the history of the song. Various stories suggest that the fame of the song, A Few of My Favorite Things, is because of Julie Andrews singing the song on The Garry Moore holiday special back in 1961 before the movie came out in 1964. Another story is that the song was created and performed to be a Billboard hit in preparation for the release of the Sound of Music movie in 1964. Still another story is that the tv stations wanted family friendly movies aired during the holidays when families were most often coming together, and Sound of Music was an easy choice. So as this year draws to a close in the coming weeks, I hope that you will embrace a few of your favorite things and share with others. May your smile be bright, your holidays be peaceful and your hearts be overflowing. Be Well!

How the season changes our moods

Common SADness

It's common for people to experience days when they feel not like themselves, down or a little blue but they can return to feeling energetic and like themselves again rather quickly. Sometimes those sad days start during the winter months and end when the days get longer. When these mood changes have a longer and more significant impact a person's thoughts, feelings and daily life, they may be experiencing what is called SAD or Seasonal Affective Disorder. SAD is not as uncommon as you’d think. It is experienced by millions of people, many of whom may not even realize it.

Here are some factors common in those with SAD: people who live in colder climates (northern states and countries), people who already have a mental illness diagnosis or family history of mental illness, occurs in more women than men, people living in parts of the country with fewer hours of daylight during winter (like New England). Here in Cincinnati it’s now getting dark around the end of the work day. Although that makes it hard to resist going straight to bed when I get home, it also feels unusual to being going out and being social or active after work when my internal clock is telling me it’s midnight!

SAD signs + symptoms

Since SAD is a specific type of depression many of the symptoms will sound much like those of major depression disorder. Now is the time to add my disclaimer for those that don’t read to the end of the blog (you know who you are). Having these symptoms does not equal a diagnosis of seasonal affective disorder; if you have many of these symptoms and you want support please talk to a licensed mental health professional. Now, back to it. Let’s look at the core symptoms of SAD:

• Feeling depressed most of the day, nearly every day

• Losing interest in activities you once enjoyed

• Having low energy

• Having problems with sleeping

• Experiencing changes in your appetite or weight

• Feeling sluggish or agitated

• Having difficulty concentrating

• Feeling hopeless, worthless or guilty

• Having frequent thoughts of death or suicide

Did you know there are two types of SAD, summer-pattern and winter-pattern depression. Of the symptoms that differentiate these, most notable is appetite and sleep changes. Diagnosis requires taking a full history of symptoms during past seasons and ruling out other mental health disorders (again, by a qualified mental health professional).

Why do people develop SAD?

Although there is no definitive scientific explanation for why people develop SAD of SAD-like symptoms, the experiences are still valid. Here is what scientists and clinicians have posited

• Your biological clock or circadian rhythm. Shorter hours of daylight and colder temperatures almost seems to push us to stay inside or under the covers. Fewer hours of daylight may confuse our internal clock of our usual wake/sleep cycle.

• Drop in serotonin levels. Serotonin, A neurotransmitter, is the primary mood stabilizer. Often considered the happy chemical, it is constructed by vitamin D (the ‘sunshine drug’). So less daylight = less vitamin D = less serotonin.

• Intrusive thoughts/feelings. Ruminating on negative thoughts and feelings associated with colder and shorter days such as the limitations of socializing, access or mobility. Additionally, associated memories or events can trigger negative thoughts and feelings and may contribute to associated behaviors of SAD such as isolating, increased sleeping, ruminating.

What can I do?

As I indicated at the start of the blog many people experience these symptoms and may not have realized that they could have SAD. Or they have some of the symptoms but not enough for a diagnosis. Bottom line is if you are experiences mood changes related to the season change, you can make changes to help you feel better. And if you have been successfully managing your SAD-like symptoms thus far, hooray! You can still take a look at the list below and consider making adjustments or additions to having a brighter fall and winter!

1. Stick to your routine. Although it’s harder now, sticking to your routine will help stave off the disruption to your circadian rhythm. Wake up and go to sleep at the same time as you do in summer months.

2. Make plans. Having something or someone to look forward to increases your chances of acting on it. So make those plans in the evening; go to happy hour, walk around downtown with hot cocoa, schedule to snuggle on the couch and watch a movie.

3. Use light therapy. Ever popular and available for quick delivery are light therapy lamps. Its popularity started in the late 1980’s and has been a bright light in effectively treating SAD ever since.

4. Psychotherapy. Yes, I mention it because I’m a therapist but more importantly I mention it because it works! Talking to a therapist about your thoughts and feelings can lighten the load you carry during the season.

5. Supplements. Increase your intake of omega fatty acids and vitamin D and helps improve your moods. Since many of the neurotransmitters associated with our moods are fat soluble, having healthy fats in our body is super important. Supplements are the most common way to absorb more of these nutrients but the best way is through whole food nutrition. Always talk to your doctor first.

Try some of these strategies, share some of your own, talk to your friends, make plans and Be Well!

We all need a measuring stick

Have you ever been pressured to participate in something but you felt really uneasy with it? Like so much so that your guts were churning, your head ached and you felt frozen? One reason could be because it goes against your internal Value system. 

A what?! 

What is a personal value system

A personal value system helps us navigate difficult situations and guide us toward decisions or responses that align with who we are. Values, morals, or what's important to us, are ever present. It also directs us to the people we invite into our lives and how we treat others. 

For example, you get a call from someone you used to be friends with and they want to rekindle the friendship. You're torn because although you feel compassion for the person as they were often the butt of many jokes you also recall feeling very uncomfortable around them and how they treated others. What do you do? 

You go back to examine your values. If we tease out some key points from this example above we see that you value comfort and trust in relationships while also hold compassion for others at great value. These seem to be in contradiction though. So now what? Now we place them in a hierarchy. Which is more important and which will lead to greater satisfaction for you. 

A personal value system takes time and experience to develop. It's not something that pops up overnight. Rather we adopt or adjust some that we inherited from our childhood, we develop others because of our social circles or spiritual practices. Still others are formed from past experiences, whether those experiences be positive or negative. Main categories of value systems are also present in the #4pillarsofwellness that I discuss with my clients-- relationships, spirituality, physical health, and profession. 

Each day we demonstrate our personal value system to the world. It colors every decision we make, and it's present in each action we take. Are we confident in our value system? Since we as individuals are not islands, what we do, what we say, has impact upon those around us. The more we live true to our personal values, the greater the impact we have on our moods, decision-making, and surroundings.

So now whose thinking, "how do I identify my value system?" 🙋🏻‍♀️ Good!

So here's some tips to get started:

1. Write a list of everything you value. Consider characteristics or qualities of persons. Even list material things or experiences

2. Group like things together. For example, you may have listed trustworthy, sincere and committed. These could be grouped together into a category of steadfast/ loyal. Another way to categorize them is by what is important in yourself and what's important you see in others.

3. Place them in rank order of importance. What is the most important value to you? Second most? Etc. by creating a ranking it assists you as you measure all future situations against this criteria.

4. Understand that value systems are not static, in fact the more static they are the greater the chance that we can harm or limit ourselves. Be open to adjust your values based upon evidence not emotion.

For more information about personal value systems, check out this article. If you find you need more assistance, reach out and ask for help!