Now as never before we are being challenged in ways many of us could not have imagined a few months ago. Life has been irrevocably changed by the arrival of Covid-19, a virus whose global impact is unfolding at this very moment. How can we continue to move forward with our lives maintaining a semblance of normalcy with all this uncertainty?

Even before this most recent crisis, a growing number of practices have added online therapy, also known as telehealth, to the catalog of services they offer. While research on the effectiveness of online therapy is still relatively scant, some studies indicate that the approach does show promise. The mental health community is divided on the subject, and many traditional therapists argue that there is no substitute for the personal contact face-to-face therapy provides. On the other hand, many traditional therapists are expanding their own practices to include online sessions. The most recent world events have decidedly skewed in favor of telehealth services. Just today Connecticut Medicaid has joined the ranks of commercial insurances to offer reimbursement for these services indicating their value and necessity at this juncture in time.

Finding the most effective care online

If you are interested in exploring online therapy, the question becomes, how do you choose the best online therapist? The most important consideration is to find a therapist with the proper credentials. Be sure the therapist you choose has the education, training, and experience necessary to provide you with effective counseling. Many firms that purport to practice online therapy employ people whose training qualifies them to be little more than chat buddies. Before you choose an online therapist, be sure to research his or her qualifications.

What if I take medication?

Online therapy providers employ many different kinds of practitioners. But not all have medical doctors or nurse practitioners who are licensed to prescribe medication on staff. In addition, some medications cannot be legally prescribed online at all. If you are currently taking an ADHD or anxiety medication, chances are it falls into the category of drugs that can only be prescribed by visiting a prescriber in person. You’ll need to maintain a relationship with your medication prescriber if you decide to try online therapy.

What’s the bottom line?

Successful therapy and good mental health are rooted in relationships. Our world has been set on end with school closures, quarantines and health advisories promoting distance. There is no need to suffer alone. If you would benefit from talking with someone, Collaborative Counseling Group offers therapy and medication management through HIPAA compliant services on your smart phone, tablet or computer. You need only have a strong wifi connection. These are challenging times. If telehealth services can help you, please don’t hesitate to contact us today.

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By Laura Petiford PMHNP, LMFT

It’s interesting.  Since I have completed my training as a nurse practitioner with a specialty in psychiatry enabling me to prescribe medication, I’ve become less inclined to see medication as a first grab solution.  In some respects, this isn’t surprising based upon my background as a marriage and family therapist. MFT as a field is known to eschew medication exalting therapy almost to the level of panacea. But my experience taught me differently.  There were times when I saw medication absolutely open up a life of possibility when before there had been no options. And is most often the case in life, the utility of medication isn’t an all or nothing proposition but rather somewhere in the middle. So how do you know if YOU would benefit?

You have thoughts that life isn’t worth living.

This is the number one reason to consider medication. Nothing is more important than your safety. If you are experiencing thoughts that the world would be better off if you weren’t around, it’s time to consider medication.  Notice, I say consider.  It could be meeting with a therapist to talk on a regularly basis would be enough to pull you out of this line of skewed thinking.  But if the thoughts have moved to planning, even if you have no intention of acting on the plan, it’s time for medication.  Again, nothing is more important than your safety.

You’ve tried therapy and the results aren’t what you or your therapist hoped.

If you have been steadfastly addressing your thoughts and behaviors for 3 months with little to no relief from symptoms that are sucking the joy from your life, it’s time to consider medication. Notice again, I said consider. It doesn’t mean you have to or “should.” It means it’s worth taking a look to see if the benefits of taking medication outweigh the costs.  Your list of both will be unique so there isn’t a formulaic answer. At this juncture, you owe it to yourself to consider another option and that includes the use of medication.

You can’t stop wondering if medication might make your life better.

I believe unresolved questions are worth checking out. If you have a persistent question about whether or not you would benefit from being on a medication, I encourage you to make an appointment with a word of mouth referred clinician to help you get a handle on that question. Please chose your clinician carefully. While choosing a random name off the list your insurance panel provides can quantify how much you will pay in dollars, it does nothing to let you know what your experience will be. You don’t want to become another nail to someone’s hammer. Ask your friends who they use or go on a website like psychologytoday.com to do your own research.  And be prepared to hear the answer “no.”

Psychiatric medication can be a welcome balm to a mind in need of healing. It can enhance the work required to become whole whether that’s a return to wellness or a destination set for the first time. Working with a clinician who will make a careful assessment in collaboration with you is the best way to find out if it’s right for you.

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Glitches. Life is full of them. Who hasn’t had the experience of a well thought out plan being disrupted by, well, life. It’s the child with a fever and sore throat the morning of an important presentation at work. It’s the traffic pile up on I95 when you are already late. It’s the phone call from the Dr. letting you know there was a suspicious finding on your mammogram. From the miniscule and mundane to the powerful and profound, they force us to reorganize, re-evaluate, re-prioritize. They can fill us with fear and anger and they can keep us from running on autopilot creating a more authentic and intentional life for ourselves.

How do you respond when you hit the proverbial speedbump in life’s road? Do you focus on what is lost or do you use it as an opportunity to learn about yourself and seek new solutions?

Here are THREE things to ask yourself next time you find yourself at odds with your best laid plan:

What am I telling myself about this situation that is based upon fear and may or may not be true?

Determine what story it is you are telling yourself about your current situation. Likely there is a boogie man lurking somewhere. Take the time to open the closet door, shine the flashlight all around and remind yourself, while life does present challenges, you are equipped to handle them.

How is my breathing?

I know, this one sounds silly or maybe even condescending. But the physiological fact is that breathing patterns impact our emotions. So if you want to change the way you feel, change the way you breathe. Belly breathing, taking in a deep breath so that your tummy pooches out, loosens the grip of negative feelings. Shallow breaths typically accompany stress and anxiety and alert the brain that oxygen is in short supply making things only worse. Take the time to breathe deeply.

Is there something I could be doing differently that could alleviate this stress in some way?

The power we have in life lives largely in the choices we make. Make sure you are as powerful in your own life as is possible by examining your choices and adjusting them to reflect your values. Don’t like being late to work? Maybe leaving the house 10 minutes earlier will prevent this. Feeling sluggish and overwhelmed? Perhaps it’s time to take a look at diet and exercise habits. Own your power and make needed changes.

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Gypsy

I always finds it interesting to observe how psychotherapy and psychotherapists are portrayed in the media. I suppose there must be some examples in which fictional therapists are shown in a positive light or at the very least in a realistic fashion. What stands out in my mind of course is the other version, the PSYCHO-therapist. To some degree, just as what we believe about love and relationships is influenced by what we see on screen, I believe that these depictions impact what clients expect of the therapeutic process. It is this curiosity that led me to check out the show, Gypsy on Netflix after it was mentioned to me by a colleague. And it’s based on a female therapist living in Fairfield county Connecticut, what hits closer to home than that! While the therapist character is initially likeable and relatable, not just to other therapists but to mothers, to working parents, to people trying to keep their marriages intact etc, you soon discover that the therapist engages in unethical practice by seeking out and entering into relationships with people in the lives of her clients that they have discussed with her in therapy. I will not give too much away as I do not want to have to identify this post as a spoiler for the show, but it demonstrates a therapist working through her own internal conflicts in a manner that violates the trust that her clients have had to bestow in order to share some of their most intimate and painful stories.

“Good” therapists

What I would want to say first is that the majority of therapists go to great lengths to ensure that they are providing sound treatment to their clients and upholding their privacy and confidentiality. “Good” therapists engage in supervision with colleagues that they can reveal themselves to, as well as seeking their own therapy when necessary. “Good” therapists make mindful choices about what kinds of difficulties they will or will not treat at any given time as a result of what is going on in their own lives and based upon how is it informing the way that biases show up in treatment. “Good” therapists tell their clients if they feel they have lost objectivity or have offered as much help as they are skilled to provide. “Good” therapists refer their clients to other resources if they feel they are out of their depth. It would be a loss if someone in need of help were to be deterred from therapy as a result of media portrayals such as this one.

We’re all human

However, once you get past the absurdity of entering into clients’ lives in such an intrusive manner, what you find is that this character is also grappling with her own commitment to her marriage and the life she’s built. This character is struggling to be a supportive mother to a child that expresses some degree of gender dyshporia. This character, in ways longs for a former version of herself that wasn’t responsible for having or finding the appropriate answers. So what I would also say is that yes, psychotherapists are flawed human beings, just as we encourage our clients to have patience to be themselves. We carry distress and confusion and longing and pain. It is in this full range of human experience that we are able to walk beside our clients as they do us the honor of sharing their stories with us and being vulnerable enough to expose wounds that have yet to heal.

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ADHD defined

Attention Deficit Hyperactivity Disorder (ADHD) is a disorder that impacts an individual’s ability to sustain attention that could also result in hyperactive and impulsive behaviors. Individuals with ADHD may present with symptoms of both inattentiveness and hyperactivity, or show primarily symptoms of inattention or primarily symptoms of hyperactive and impulsive behaviors.

Prevalence of ADHD

According to the Centers For Disease Control ADHD affects about 11 percent of children. About half will continue to experience the effects of the disorder into adulthood. ADHD is diagnosed three times more frequently in boys then girls. It is believed that ADHD is caused by differences in brain chemistry, mostly due to genetics. Differences have been found in the communication route linked to reward and consequences. ADHD is treatable with medication and therapies such as Cognitive Behavioral Therapy.

Symptoms of ADHD

According to the American Psychiatric Association Diagnostic criteria (DSM-5) the following are symptomatic of inattention.

Failure to pay close attention to detail
Makes careless mistakes
Has difficulty sustaining attention during tasks or play
Does not seem to be listening when spoken to directly
Does not follow through on instructions or finish tasks
Is frequently distracted by outside stimuli

The following are symptoms of hyperactivity and impulsivity identified by the American Psychiatric Association criteria (DSM-5)

Fidgeting or squirming
Often leaving seat in situations where remaining seated is expected
Is often on the go
Often talks excessively
Often blurts out an answer before a question has been completed
Often has difficulty waiting for his or her turn
Often interrupts or intrudes on others

Evaluating ADHD

Problems with attention impact children and adults. Children who are diagnosed with ADHD may require accommodations in school such as being given extra time to complete schoolwork or tests. The problems may continue to have an impact on success in higher education, and accommodations may be requested at that time as well. ADHD may be identified through a combination of observation by parents and school personnel, and psychological testing performed by a psychologist. Psychological Testing looks at executive functioning skills such as sustaining attention, concentration, memory, motivation, organizational skills, cognitive flexibility, higher order reasoning skills, motivation and effort.
For more information on testing for ADHD contact Robyn Goldman Ed.D. LADC Licensed Psychologist at the Collaborative Counseling Group at (203) 220-6595.

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Ambivalence, difficulty making decisions

Read more about depression treatment here. Whether it’s what to eat for lunch or if you should go to see that band with friends to whether or not you should end your relationship or look for another job, indecision can become a symptom of depression that keeps us anywhere from feeling stuck to outright paralysis. Even if you’ve considered yourself a somewhat wishy-washy individual anyway, an increase in difficulty making decisions can be a sign of depression that people come to view or understand about themselves as a character flaw.

Low level but always there irritability

Irritability is another one of those pesky little things that we sometimes beat ourselves up for or assign onto our partners as the source of. And while it may be true that there are unaddressed relationship issues or it may be true that we need more sleep or a healthier lifestyle to reign in the irritability, it may also be that despite our best efforts, that underlying irritability feels like its rolling alongside us just under the surface. This too may be a sign of depression that we seek to remedy to no avail and then start the negative self messages therefore exacerbating the depression. Beginning to see the circle emerge?

Spending too much time in your own head, even if your body is showing up for life

I think everyone can wholeheartedly agree that some level of self awareness and even self analysis is valuable if not necessary. Where things can get blurred is when that self analysis begins to slip into rumination and we can no longer enjoy our experiences in the moment because we are too tied up in evaluating our own behaviors, thoughts and feelings, and those of others. A blog post on psychologytoday.com, written by Sophia Drembling describes this in greater detail, click here for this reference. So even if you think you’re just an introvert and socialization isn’t so much for you, you may be denying yourself a richness of experience that depression keeps you from recognizing as rumination.

The good news is once you begin to see these nuances as changeable symptoms rather than as characteristics of who you are as person, you are on the path to deciding when you just don’t want to be the decision maker or when your introspection suits you and when you can push past this to a more versatile version of yourself. Contact us here to set up your first appointment with Collaborative Counseling Group.

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#1) People with Learning Disabilities are smart. Their difficulties are not due to low intelligence or unwillingness to learn.

Read more about receiving help with learning disabilities here. Learning Disability or LD is the term that describes a category of specific disorders that impact functioning in school, on the job, or in life in general. Examples of a learning disability include specific weaknesses in areas such as reading (commonly referred to as dyslexia), writing, spelling, or mathematics calculations. People who have learning disabilities do not have these difficulties because of low intelligence, poor learning environment, or lack of trying. Learning Disabilities are not the result of problems with vision, hearing or motor skills. Individuals with mental retardation, emotional disturbance, or autism are not considered to have a learning disability. However an individual could have mental retardation, emotional disturbance, or autism and also have a learning disability. Individuals who are diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) that involves difficulties sustaining attention are not considered to have a learning disability, although they may still require individualized academic supports. ADHD can be helped with medication. LD is not helped by medication.

#2) People with Learning Disabilities when provided with the right accommodations and supports will learn, achieve, and excel.

Learning disabilities are complicated and identification with a comprehensive evaluation and testing is important, both for specifically pinpointing the areas that are impacted, implementing appropriate services, and helping the individual to understand the issue.

#3) Learning disabilities, particularly if unidentified may impact all areas of the person’s life.

Individuals with learning disabilities have normal intelligence but challenges in specific areas of learning. For example a child who has a reading disorder may be challenged sounding out words. They have difficulty making the automatic association between the letter and the sound it represents. This will eventually impact reading comprehension, as the time, energy and focus that the child needs to use to decode words will impact their ability to absorb the meaning of what they are reading. With appropriate supports and accommodations in the learning environment such as tape recorded books and focus on language enrichment skills, the child can learn over time to compensate and use context to assist in identifying words, instead of relying solely on sound/symbol relationships.

#4) Individuals will always have the learning disability. However they can use their strengths to compensate and achieve success.

It is estimated that between 4% and 6% of the general population meet qualifications to be identified with a learning disability. Individuals with learning disabilities have strengths and talents, and potential for achievement that should be supported, nourished and empowered. There is no cure for a learning disability, it will always be there, but the potential for achievement and success is also there. Just look at some notable people who have made their LD diagnosis public.

• Tommy Hilfiger: Designer-Dyslexia
• Henry Winkler: Actor (The Fonze) –Dyslexia
• Kenau Reeves: Actor –Dyslexia
• Steven Spielberg: Director-Dyslexia

What can you do if you think you or a family member has a learning disability?
Call and set up a consultation with Psychologist Robyn Goldman Ed.D. LADC. Look into obtaining a psychological/educational evaluation. It is never too late. Collaborative Counseling Group provides this service. You can contact Robyn at (203) 220-6595 extension 510. Read more about psychological/educational testing here.

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#1) Allow opportunities for each person’s preferences to be honored.

Be sure that the the person with the loudest voice or the one most likely to get upset, or the one that always has a plan does not become disproportionately in charge of deciding for the whole family. Adaptability is a skill that serves a person well in his/her life, but we tend to see that sometimes the person with the lowest level of adaptability is rarely challenged to accept the preferences of others. Conversely the person who is most comfortable deferring to the preferences of others misses out on learning how to identify what he/she really wants which can be an essential element of creating a fulfilling life.

#2) Carve out physical space where each person has access to what he/she needs to self soothe.

If you need a quiet place to read, or a place to play drums without driving the whole house away, or a place to journal, or a place to hit a speed bag, or furniture fit for snuggling or desks cleared off for working, be sure that you get creative about how you organize space so that each person knows where to go to regroup. If each person in a family is able to self soothe, then it becomes much easier to tolerate togetherness without it becoming overwhelming or frustrating. It’s also important for each person to come to understand his/her rhythms of closeness and distance. That does not mean that one person never has to attend family meals or never has to spend time entertaining him/herself but simply that each person has some influence over when and how they engage with the family and when and how they disengage with the family. A special note about disengaging: be cautious about an overabundance of disengagement through technology, the here-but-not-here of our current culture. If family meals are held sacred a few nights per week, then make that a technology-free 30 minutes, parents included. The need to for space can become confused with what is actually a fear of being out of touch with the digital world or a habitual checking out that is conditioned rather than coping.

#3) Kids can benefit from differing parenting styles.

Barring an abusive or neglectful manner of parenting, there can be room for more than one way of doing things. More than likely your children have differing temperaments and therefore may naturally respond differently to the same methods of parenting. You can use the feedback of how the family is adjusting and when things run more smoothly as evidence of when to make modifications and which person’s strength in an area of parenting is most helpful. If parents make a decision to approach places where their styles deviate as complementary and not qualify things as the right way or the wrong way, then children may just get the best parts of what each partner has to offer.

#4) Be a family that fosters empathy.

Demonstrate empathy as often as is available to you, be a role model for empathy to your children as well as take note and make mention when you see them communicate or behave with empathy for each other. Common ways of describing empathy is walking in someone else’s shoes or seeing through someone else’s eyes. If empathy is a regular practice in your home, family togetherness will be a more satisfying experience for all members because each person’s experience and emotions will be accepted, even when there is disagreement. It means that each person is loved here which is not the same message as anything goes here. A family can have order and empathy at the same time.

Please read more here about family counseling.

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#1) If I weren’t feeling anxious at this moment, might I have anything to be angry about?

For example if I weren’t feeling anxious about attending to the six tasks my boss just “delegated” to me as I was about to walk out of the office at day’s end, and anxious because I’ll miss or nearly miss my daughter’s choir performance, and anxious because my wife will be upset at my priorities for the umpteenth time, might I be angry at my boss for expecting me to do my job and hers. And if I am angry, what are my options?

#2) Am I taking care of myself?

This means, are you sleeping, eating well, exercising the body to keep that as active as the brain and to take the focus off of the distressing sensations of anxiety in the body. Are you making time for the things you want to be doing rather than just the things you believe you need to be doing? There are in fact times when the to-do list can be set aside for some laughter, companionship, reading, baking, hiking or lounging, and it will not have grown exponentially since you last took a look at it.

#3) Am I asking for help?

If your mother in law has offered child care so you could have a date night every month for the past three years and you have yet to take her up on it because you don’t want to burden her or because your children may eek another 20 minutes out of her at bedtime which will surely throw off everybody’s day tomorrow due to the over tiredness, it might be time to accept the offer. And if your partner offers to get up with them on Sunday morning because you haven’t slept past 6 AM since college, it maybe OK this one time even if they have skittles alongside their eggs while watching cartoon network. Bottom line is that it’s OK to be a person who gets angry, holds people accountable for their behavior, and communicates assertively. It’s also OK to be a person who needs more than 6 hours of sleep some nights, would rather finish a book then unload the dishwasher and who asks their neighbor to put the kids on the bus when the 5th delayed opening hits for the winter. Your anxiety might just be the post it note that keeps showing up everywhere to remind you of these annoying little tidbits!

Please read more about anxiety treatment here.

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#1) Set aside time to check in with each other about the mental relationship piles.

This occurs formally when you are participating in therapy however it’s crucial to any relationship. It isn’t uncommon for one person in a couple to experience great feelings of reassurance and relief from talking, while the other may prefer scrubbing toilets to hearing the words “we need to talk.” If it’s just a part of your routine, the partner that craves it will know with confidence that the time is approaching and have a greater sense of ease, and the partner that may avoid it will not be blindsided by a tearful outpouring in bed at the end of a long day.

#2) Ask yourself each morning “what is one thing I will do today that I know will be meaningful to my partner?”

I don’t mean the things that we bring up in our defense when our partner is upset with us “but I made your lunch or “I shoveled the driveway” or “I took out the garbage” or “I cooked dinner.” What are the things he/she is always asking for in those repeated heated moments? “Just listen to me” or “just hug me” or “just touch me” or “just call me.” Not always, but often, it would only take a few moments to come up with an answer to this question and it would only take a few moments to offer it.

#3) Acknowledge what else is going on in your life that may be contributing to your frustration and take ownership of that in conversation with your partner.

When you are feeling overwhelmed and lonely in your relationship, it is important to let your partner know that. It is equally important to identify what else is happening for you that is depleting you or worrying you or quite frankly boring you so that you both know what belongs to the relationship and what are actually individual concerns that may require additional support from your partner. Unhappiness is often multifaceted.

#4) Take the time to understand what you really want from your partner and be kind enough to clue him/her in.

Avoid the pitfall of convincing yourself and trying to convince your partner that he/she knows you well enough by now to know exactly what you’re asking for, even if you’re not actually asking at all. If support means” stay in the house with me but don’t ask me to talk tonight” or if support means ” tell me that it’s okay that this thing that’s been bothering me for three weeks is still bothering me, even though I”m struggling to do anything about it” or if support means “just sit with me” or if support means “help me find a therapist for us/for our child/for our family” then let your partner know. Give him or her, at least the opportunity to meet your need.

#5) Make your first few moments rejoining at the end of the day (or in the morning or in the afternoon) count.

Even if you are rushing to use the bathroom or throw something together to eat because your day leading up to now didn’t allow it, take a few moments (I really mean just a few moments) to look your partner in the eye and greet her/him or if he/she is on the phone when you come in, place a hand on his/her shoulder before you move along. If you travel often or work opposite shifts, can you take a moment to call and say “I know you’re usually falling into bed at this time, I just wanted to say that I hope you rest well.” What we do in relationship to our partner in those first few seconds of coming back together usually sets the tone for all that comes after.

Please read more about couples counseling here.

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