How Do I Know If I Need Therapy?

By Annabelle Parr

Each May we celebrate Mental Health Awareness Month to draw attention to and reduce stigma around mental health issues. According to the National Alliance on Mental Illness, or NAMI, 1 in 5 people will be affected by mental illness in their lifetime. And as we discussed last May during #CureStigma, “while 1 in 5 Americans are affected by a mental health condition, 5 in 5 Americans know what it is to feel pain. The frequency, intensity, and duration can vary, but pain itself is a function of being human. When culture stigmatizes the 1 in 5 and simultaneously dichotomizes illness and wellness, the resulting message is that it is shameful to struggle and to feel pain. In essence, stigma says that it is shameful to admit our own humanity.”

Do I need therapy?

Given that all of us will at some point encounter painful experiences and emotions, this year we are discussing how to know when it might be helpful to seek therapy. Though it may be clear that those affected by a previously diagnosed mental health condition could benefit from therapy, for those who are either undiagnosed or are struggling with anxiety, stress, grief, sadness, etc. but do not meet diagnostic criteria for a mental health disorder, it may be harder to discern whether therapy is warranted.

How am I functioning in the important areas of my life?

For nearly every condition in the Diagnostic and Statistical Manual (DSM-V; APA, 2013), clinically significant impairment in an important area of functioning is a required criterion to receive a diagnosis. In other words, the presenting symptoms must be making it very difficult to function at work or school, in relationships, or in another important life domain (e.g., a person is feeling so anxious that she is not able to make important presentations at work, or so stressed that he is finding it difficult to connect with his loved ones).  When life has begun to feel unmanageable in some capacity, or if something that was once easy or mildly distressing has become so distressing it feels impossible, it may be worth considering therapy.

Could things be better?

It’s also important to note that you do not have to feel as though things are falling apart before you seek professional counseling. Therapy can be helpful in a wide range of situations. It can help you not only navigate major challenges or emotionally painful periods, but also can enhance your overall wellbeing by helping you to identify your values and lean into them. Maybe things are going fine, but could be better. A therapist can help you identify what could be going better and can help you learn to fine tune the necessary skills.

I want to try therapy, but where do I start?

Whether things feel totally unmanageable or it just feels like they could be better, it’s important to find a therapist with expertise relevant to what you would like assistance with. Working with children requires different expertise to working with adults, just as working with couples and families requires additional expertise to working with individuals. Different conditions also correspond with particular evidence based practices. For stress and anxiety disorders – including social anxiety, generalized anxiety, panic disorder or panic attacks, and phobias – evidence based practices include Cognitive Behavioral Therapy (CBT) and Acceptance and Commitment Therapy (ACT). The gold standard of treatment for obsessive compulsive disorder (OCD) is Exposure and Response Prevention (ERP), and evidence based treatments for PTSD include Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT) (all of these—ERP, PE, and CPT --fall under the CBT umbrella). So no matter what you are seeking treatment for, ensuring that the therapist you choose has expertise that aligns with the types of concerns you are struggling with is critical. For some more tips on finding and choosing a therapist, click here and here. For more information on the different kinds of licenses a therapist may have, click here.  

Though there is no right or wrong answer as to whether or not you need therapy, if you are unable to behave in ways that make life manageable and/or fulfilling because of difficult thoughts or feelings, you may find therapy beneficial.

CSAM IS HERE TO HELP

If you or someone you love might benefit from cognitive behavioral therapy (CBT) or acceptance and commitment therapy (ACT) for anxiety, panic, phobias, stress, PTSD, OCD, or insomnia, or if you would like more information about our therapy services, please contact us at (858) 354-4077 or at info@csamsandiego.com

How Do I Know What Kind of Therapist to Choose?

by Annabelle Parr

Choosing a therapist can be overwhelming. If you search Google or Psychology Today, you will likely find a long list of different therapists including licensed marriage and family therapists, licensed professional clinical counselors, licensed clinical social workers, psychologists, and psychiatrists. How do you know what kind of therapist will be the best for you? And what is the difference between all those different licenses?

Licensed Marriage and Family Therapists (LMFT):

An LMFT holds a Master’s degree in counseling, which typically involves between two and three years of school. LMFTs are trained to view individuals from a family systems perspective, meaning that they learn to see individuals in the context of their relationships. Relationships include family, friends, significant others, and even your relationship to yourself. Despite what their license seems to imply, LMFTs also work with individual clients; they do not exclusively offer marriage and family therapy. Their license speaks to the lens through which they view clients and the various presenting problems they may bring into therapy. LMFT’s must complete at least 3,000 hours of supervised experience before becoming licensed, and this experience must include working with children, families, and/or couples.

An Associate Marriage and Family Therapist has completed their Master’s but is still working on their 3,000 hours of supervised experience.

Licensed Professional Clinical Counselors (LPCC):

An LPCC also holds a Master’s degree in counseling. Many Master’s programs qualify students to sit for both the LMFT and LPCC licensing exams. However, LPCCs tend to work more generally, with a focus on mental health issues as opposed to relational issues, and tend to focus on the individual rather than the individual in the context of their relationships. LPCCs also must complete 3,000 hours of supervised experience prior to licensure, and a portion of their experience must be in either a hospital or community based mental health setting.

An Associate Professional Clinical Counselor has completed the Master’s degree requirements but is still working toward the 3,000 hours of supervised experience.

Licensed Clinical Social Workers (LCSW):

An LCSW holds a Master’s degree in social work. Their training teaches them to help connect clients with resources, both externally (like community resources, support groups, etc.) and internally (like coping skills). An LCSW must complete 3,200 hours of supervised experience in order to get licensed, and they must be supervised specifically by another LCSW for a portion of their hours. They may also provide individual, family, or couples therapy, but the lens through which they have been trained focuses on ensuring clients have access to all the resources they need to thrive.

An Associate Clinical Social Worker has completed the Master’s degree requirements but is still working toward the 3,200 hours of supervised experience.

Psychologists:

A licensed psychologist holds a doctorate degree, either a Ph.D. (doctor of philosophy in psychology, focused on both research and clinical work) or a Psy.D. (doctor of psychology, more clinically focused than research focused), which can take between four and seven years to complete. Licensed psychologists also require 3,000 hours of supervised clinical experience for licensure. Psychologists typically have more training in psychometric assessment and test administration than an LMFT, LPCC, or LCSW. A psychologist with a Ph.D. is prepared to practice clinical work, conduct research, and/or teach, whereas a Psy.D. is typically primarily focused on clinical work.

Registered Psychological Assistant or Postdoctoral Fellow: A registered psych assistant is still working toward the doctoral degree and receiving supervised clinical experience. A postdoc has already completed the doctorate, but is completing the supervised clinical experience hours toward licensure.

Psychiatrists:

A psychiatrist holds a medical degree, and has completed a period of residency, and fellowship. Psychiatrists are medical doctors and are able to prescribe medications. A psychologist, LMFT, LPCC, and LCSW are not able to prescribe medication. Psychiatrists are also able to provide psychotherapy services, but their training is more medically focused.

What’s the takeaway?

Ultimately, there can be a lot of overlap in the services provided by the above practitioners. They are all qualified to assess, diagnose, and treat the full range of mental and emotional disorders found in the Diagnostic and Statistical Manual (DSM). The specific license under which a therapist operates speaks to the lens through which they have been educated, and the duration of education.

However, the provider’s area of expertise and scope of practice tends to depend upon the clinical experience that they have gained. So when looking for a therapist, it can help to understand what their license means, but it is perhaps more important to understand the specific supervised and licensed experience that the therapist has. Do they have experience working with anxiety, panic, trauma/PTSD, depression, identity issues, couple’s therapy, child therapy, family therapy? What modalities are they trained in? Cognitive Behavioral Therapy, Acceptance and Commitment Therapy, Psychodynamic Therapy, EMDR, Emotion Focused Therapy, Somatic Therapy? Do their areas of expertise and treatment modalities align with your needs and goals?

Research consistently shows that the therapeutic relationship is the most important factor in whether therapy is successful. So it’s key that the therapist you choose feels like the right fit for you personally. But it can be hard to try to figure out who might be a good match based on credentials and website information alone. A good place to start in narrowing your search is looking at the therapist’s areas of expertise and preferred treatment modalities. Once you have found someone whose specialties line up with your goals, you can reach out to the provider and ask any questions that may not have been addressed on the practice website. (If they won’t take the time to respond to your questions, they might not be the best fit!) If you feel comfortable with the therapist during the initial contact, you can schedule your first session. You will want to meet with the therapist 2-3 times to evaluate how safe and comfortable you feel working with this person. Choosing a therapist is a process, and it can feel overwhelming at first. But once you know how to narrow your search and find a provider that feels like a good fit, it can be incredibly rewarding.

Five Ways Parents Can Help Children with Political Anxiety

Guest Post by Tracy Dunne-Derrell, writer at Teach.com

One hundred years from now, America in 2017 will exist only in history books. Those future writers will have plenty of material to work with: mass shootings, terrorism fears, international turmoil, and “fake news.” But those facts probably won’t capture the anxiety that’s been generated by these events. A poll conducted earlier this year by the American Psychological Association found more than half of American adults cited the current political climate as a source of stress.  

Children are feeling anxious too. A recent UCLA survey found that 51% of teachers reported more anxiety among their students. As a parent, the past year may have presented you with unique challenges as your children grappled with a range of emotions- from general anxiety to personal stress over the impact potential policies could have on them and their friends. You may have a child who’s finding that current events are causing anxiety, and are struggling to figure out how to best provide support.

As an adult, you might be experiencing negative feelings too, but you have the advantage of being able to channel them productively by contacting elected officials and engaging in activism and service. And you’re more likely to have developed meaningful ways to help yourself get through uncertain, difficult times. But your children might not be able to grasp the concepts that are troubling and confusing to them, and they may lack the skills they need to identify and cope with their feelings. Here are some ways to help them.

1. Listen, but accept that you might not always have good answers. 

As a parent, you may be tempted to help by dismissing and downplaying the concerns and worries of your anxious child. But this approach, while well-intentioned, isn’t helpful. Validating kids’ concerns and making sure they understand that it’s ok to feel what they’re feeling is important.  And unfortunately, you can’t magically erase the sources of stress for them. But you can be a sympathetic ear, and make a point to spend a little time each day talking to them about their concerns. Help them develop coping skills, which won’t eliminate the sources of negative feelings, but will help them learn to work through them. The ability to cope with challenging times is a necessary life skill.

2. Help them take action.

With so much beyond their control, your kids may find themselves feeling powerless. They might want to do something to distract them from their fears and help them feel like they’re contributing to the world in a positive way. Some adults are channeling their concerns into helping others, and there are ways children can do the same. Talk with them about some of the needs they observe in your community, and help them think of ways to address them. Young children can choose items from the grocery store to donate to a local food pantry, while older ones can join service-oriented local organizations, or look for a project to support, like a winter coat drive. Even small actions help students feel like they matter, and lead to a life-long involvement with community service.

3. Connect with the school counselor.

Kids spend a substantial amount of time in school, and their counselors are a valuable resource. School counselors are already trained to help students learn to manage a wide range of situations and challenges. And they’ve got ample materials to help them work with students who are living with political anxiety. Last year the American School Counselor Association published a guide for counselors, with suggestions for supporting children experiencing post-election stress. Sitting down with a school counselor could be a great opportunity for your child to share his or her fears with a trained professional. Ask for ideas and strategies to use at home to talk about current events, and the feelings these events generate.

4. Examine the impact of technology.

News and social media might play a role in fostering negative feelings. Escaping bad news used to be as easy as turning off the television and radio. Now, with 24-hour cable channels, mobile apps, and social media, it’s almost impossible to get a break from current events. Consider the role screen time with televisions and gadgets may be playing in your child’s politics-related stress. Evaluate the amount of time your child spends watching and reading news, and discuss alternative activities which may help them manage their stress.

5. Talk about previous times our country experienced turmoil and got through it.

It feels like we’re going through unprecedented uncertainty, but America has faced crisis before, more than once. Our country has survived wars, recessions, and natural disasters. Your children likely have some awareness of challenging times in our history, but events of long ago probably feel abstract to them; they may not be able to connect past and present. Depending on your age, you may have your own personal stories to share which might resonate with your anxious children and help them feel more optimistic. For example, during the 1970s, Watergate dominated the news, and led to concerns about government. In the 1980s, the Cold War between the United States and the former Soviet Union generated fears as both countries and their allies engaged in an arms race, generating legitimate concerns over the possibility of nuclear war. Share your stories and take this opportunity to talk with your kids about America’s resilience.

Providing support for anxious kids is challenging, but it is possible. As a parent, you know your child better than anyone, and are the best person to help them manage stress and anxiety. However, if you need some outside support to help your child, you can check your child’s school for resources, and reach out to outside resources, like local therapists, as well.

CSAM IS HERE TO HELP

If you or someone you love might benefit from cognitive behavioral therapy (CBT), acceptance and commitment therapy (ACT), or biofeedback for anxiety, depression, stress, or PTSD, or if you would like more information about our therapy services, please contact us at (858) 354-4077 or at info@csamsandiego.com

DEALING WITH BACK-TO-SCHOOL ANXIETY IN YOUNG CHILDREN

a guest blog post originally posted on SitterCity.com

As parents prepare their children for the school year to begin, it’s easy to get swept up in all the details: Are the school medical forms filled out? What’s left on the school supplies list? Have you found an after-school sitter yet?

Ticking off all the items on your family’s back-to-school checklist is important, but it’s equally important to pay attention to your child’s behavior during the weeks leading up to school. Anxiety about advancing to a new grade or starting a new school is normal; after all, people of all ages need time to adjust to a new situation. Here are a few ways you can turn those back-to-school jitters into excitement.

(Please note: If you suspect that something more than garden-variety jitters is going on, call your pediatrician who can refer you to a child psychologist for a consultation.)

Get some sleep.

A well-rested kid is a happy kid. While it’s fun to stay up late and sleep in during the summer, it’s important to get bedtime on track at least a week before school starts. Kids can feel grouchy, upset or fearful when they’re sleep deprived. Start practicing normal school day wakeups a week or two in advance so they get used to their new schedule.

Attend the open house. 

Schools often host an open house a couple weeks before classes begin. Be sure to clear your schedule for it — it’s an invaluable chance for your child to meet their new teacher and start feeling comfortable with them, as well as a chance to check out their new classroom.

Plan play dates. 

If you’re new to a school, open houses are also a chance for kids to mingle with their new classmates a little with the safety of you still being around, so they’re not making as many introductions on the first day of school. As you chat with the other parents, see if any of them are open to the idea of a play date, even if it’s just meeting up informally at the playground so your kids can continue to get to know each other.

Do a practice run. 

If your child is starting at a new school, take the time to do a dry run of the morning commute. On one of the mornings they’re waking up early, be sure to get them dressed and out the door on time, too. Practice walking or driving to school — whatever your normal commute will entail. If your child is taking a bus to school for the first time, drive along the bus’s route and answer any questions they might have about what school buses are like.

Eat at a cafeteria. 

Is this the first time your child will be eating a hot lunch at school? Go to a cafeteria-style restaurant to help them practice holding a tray, waiting in line, selecting from multiple options and sitting at a bench-style table. Even if you’re planning to pack a bag lunch, it’s doesn’t hurt to get your child used to a cafeteria-like environment.

Visit the library.

It’s time to do a little back-to-school reading! There are plenty of great children’s stories that address back-to-school anxiety. A few worth checking out are First Day Jitters by Julie Dannenberg; The Night Before Kindergarten and The Night Before First Grade, both by Natasha Wing; The Kissing Hand, by Audrey Penn; and Miss Bindergarten Gets Ready for Kindergarten, by Joseph Slate. Talk to your librarian to see if they have any other recommendations as well.

Take care of the details.

Pay attention to little things that will help make the first week of school smooth sailing. Have them pick out some new clothes and a new backpack for the first few days of school so there are no morning wardrobe meltdowns. If they’re bringing their lunch, plan out a few of their favorite meals ahead of time. Create a morning “launch pad” for backpacks and coats. These may seem like little things, but they can add up to a lot of stress for a child, and they’re easy to prepare for in advance.

Listen to them.

Keep those lines of communication open! Ask you’re child if they’re excited for school, what subject they’re looking forward to most and what friends they’re excited to see. If they’re experiencing social anxiety this is a good time to start talking it out and reassuring them. Being understanding and supportive is the most important thing you can do to ensure your little one has a great back-to-school experience.

Anxiety in Children

Have you noticed that your child seems to be experiencing a significant amount of anxiety? Learn more about the anxiety disorders that can develop at a young age and the support that is available. If you would like to seek the help of a professional, contact us to schedule an appointment with our child anxiety specialist now.

Childhood Anxiety Disorders

Generalized Anxiety Disorder

Learn more about GAD.

Things to look out for:

·      Excessive worry about a variety of things in your child’s life

·      Perfectionism and self-criticism

·      Constant need for approval or reassurance

Obsessive-Compulsive Disorder (OCD)

Learn more about OCD.

Things to look out for:

·      Obsessions: Experiencing unwanted and intrusive thoughts

·      Compulsions: Repeatedly perform rituals and/or routines in order to ward off anxious feelings

Panic Disorder

Learn more about panic disorder and panic attacks.

Things to look out for:

·      Panic/anxiety attacks that come on for no reason or out of the blue

·      If your child is concerned about or afraid of having another panic attack in the future

Posttraumatic Stress Disorder (PTSD)

Learn more about PTSD.

Things to look out for:

·      Experiencing or witnessing a traumatic or life-threatening event

·      Intense fear/anxiety

·      Emotional numbness

·      Easily irritable

·      Avoidance of places, people or activities

Separation Anxiety Disorder

Learn more about separation anxiety disorder here.

Things to look out for:

·      Your child is slightly older (common in ages seven to nine)

·      Unable to be separated from loved ones or takes significantly longer to calm down compared to other children

·      Experiences extreme homesickness/misery at being separated from loved ones

Social Anxiety Disorder

Learn more about social anxiety disorder.

Things to look out for:

·      Intense fear or anxiety related to social interactions

·      Anxiety about performance and activities

·      Extreme shyness or inhibition

·      Difficulty making new friends or speaking with peers

Selective Mutism

Visit online: Selective Mutism Group

Things to look out for:

·      Refusing to speak in situations that make your child anxious

·      Standing motionless/expressionless

·      Avoiding eye contact, chewing/twirling hair, turning heads

Specific Phobias

Learn more about phobias.

Things to look out for:

·      Intense irrational fear of a specific object or situation (such as animals, storms, blood, needles, medical procedures, etc.)

Treatments Offered at CSAM

Cognitive Behavioral Therapy (CBT)

Cognitive Behavioral Therapy (CBT) is an empirically supported treatment that focuses on modifying problematic thoughts & behaviors that contribute to & maintain emotional problems like anxiety, stress, & depression. Like traditional forms of therapy, CBT emphasizes a warm, safe, & empathic therapeutic environment. CBT is different from some approaches in that it focuses on present-day problems & learning skills to overcome symptoms. It teaches children to identify thoughts & behaviors that are keeping your child stuck, so your child may develop more adaptive ways for navigating life.

Acceptance and Commitment Therapy (ACT)

Acceptance and commitment therapy is an empirically supported treatment that focuses on reducing experiential avoidance and accepting internal experiences (thoughts and feelings) in the service of living a valued, vital, meaningful existence.  Mindfulness, metaphors, and experiential exercises play a central role in ACT.

Biofeedback

Biofeedback is an empirically supported treatment that focuses on balancing the nervous system. Biofeedback is shown to be extremely effective at helping patients reduce anxiety and stress, lower blood pressure, reduce chronic pain (including migraines), increase focus and attention, and reduce hyper-vigilance commonly experienced after trauma.

How Can I Respond to My Child?

ADAA provides the following suggestions in their article “Tips for Parents and Caregivers”

Source: http://www.adaa.org/living-with-anxiety/children/tips-parents-and-caregivers

Here are things you can do at home to help your child manage his or her anxiety disorder:

Pay attention to your child’s feelings.

Stay calm when your child becomes anxious about a situation or event.

Recognize and praise small accomplishments.

Don’t punish mistakes or lack of progress.

Be flexible and try to maintain a normal routine.

Modify expectations during stressful periods.

Plan for transitions (For example, allow extra time in the morning if getting to school is difficult).

Keep in mind that your child’s anxiety disorder diagnosis is not a sign of poor parenting. It may add stress to family life, however. It is helpful to build a support network of relatives and friends

Resources:

The Anxiety and Depression Association of America, ADAA

www.ADAA.org

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Are you interested in scheduling an appointment with our child specialist? If you'd like to speak with a professional at the Center for Stress and Anxiety Management for help with anxiety, please click here.

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10 Tips to Stop Sleep Anxiety: More Rest, Less Stress (Part 2 of 3)

by Lucas Myers

With people juggling work, school, friends, families, and the 1,001 other things we've got to do everyday, Americans are not getting enough sleep. This week we continue our 3 part series 10 Tips to Stop Sleep Anxiety: More Rest, Less Stress.

4. Practice good habits

Having the same bedtime ritual night after night teaches your body when to expect sleep and eases the transition into a drowsy, bed-ready state. Bright lights, especially those from TV's computers and other electronics promote alertness, so try to avoid them before bedtime. Instead, try reading a book, taking a soothing bath or shower, listening to relaxing music and dimming the lights as you get ready for bed.

5. Eliminate distractions

The bedroom should be your sanctuary for sleep, so avoid watching TV in bed, bringing the laptop to bed, or engaging in any other activities. You want your mind to associate this setting with relaxation and rest rather than stimulating daytime activities. Consider setting limits on children or pets sleeping in your bed with you.

6. Get comfortable

Find bedding that feels comfortable to you. If you share your bed, make sure it is large enough for both of you to sleep comfortably. Most mattresses last 9-10 years; make sure to replace them when they exceed their life expectancy because a good mattress should be comfortable and supportive. Your pillow should support your head without straining your neck. Make sure your bedding is allergen free.

7. Set the mood

Dark curtains can help prevent light from inadvertently resetting your internal clock. Even the tiny light from an alarm clock can be disruptive so seek ways of limiting light pollution. Even small noises can interrupt sleep. Earplugs are helpful for some. A fan, or a free white noise app on your phone can help cover the sounds of noisy neighbors, car alarms, traffic and other disruptive nighttime noises. To keep your bedroom from becoming too hot or dry for comfort consider a fan, air conditioner, or humidifier.

REMEMBER: Having an occasional sleepless night is normal, but if you are experiencing a pattern of restless or sleepless nights, don't hesitate to seek an expert, especially if lack of sleep is beginning to interfere with your normal daytime functioning. Contact your doctor to determine whether physical causes may be contributing to sleep problems. If your physical health is sound, contact a psychologist with experience treating sleep problems. Cognitive behavioral therapy and other evidence-based treatments are highly effective for improving sleep. If you are in the San Diego area and you would like to speak with one of our other qualified therapists, you may contact the Center for Stress and Anxiety Management at 858-354-4077 or csamsandiego@gmail.com.

Want more tips? Subscribe to the CSAM RSS feed, and follow us on Facebook or Twitter (@CSAMSanDiego) so you don't miss Parts 2 and 3 of our 10 Tips to Improve Your Sleep and articles on other hot topics such as stress, anxiety, depression, OCD, PTSD, and more. 

References

Dement, William C; Vaughan, Christopher (1999). The promise of sleep: a pioneer in sleep medicine explores the vital connection between health, happiness, and a good night's sleep. New York: Delacorte Press. ISBN 0-385-32008-6.

Dement, WC (2005). "Sleep extension: getting as much extra sleep as possible". Clinics in Sports Medicine 24 (2): 251–268, viii. doi:10.1016/j.csm.2004.12.014. PMID 15892922.

Kryger, Meir H; Roth, Thomas; Dement, William C (2011). Principles and practice of sleep medicine (5th ed.). Philadelphia, PA: Saunders/Elsevier. ISBN 978-1-4160-6645-3.

Sleep Tips: Seven steps for better sleep. Mayo Clinic Staff. Retreived on November 25th, 2013 from: http://www.mayoclinic.com/health/sleep/HQ01387

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