What to expect your first session

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The first session with a therapist is a unique experience. It is different from all future sessions, which will be dictated by what problems you are facing. But in that first hour, there is lots of important information you and your therapist will be going through. Every therapist is different, but here’s what you might expect in your first session.

First of all, arrive early. There is likely some paperwork for you to fill out. Some of this will be

financial. This would include insurance information, so make sure to bring that with you. If you don’t have insurance, you may have to sign a contract stating that you take financial responsibility for paying for the sessions. You might also be asked to fill out questionnaires about your symptoms and history.

You might also be given a paper stating the limits of confidentiality. Whether or not you get the paper, your therapist should talk to you about it and answer any questions you have. You can also read more about confidentiality in therapy here.

You may have filled out paperwork on it already, but your therapist will likely ask you about your background and what symptoms you are experiencing. Be completely honest. You’re not going to be rejected for telling the truth. Only if you are open can your therapist formulate the best possible treatment plan for you.

There will also probably be questions about your current situation – occupation, relationship status, living situation, family and social relationships, and so on. This is done to get a better idea of the stressors you might face and the support you have. Again, be honest. You’re not trying to impress anyone.

The most important question, though, is what brings you to therapy. Think ahead of time about what you would like to accomplish with your time together. You don’t need to know exactly what the plan is – that’s something your therapist and you will come up with together. But a basic idea of what you want to change in your life is very helpful and an important starting point for treatment.

With all the questions you are being asked, you probably have some of your own. That’s perfectly appropriate. Now’s a great time to learn about your therapist and the process of therapy. Some ideas for questions you might want to ask are here. 

What you shouldn’t expect, however, is for problems to be solved. Some therapists might jump right into the issue and leave some of the questions discussed for later, but even then, remember that therapy is a long-term process. If you have an imminent emergency, make that clear to your therapist early on, but if not, let the first session be what it is. It’s a time for you and your therapist get to know each other and make goals for treatment.

What has your experience been with first sessions? Tell your story in the comments.

25 safety tips

Being the victim of a crime or accident can be traumatizing and, as we know, trauma is bad for your mental health. This is why it’s very important to protect yourself at all times. Following are 25 ways you can be safer in your everyday life.

     

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1. Let someone you trust know where you are going and when you will be back.
2. When walking, be aware of your surroundings at all times. You can check your phone later.
3. Keep your car doors locked both while parked and driving.
4. Do not “check in” on social media when you are out of town. It will alert potential burglars that you are gone.
5. Have your keys out when walking to your car or home so you can enter more quickly.
6. Walk on the side of the street that is facing traffic.
7. Keep any entrances to your home well-lit.
8. Always secure your windows and lock your doors.
9. Never tell anyone that you are home alone.
10. If you receive a call from someone about a problem with your credit card, hang up and call the number on the back of your card to make sure it’s actually them. 
11. Never accept drinks that have already been opened or are given to you by strangers.
12. Do not leave valuable items visible in your car. Store them in the trunk.
13. If someone calls and has the wrong number, do not give them your name or repeat the number back to them.
14. Stay on well-lit streets. If it takes you longer to get somewhere, so be it.
15. Get a copy of your credit report once a year (it’s free) and check for inconsistencies. 
16. When out of town for an extended period, have someone check on your home regularly.
17. Shred all papers that contain personal information.
18. Stay away from bushes and other overgrown areas.
19. Use a headset while driving or, better yet, stay off the phone while on the road.
20. Don’t leave a spare key near your front door. Consider leaving it with a trusted neighbor or family member.
21. Hang up immediately if you receive an obscene or harassing call. If the problem persists, contact law enforcement.
22. Memorize important PINs and passwords; do not write them down.
23. Get sufficient sleep so you are alert, especially if you are driving long distances.
24. If you have a GPS, set “home” as somewhere near where you live, but not your exact location.
25. If you are being followed, don’t stop. Keep walking or driving to the nearest public place.

How do you keep yourself safe? Share your most helpful tips in the comments.

Past vs. present

   

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When in the middle of a stressful or triggering situation, it can be easy to let emotions get the best of you. The thing is, those feelings aren’t always connected to the present circumstances. Luckily, there’s a quick way to calm down and see what’s really going on. It’s called past vs. present.

This technique is pretty much what the name suggests: comparing the past and the present. When you are feeling emotionally overwhelmed, take a minute to look back and consider other times you have felt similarly. Then you can tell yourself what is currently different than the past situation. Here are some examples to help you get the point.

You ask out someone that you met at a party and get rejected. This might make you feel upset or confused and lower your self-esteem. When you think of where you’ve felt those feelings before, you realize that it’s how you felt when your ex left you. But in the present, we’re not talking about someone you had made a commitment with. This concerns a relative stranger. Someone you just met should not be allowed to have the same emotional sway as someone you were deeply connected to. You recognize that the current situation does not carry as much weight as the one in the past, so while it’s not fun being let down, it doesn’t have to ruin your day.

You have to give a presentation at work. No matter how much you prepare, you feel anxious and like you are going to mess up. You are afraid you’re going to be made fun of, so you think back and see if you can remember a time that it actually happened. You remember that in junior high, you had to do a presentation, but forgot and had to go in front of the class unprepared. As you stumbled around a topic you didn’t know much about, you could hear snickering and whispers in the room. In the present, however, you are prepared. You know the material and have been practicing what you will say. You don’t have to feel as nervous as you did back then.

Someone you encounter seems to upset you for no reason. You don’t know why you dislike him; others around you might think he’s great. She may never have said or done a single offensive thing to you, but you can’t get rid of your dislike for her. That is when you look back and see who this person reminds you of. Maybe he looks like a mean coach you once had. Maybe she has the same tone of voice your mom had when she was angry. It can also be a matter of position, such as having a bad experience with a doctor and projecting that onto future doctors. Once you can recognize that the person who upset you is actually in the past, you can move forward with the present person.

It can sometimes be a little tricky to find out who or what you are actually dealing with emotionally, but a little reflection can go a long way. Even if you can’t find a person or reason in your past, looking for it might help you realize that the situation is not as bad as it might feel. 

Do you think this technique could be helpful for you? Try it out and come back to tell us how it went.

Service Models in College Counseling Centers

An earlier post focused on one role and philosophy for campus counseling services based on my professional experiences.  But discussion on this subject would not be complete without an at least a brief overview of various service models already in use across the United States and perhaps other countries as well.

I have been surprised, even dismayed, to repeatedly observe how little literature or direction is available concerning these guiding philosophies or models.  Since very few mental health professionals receive any management training prior to becoming the manager of counseling services, this places new or emerging directors in a vulnerable position.  In the haste to develop services sorely needed by students, we can create a patchwork of disjointed programs and services which may not be rationally related nor focused on any particular values or orientations.  Further, we may also be vulnerable to other influences which are better schooled in business models but which have little to nothing to offer in the area of psychotherapy or relationship-based healing.

A comprehensive view of existing models is beyond the scope of a brief blog post.  Suffice it to say that what is offered here is a sample, a taste if you will, of the choices available to campus leaders.  It is my hope that this may whet appetities to examine this more deeply, and to investigate what models may best suit a particular campus, its culture, and its student body.  The reader will note that definitions are not presented here.  This is partly because the literature is so scanty I am not sure there are agreed upon definitions available, and partly because I do not want to constrain the imaginations of managers working to grow a center (more on that later).

The list below was developed by a convenience email sample of counseling service directors in August of 2014.  It is not to be construed as complete or exhaustive.  Each of the models listed have advantages and disadvantages, and none, in my opinion, is inherently superior to the others in all contexts, though some may claim otherwise.  And context is the key: understand yours first.  Then select the models or models which you think may best suit campus needs.  Then investigate and experiment and evaluate and refine.

A Sample of Service Models

1. Bio-Psycho-Social Model

2. Brief Therapy Models

     a. Brief Intermittent Model

     b. Short Term Episodic Model

     c. Time Attendant Model

3. Building Resiliency and Supporting Personal Success and Goals Model

4. Campus Stakeholder Model

5. Client-Directed, Outcome Informed Model

6. Community Mental Health Model

    a. Brief Campus-wide Services Model

7. Consultation or Organizational and Community Development Model

8. Contextual/Environmental/Ecological/Systemic Models

9. Cube Model

10. Developmental Model

    a. Broad-based Comprehensive Student Development Model

11. Educational Services Model

12. Feminist Model

13. Human Service Model

14. Medical, Health Service or Clinical Model

15. Multicultural and Cross Cultural Models

16. Public Health Model

17. Strengths-based Model

18. Hybrid (of two or more)

Significant Areas of Emphasis in Centers

1. Training Emphasis

2. Evidence-based Therapy

Two-week hiatus

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Right now is a slightly chaotic period for me. I am currently in the process of both moving and starting a new semester at school. Because those two things are taking a lot of my attention right now, I need to give myself a little break from this labor of love. I am hoping that in the next two weeks, I will get settled down enough to come back refreshed and less stressed.

In the mean time, you can leave suggestions in the comments for posts you’d like to see. I don’t guarantee that I’ll get to everything, but I’ll try to do at least one idea from when I was gone. 

I hope things are going well for all of you. Keep taking care of yourselves and I’ll see you in two weeks!

Best wishes,

Lindsey

5 ways to support a loved one in inpatient treatment

Sometimes, mental illness or substance abuse requires more intensive treatment than can be provided on an outpatient basis. Situations like being suicidal, the inability to get substance abuse under control, going through a medication change or an eating disorder becoming life-threatening call for inpatient treatment. The amount of time someone is gone varies, too – rehab can take months while most stays at the psychiatric ward of a local hospital are only a few days. The uncertainty of how long it will take can make the situation even more distressing.

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While this is a lot to deal with for the patient, it also leaves loved ones not knowing what they can do. Visiting hours are often very restricted and you might not even know if your loved one wants you to come. Besides, these programs are sometimes pretty involved, with individual counseling, doctor’s visits, group therapy, psychoeducational classes and more. You want to help; it’s just hard to know what to do.

In these times, grand actions are not very viable. It’s the simple shows of support that end up being meaningful. Following is a list of suggestions for showing that you care. Keep in mind, however, that the rules and policies of each treatment center varies. If you are uncertain of whether a specific item is permitted, call the unit your loved one is staying at and ask a staff member. 

1. Let him know you are there for him… 

An in-patient stay cuts someone away from the world, leaving most of society’s currently used methods of communication off limits. She likely won’t have access to her cell phone or the Internet. This brings up the question of the best way to show support. Even if your relationship is close, he might not be ready to accept you reaching out. A card or a letter is a non-threatening way to show support that allows her to decide if she wants to give you a call or invite you over to visit. Include your phone number, as he might not have it memorized.

2. …but respect her privacy. 

Because it is closed off, knowledge of what goes on within the program can seem mysterious to outsiders. Your curiosity might naturally be piqued, however. But unless you are the parent of a minor, you most likely don’t have a right to know what is going on. You have to trust that the treatment team has the situation under control and will make good decisions. If your loved one wants to talk about his treatment, he will. Be nonjudgmental and a good listener. Avoid giving advice at this time. Besides, after a long day of processing issues and psychoeducational material, hearing about the latest game or celebrity gossip might actually be relaxing. 

3. Pictures 

Due to risks of patients harming themselves or others, there are a lot of restricted items in the inpatient setting. Pieces of paper, however, are generally considered benign, so bring pictures. Don’t just stick with family portraits. Go to your loved one’s Facebook page and print out a few of her having fun with her friends or on a vacation. A picture of a beloved pet can also be appreciated. If your loved one has a strong attachment to a particular location, a photograph of a place that soothes her can also be calming. If permitted, bring Blu-Tack so he can hang them up. Frames will not be allowed, at least not with the glass in.

4. Entertainment 

Despite intensive treatment, there is downtime. If left with the facility’s resources, however, your loved one might spend a lot of time coloring pictures with crayons or playing checkers. While often highly regulated, entertainment is appreciated. Some books and magazines are restricted based on the content, but you probably won’t know until you get there, as it is very arbitrary. Less frequently, a center might allow an iPod or MP3 player. They may, however, require a small speaker, as headphones can be a safety risk. With this, it’s especially important to talk to the staff before you bring something over.

5. Something from home

It is normal to get homesick when in an inpatient setting, seeing as one is pulled away from all the comforts one is used to. Bringing something meaningful from home can ease some of that feeling. Take over a favorite stuffed animal, pillow or blanket. A small, unbreakable trinket with personal significance can be a lovely connection to home. Avoid brining valuable or irreplaceable items. Not all inpatient stays are planned, so a fresh change of clothes can be much appreciated. If you are allowed to bring food or treats, a comfort food can also mean a lot. A connection to life outside the treatment center can serve as a lifeline when treatment is at its toughest.

Have you spent time in an inpatient unit? What shows of support did you find helpful? Add to the list in the comments.

Why you should see a student therapist

Every therapist has to start somewhere, so there are plenty of student therapists who are practicing under supervision. They can often be found in university counseling centers and in community clinics. This means that college students and those utilizing community resources may well end up working with a student therapist.

   

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Not everyone is entirely comfortable with this. If you’re a senior citizen, how can you put your trust in someone in her twenties? Does a student feel like he is getting appropriate treatment when his therapist only a couple years ahead? It’s an issue that student therapists have to deal with sometimes. The thing is, they shouldn’t have to.

Research shows that student therapists perform just as well as licensed practitioners. Some even suggests that they might actually be better. The reason for this is unknown, but it could have to do with being regularly supervised, the fact that their education is still present or recent, and the initial zeal that old hands lose. No one knows for sure. What matters is that you shouldn’t be worried about having a student therapist – you might actually be better off that way.

Supervision allows students to have a second pair of eyes on their clients. Supervisors often watch tape of students performing therapy, meaning they can give very detailed and relevant feedback. Students also have someone who can help them conceptualize their clients and give suggestions. It’s kind of like having a second therapist behind the scenes.

By virtue of being in school, students are actively learning. They are dealing with the material both theoretically and practically. They spend a lot of time actually thinking about all the things that lie behind therapy, something a seasoned clinician might not do. Students also have multiple professors at their disposal, meaning that experts are on hand.

Students are also enthusiastic about their work. They are at the very beginning of their careers, following their dreams. You don’t commit to graduate school unless the subject has significant meaning to you. They haven’t been jaded by time and they are excited to learn and grow. It’s a unique period in their lives where there is lots of energy on hand. 

So if you are under the care of a student therapist, you shouldn’t worry about her being inexperienced. There are other factors at play that make up for that. Every therapist, no matter how long he has been practicing, has something unique to offer. If you find someone who’s a good fit, it doesn’t matter whether or not she has “Ph.D.” after her name.

Have you seen a student therapist? How did it go for you? Tell us in the comments.