We Will Be Called to Approach What We’ve Avoided

For many people, a continuum exists of feeling free and feeling trapped, of feeling free to _____ and feeling free from _____.

Confined to their homes, people may experience shifts along the feeling free/feeling trapped continuum. They may feel relieved from burdens, free to finish what they start, and trapped by circumstance.

Gently approaching what we've avoided

When literally trapped by circumstance, people may find themselves up-close-and-personal with realities they have been able to avoid for awhile.

Note: “Avoidance” is a clinical term with judgmental overtones for the very human and humane desire to protect oneself from troubling feelings and thoughts. It’s not a moral shortcoming. It’s simply a practice that causes more problems than it solves in the long-term.

To help oneself with avoidance, one gently begins to approach uncomfortable realities with self-compassion and self-kindness.

People may feel backed into a corner in these areas:

  1. self: how they talk to themselves and treat themselves
  2. personal interaction style: the part they play in problematic patterns of interactions with others
  3. problematic interaction styles of others: what others do that cause problems in interactions and relationships
  4. mental illness symptoms: what thoughts, memories, and behaviors arise under stress
  5. avoidance methods: what they do to evade troubling feelings and thoughts when any of the above occurs

Self-concept example: People who repeatedly say to themselves, “I can’t handle this!” are going to feel terrorized by that belief because, in isolation, unless they have a 24-7 caregiver, they’re now the only person on the job.

Personal interaction style example: People who over-function in relationships and use the people they live with to reassure themselves are going to wear those people out. People who under-function and aren’t sustainably connected to the people in their worlds may find themselves losing energy and feeling disoriented from over-isolation.

Interaction style of others example: People who have tolerated disrespect, even cruelty, from their co-inhabitants, hoping things would work out or go away over time, may experience these frequently and painfully, perhaps in escalated form.

Mental illness symptom example: People who trusted they were successfully managing symptoms primarily through medications may find these symptoms “breaking through” the limits of assistance medication provides.

Avoidance method examples: Things people use and do to get away from all these challenges – alcohol, nicotine, marijuana, other drugs, overuse or underuse of food, overuse of the Internet, exercise, gambling, sex, the list goes on and on – may be in short supply, or no supply may exist, or they may be undoable because of lack of privacy.

You may be thinking: Whaaat?! I’ll have to look at all this all at once?!

Possibly.

People may feel panic when they believe they are trapped. However, they can help themselves with panic.

With an inner state in a more stable range, this process can be helpful:

“If I can become aware of the primary, natural feelings that arise, the thoughts I’m thinking, and the secondary feelings born of these thoughts, I can reassure myself and regain stability. I can sort facts from unhelpful beliefs, shift my attention to the facts, orient myself with my values and priorities, and help myself skillfully and effectively handle whatever is happening.”

Current crises are certainly on everyone’s minds and hearts. Whether in stable or unstable times, whatever is happening can call to us and we usually handle it as we’ve always handled it, sometimes unskillfully and ineffectually.

As never before, we are now called to be skillful and effectual.

Since addressing avoidance is a hard task, softness is needed. The task may be unwelcome and seem overwhelming. Separating the task into manageable parts may be helpful. Consider trying these questions:

What are the top two areas that may become problematic for me:

  1. in the ways I talk to myself and treat myself?
  2. in the ways I interact with others, particularly partners or my closest family member(s)?
  3. in the ways I have ended up being interacted with by others?
  4. in the ways I have managed mental illness symptoms (if I have them)?
  5. in the shortage or absence of what I often use or do to get away from what’s bothering me?

Even becoming aware of areas that may be challenging can offer strength to handle them. When problematic patterns arise, they are expected.

Simply recognizing when feelings are intense and thoughts are troubling can free people to pause and consider what to say or do next – or not say or not do – to be kind to themselves and others.

I theorize that gaining skill and power in the areas we have avoided will give us unprecedented skill and power to handle whatever happens in unprecedented times.

Wren West, L.P.C. contributed to this post.

Image: iStock

For people in the Blacksburg and Roanoke, Virginia areas who want to be able to follow up in-person after online counseling sessions, I recommend these providers of telehealth sessions: Stephanie Fearer, Ph.D., L.C.P. in Blacksburg (540-251-1567), and Wren West, L.P.C. in Roanoke (540-808-7948). I offer online counseling services to Blacksburg-area and Virginia residents as well, both individual and group sessions.

This guide to selecting an online counselor may be helpful.

The views expressed are mine alone and do not necessarily reflect the positions of my colleagues, clients, family members, or friends. This content is for informational purposes only and is not a substitute for medical or professional advice. Consult a qualified health care professional for personalized medical and professional advice.

I Sing a Song of Myself

I Sing a Song of Myself

“I celebrate myself, and sing myself…”
Walt Whitman, “Song of Myself”

“Love, evidence & respect.”
– Maia Szalavitz’s answer via Twitter to the question,
“What fights addiction?”

I am kind to myself.

I identify my feelings and thoughts.

I learn, practice, master, and use skills that help me with my feelings and with my thoughts.

I empathize with my feelings.

I understand and validate the existence of my feelings and thoughts.

I learn, practice, master, and use skills that give me – my self – the power to choose to what I give my attention – which feeling, which thought, which sensation, which memory, which thing that is happening now.

I use my empathy, understanding, and attention to connect with my inner wisdom, the finest synthesis of my feelings and thoughts, the unique gift of my individual heart and mind.

I inform my inner wisdom’s guidance with courageously selected values.

I sort my thoughts into “helpful” and “unhelpful” categories and give my attention to the helpful thoughts.

I note physical sensations and the levels of comfort and discomfort in my body.

I become aware of sensing that I am hungry, full, hot, cold or thirsty. I respond to my physical needs.

I soothe, ease, comfort, and reassure my heart, mind, and body.

I become aware of my sensory preferences and use sensory experiences to help me feel more stable with my feelings, thoughts, attention, and sensations.

I am interesting company for myself. I learn new things and new ways so I can continue to be an engaging companion for myself.

I acquire sophisticated skills that enrich my inner wisdom’s tools and abilities.

I use my inner wisdom’s skills – constantly growing and evolving – to track what I’m doing. If I’m aware of something, I give myself a chance to do something about it.

I make decisions grounded in acknowledgement and acceptance of reality, however hard the decision might be, however much I might wish reality were different. I approach, rather than avoid, reality.

I take conscious action based on my inner wisdom’s guidance.

I continue to gain clarity on what’s important to me and how I want to live my life.

I discover and develop my strengths.

I discover and validate my needs and wants.

I discover my preferences – in addition to my preferences for, perhaps, actions and substances that, unfortunately, have become problematic for me – for meeting my valid needs and wants.

I learn, practice, master, and use personal and interpersonal skills effectively.

I make conscious choices about with whom and how I will love, relate, live, and work.

I live in ways that I value.

I am aware that I am a self-knowing, self-loving, self-deciding, self-respecting, other-respecting, powerful person.

I have the freedom, power, and peace that awareness gives me.

I am free.

Excerpted from Help That Helps: A Kind, Research-Informed, Field-Tested Guide for People with Substance Use Concerns, by Anne Giles, M.A., M.S., L.P.C. and Sanjay Kishore, M.D., July 2019.

This content is for informational purposes only and is not a substitute for medical or professional advice. Consult a qualified health care professional for personalized medical and professional advice.

How to Self-Administer an Antidote to Panic

If you have assessed a situation and found no immediate threat, have followed advice from medical professionals, but still find yourself feeling a sense of panic, here may be a way to use cognitive therapy on your own behalf.

Panic is usually an inner state resulting from thoughts about believing one is helpless. Believing there’s no way out understandably causes what we’ll term the brain’s “feelings processes” to overpower the brain’s “thinking processes.” The antidote is to regain access to one’s ability to think, then to use both feeling and thinking processes to consider helpful possibilities. According to research by the Gottmans, regaining this ability takes about 20 minutes.

Awareness of feelings and thoughts accesses inner wisdom

1. Say, “I am feeling panicked.”

Simply naming what you are truly feeling, whether to yourself or aloud, requires you to think, thus beginning the process of bringing your thinking “back online.” You activate your brain’s innate ability to work with reality by approaching it rather than avoiding it.

2. Move.

With the physical abilities you have, stand up, shift your posture, pick up an object, pat your pet.

Deciding what to do and doing it, again, activates the thinking processes of your brain.

3. Identify the thoughts you had prior to feeling panicked.

This, too, helpfully activates your thinking processes. Try to be as specific as possible. One thought is usually along the lines of “I feel helpless to __________.” Many thoughts may be in the form of “if-then” doom, i.e. “If ________, then it’s all going down!” Writing down your thoughts may offer additional clarity.

4. Challenge any thoughts that are “shoulds” with this fact: “I feel as I feel.”

The odds are good that feeling what you feel under the circumstances is legitimate. “I shouldn’t feel this way” is a belief that isn’t true. Further, thinking “I shouldn’t” deepens distress. Simply shift your attention away from any beliefs you hold about your feelings.

5. Imagine adjusting the volume knob on your inner state down a notch.

The brain has an innate ability to restore itself to stability. Simply becoming aware of one’s inner state eases it. Although one’s inner dialogue may be “I should/shouldn’t be feeling/thinking this way,” again, simply shift your attention to quieting the intensity of your inner experience.

6. Do all this with neither judgment nor rah-rah.

Unfortunately, the cure for thinking negatively is not positive thinking. Both require energy to sustain beliefs that may not be supported by facts. Reality is the groundwork upon which your brain primarily operates. Gently let the brain be real and do what it does.

7. Acknowledge that often beneath panic, sometimes at a nearly inaccessible level, is sorrow.

We feel so sad that things are as they are and that things have gone as they’ve gone. We may regret the past, ache for the present, and worry about the future. We may wish ardently that we could change things. Panic is often the brain’s way of putting distance between us and what we are so very, deeply sorry that we can’t change for ourselves, others, or our world.

8. Ask yourself, “What can I do to help myself with this?”

And there it is. By asking that question, you have accessed the very best of your feelings – your empathy and compassion for yourself – and the very best of your thinking – solving problems with facts. You can examine thoughts that have troubled you with your full humanity. In dialectical behavior therapy, the ability to access the synergy of one’s most skillful feeling and thinking is termed “Wise Mind.”

Giving oneself time to skillfully call forth one’s own inner wisdom can be the antidote to panic.

. . . . .

Image adapted from ” Mindfulness Handout 3: Wise Mind: States of Mind,” DBT Skills Training Handouts and Worksheets, Second Edition, by Marsha M. Linehan, 2015.

The content of this post is a synthesis by Anne Giles, M.A., M.S., L.P.C. of work in cognitive theory by Judith Beck, Ph.D., Marsha Linehan, Ph.D., Patricia Resick, Ph.D., Daniel J. Fox, Ph.D., and others.

This content is for informational purposes only and is not a substitute for medical or professional advice. Consult a qualified health care professional for personalized medical and professional advice.

Why and How to Find Online Counseling

Although it seems counterintuitive, research suggests that receiving counseling through video conferencing is as effective as receiving it in person. For conditions ranging from post-traumatic stress disorder to illness-related depression to chronic pain to substance use issues, people can achieve desired treatment outcomes through telehealth counseling sessions.

Self-awareness offers us a chance to choose

Disclosure: I offer evidence-based counseling protocols via telehealth through HIPAA-compliant SimplePractice and am listed in Psychology Today’s database of providers. I can offer counseling services only to residents of Virginia.

I have been studying research on electronic delivery of counseling services since 2008. I was part of several startups attempting to take a counseling software platform and a substance use disorder treatment mobile application to market.

In 2013, the popular term used in the field was “mHealth” for “mobile health.” I presented at the mHealth Summit in 2012. (The mic didn’t work at the conference so I rerecorded my presentation here.) Here’s the content for a related presentation I made at the Virginia Counselors Association in 2013.

My point is that research has reported on the effectiveness of electronic delivery of counseling protocols for over a decade.

I have contributed to developing online counseling software, have researched it, and have both offered online counseling and received it. My personal experience corroborates the research data.

The easiest ways to get online counseling are to find a licensed counselor who offers telehealth counseling or to use an online counseling service with licensed practitioners. In the United States, licensing occurs by state so the counselor needs to be licensed in the state in which an individual resides.

Counselors can apply to be listed in Psychology Today’s database of therapists. If they pass Psychology Today’s screening process, they can pay a monthly fee to keep a current listing. Once database users indicate their location, the site offers a menu of options for conducting a search, including “Online Counseling.” Clicking or tapping that option reveals a list of counselors who offer telehealth counseling services in one’s area.

(I found the assistance of Melanie Bosco, LPC through online counseling service Talkspace very helpful when I needed extra support upon learning of my father’s neurocognitive disorder. She offers cognitive behavior therapy and is licensed in Virginia. In the Blacksburg, Virginia area, Stephanie Fearer, LCP, offers a variety of evidence-based protocols through telehealth counseling services.)

Although individuals will have their own questions to ask, here are three specific questions I recommend asking a potential online counselor:

  1. Does the telehealth software we will use meet federal regulations to protect my private health information? Is the software HIPAA-compliant?
  2. What are the evidence-based counseling protocols you offer for the conditions I have?
  3. What percentage of your clients achieve their treatment goals? How effective is what you offer?

The answer to #1 needs to be “Yes.” [Updated 3/14/20: If HIPAA-compliant video conferencing is not available, your counselor may ask you to sign a release indicating you understand that is the case.]

The answer to #2 needs to at least exist. The answer to #3 needs to be answered without defensiveness and in a way that makes sense to the listener. Simply put, we need to receive as many reassurances as possible that we are receiving value for the precious dollars we are spending.

I was a teacher for nearly a quarter of a century before I studied counseling and earned a master’s degree in 2006. In my experience working with people of all ages in stable times and challenging times, when people simply wish to feel better and do better, counseling can help.

. . . . .

The accompanying image by Kelsey Sarles demonstrates the mobile version of our startup’s cognitive behavior therapy-based counseling software platform. We engaged with a research hospital for a pilot study that cleared the Institutional Review Board (IRB) but did not receive sufficient enrollment. Our efforts to develop counseling software were regretfully abandoned in 2013.

The views expressed are mine alone and do not necessarily reflect the positions of my colleagues, clients, family members, or friends. This content is for informational purposes only and is not a substitute for medical or professional advice. Consult a qualified health care professional for personalized medical and professional advice.

Why My Private Counseling Practice Does Not Take Health Insurance

Do no harm.

People’s health care records accompany them for life. Given that substance use is stigmatized and criminalized, I urge anyone with a substance use concern or an addiction issue to self-pay if they can so no third parties – including health insurance companies – are notified.

In private practice as a direct-pay, independent counselor, I keep clinical notes that can only be accessed with a client’s release or if the records are subpoenaed for use in legal matters. I write notes to meet professional and ethical standards but they carefully include minimal details. I do my best to help protect my clients’ human rights.

Doors can close with a diagnosis related to addiction of any kind. Opportunities – invitations to join in, scholarships, employment, promotions – can be denied because most do not understand – or refuse to acknowledge – that addiction is a very human, treatable condition.

(Since my health care record includes an alcohol use disorder diagnosis, even though I have been in remission 7 years, I assume I will not be allowed painkillers if I’m ever in an accident and taken to an E.R. Denial of medication to people with current and former issues with addiction is tragically sad and life-threateningly dangerous, but I’ve seen it too many times locally and it’s a noted nationwide phenomenon.)

I provide individualized, responsive, comprehensive services not covered by health insurance.

Substance use disorders, challenging behaviors, and the mental illnesses that may accompany them can be complex, on-going conditions that may not remit through medical care and individual and group counseling alone. Comprehensive assistance is needed. My fees for individual and group counseling sessions include case management services, within-24-hour replies to texts, phone calls, and emails, contingency management awards, and custom-created, individualized readings, materials, and activities. These services are not reimbursed by health insurance companies.

I offer evidence-based care.

Health insurance companies specify what treatments will be reimbursed and can deny coverage for research-backed treatment. I keep abreast of the latest research on treatment for addiction. Today, right now, I can offer the very best care suggested by research that I am qualified to provide. (Medical care is the first line of treatment for addiction and may be sufficient. I am not a medical care provider.)

Clients and I are free to co-create individualized, evidence-based treatment plans designed specially for them to include the components and pacing that fit their specific needs.

I am here to help.

If I were to take reimbursement for services from health insurance companies, I would be obligated, under contract, to charge agreed-upon fees. I would commit a billing violation if I offered a sliding scale or discounted fees for low-income or no-income individuals. I have a small practice and can only offer a limited number of scholarships. I am honored and gratified that they are filled. I respect contracts and do not enter ones that compromise my ability to be of service to those in need.

Time is finite and precious.

I am 61 years old. I respect the protective intent of the vast amounts of information required to provide services covered by health insurance. I am passionate about clients and this work. I choose to spend my remaining time on the planet serving clients, not completing forms.

If the way I offer counseling services is a fit for you, please contact me. I would welcome the opportunity to work with you.

The views expressed are mine alone and do not necessarily reflect the positions of my colleagues, clients, family members, or friends. This content is for informational purposes only and is not a substitute for medical or professional advice. Consult a qualified health care professional for personalized medical and professional advice.