Leveraging Client Accessibility

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Is it ethical to leverage the accessibility of mental health services?

That’s a loaded question. Of course, if a client ever needs or requests aid, a therapist or counselor must attempt to remove any obstacles in the way of those services. But what about if a clients goal is aimed at building resiliency? Or when a client is beginning to work toward the end of their counseling process?

My children and I recently began watching the new ‘Lost in Space’ series on Netflix. We love space and good storytelling. Most of the shows we watch together have positive narratives where things always work out. Their reaction to the first episode (and episodes thereafter) was very intriguing! The family (younger kids included) find themselves in various dilemmas! Ones that seem impossible to escape! My kids turned their heads away and buried their faces in the couch stating that these kids will not survive! It was as if they believed children and young adults can not have the resiliency to overcome obstacles unless solutions were outlined easily!

Let’s say a new client is needing to talk every other day. This might be justified by the fact of their high risk and need for fairly immediate treatment. Boundaries would need to be put into place. Now, what if this client has been in counseling for a year, and is only meeting once per month, and heading toward their termination session? Does a counselor have the ability to leverage the type and frequency of communication-based on the clients' desire for resiliency and overall well-being?

It feels strange to say that communication can be leveraged for the betterment of others. However, it’s no different than saying that silence is golden.

I have heard of many scenarios play out in the therapeutic alliance. Ones where therapists talk too much, others where clients don’t talk enough. For whatever reason, our communication styles are always fluid and they present opportunities to be mindful and cautious. They set the stage of how relationship dynamics will play out, no matter if it’s professional or casual.

Looking at it more closely, our communication is always being leveraged because it’s a natural response. Our tone, our responses, they are usually based in formulas, upbringings, and conditions.

In my practice I give the following prompt:

“Please know that you can reach out at any point, at any time, for any reason at all. But also know that I may not answer. Use that opportunity to vocalize your need. Just the simple practice of putting thoughts into words and knowing someone will hear them provides a great outlet.”

I have found this prompt grants empowerment, engagement, and leverage. Meaning for those who are practicing resiliency, they can have space and encouragement to both voice their needs and work toward a resolution with the tools they have built thus far in their sessions!

If a client ever exhibits symptoms of regression, then this is not the appropriate response! Completing risk screenings (included in the MSE’s) and setting safety plans in place provides a great deal of benefit! This is why it is so crucial to stay in touch with clients. Thinking that clients are just scheduled bodies that show up for their appointments is not the way to go. It brings lots of money, but not the right thing to do. At least in my eyes.

Here are a few statements I make with clients as needed:

“It sounds like this coming week is going to be difficult. What do you think about checking in midway over the phone?”

“So you’re saying you’re lonely, depressed, and going on a business trip before we see each other in 2 weeks? Would you be able to text or call when you arrive at your destination and track your daily symptoms with me?”

“Let’s connect once (Counseling homework) is complete and see if any change has occurred.”

“If you feel like an anger outburst is coming, consider putting your thoughts into words in a text. I may or may not respond. But it will give us a good map for our next session!”

Alfred Adler, an Austrian psychotherapist, and medical doctor emphasized the training of parents, teachers, social workers in democratic approaches that allow a person to exercise their power through reasoned decision making all the while co-operating with others. He was pragmatic and believed that we can make practical use of the insights of psychology.

By having clients use a tool to convey thought and emotion (using their phone to leave a voicemail or text), they are practicing a naturally Adlerian practice. Adlerians place an emphasis on excavating the past of a client in order to hopefully alter their future. This also increases integration into community in the 'here-and-now'. Being present in an active way!

Most of the time we think of accessibility as needing to be a smooth road. The path of least resistance to treatment. However, most of the time this process seems to be more effective for large organizations turning clients for profit. Getting the quickest treatment to the most amount of people means money, and money keeps the organization running.

In my experience, providing a meaningful process to accessibility rather than the quickest provides a catalyst for deeper buy-in and long term ownership/ goal attainment. For example, insurances ask for diagnosis and a tx plan by the 1st or 2nd session! Meanwhile, just about every therapist has been trained and educated to use various assessments, and have a thorough narrative of the client before giving a diagnosis or Tx plan. Thus we are placed in a paradox! Another example is the prompt to have goals that are client-centered, yet some insurances decline coverage if they don’t meet certain criteria.

When therapy plays by any other rules than the ones ethically and historically laid out and approved, that’s when we begin to see the degradation of services and less than desirable treatment. But when we stick to what we know to be truth and effective praxis, we can confidently interact with our clients and their therapeutic process. When their goals and needs become our basis for treatment, leveraging what treatment method is used and at what frequency no longer sounds like a strange venture.

Looking for treatment planning resources? Check out my article “Top 10 Tx Planning Resources”

https://link.medium.com/0i42KzUVSZ

Geries Shaheen is a Licensed Professional Counselor and Nationally Certified Counselor operating in and around St. Louis Missouri. Geries holds his MA in Professional Counseling from Lindenwood University, BA in Intercultural Studies from Lincoln Christian University, and holds a certificate in Life Coaching, Geries provides life coaching services to clients online globally.

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DBT Nightmare Protocol

By Geries Shaheen • 25 Mar, 2023

Dialectical Behavior Therapy (DBT) was developed by psychologist Marsha Linehan in the 1980s to treat individuals with borderline personality disorder (BPD). DBT combines cognitive-behavioral therapy (CBT) with mindfulness and emphasizes acceptance and validation of intense emotions. It involves weekly individual and group therapy sessions, where individuals learn specific skills related to mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. DBT has since been adapted to treat a range of mental health conditions and is recognized as an evidence-based treatment. DBT has been proven effective in treating a wide range of mental health conditions, including borderline personality disorder, substance abuse, and eating disorders. One of the key components of DBT is the use of specific protocols to address common issues that clients may experience. One of these protocols is the DBT Nightmare Protocol, which is designed to help individuals who are experiencing recurring nightmares. Nightmares are a common experience for many people, and they can be particularly distressing for individuals who have experienced trauma. In fact, nightmares are a symptom of post-traumatic stress disorder (PTSD), and they can be a significant barrier to healing for individuals who are struggling with this condition. The DBT Nightmare Protocol was developed to help these individuals manage their nightmares and reduce their overall distress. The DBT Nightmare Protocol is a 10-week protocol that is designed to help individuals learn to manage their nightmares through a combination of behavioral strategies and cognitive techniques. The protocol is typically conducted in a group setting, although it can also be done on an individual basis. The following is an overview of the different components of the DBT Nightmare Protocol. Week 1: Psychoeducation The first week of the DBT Nightmare Protocol is dedicated to psychoeducation. During this week, the therapist will provide information about nightmares and the impact they can have on mental health. Clients will also learn about the common triggers for nightmares and the different ways in which nightmares can be managed. Week 2: Sleep Hygiene During the second week of the DBT Nightmare Protocol, clients will learn about sleep hygiene. This includes information about the importance of getting enough sleep, as well as strategies for improving sleep quality. Clients will also learn about the relationship between sleep and nightmares, and they will be provided with specific strategies for reducing the frequency and intensity of their nightmares. Week 3: Imagery Rehearsal Therapy Imagery rehearsal therapy (IRT) is a technique that is commonly used to treat nightmares. During the third week of the DBT Nightmare Protocol, clients will learn about IRT and how it can be used to reduce the frequency and intensity of nightmares. Clients will also have the opportunity to practice IRT techniques with the guidance of their therapist. In IRT, your therapist first provides you with background information on sleep and nightmares to "set the scene" for learning to manage them. Then, working with your therapist, you create detailed, nonfrightening endings for nightmares you've had repeatedly. Write down and rehearse the nightmares with the new endings. Learn how to monitor your nightmares so you know how well your IRT treatment is working. The goal is to "reprogram" your nightmares to be less terrifying if and when they occur again. Week 4: Mindfulness Mindfulness is a key component of DBT, and it can be particularly helpful for individuals who are experiencing nightmares. During the fourth week of the DBT Nightmare Protocol, clients will learn about mindfulness and how it can be used to manage anxiety and other symptoms associated with nightmares. Week 5: Progressive Muscle Relaxation Progressive muscle relaxation (PMR) is a relaxation technique that involves tensing and then relaxing different muscle groups in the body. This technique can be particularly helpful for individuals who are experiencing nightmares. During the fifth week of the DBT Nightmare Protocol, clients will learn about PMR and how it can be used to reduce the intensity of nightmares. Week 6: Cognitive Restructuring Cognitive restructuring is a technique that is used to challenge negative thought patterns and beliefs. During the sixth week of the DBT Nightmare Protocol, clients will learn about cognitive restructuring and how it can be used to challenge negative beliefs and thoughts that contribute to nightmares. People sometimes experience distorted thinking. Thought patterns that create an unhealthy perspective of reality. Cognitive distortions often lead to depression, anxiety, relationship problems, and self-defeating behaviors. Examples of cognitive distortions include: black-and-white thinking catastrophizing overgeneralizing personalizing Cognitive restructuring allows you to notice these maladaptive thoughts as they’re occurring. And then practice reframing these thoughts in more accurate ways. During this step, you will question your assumptions, gather evidence by self-monitoring on a daily basis, and perform cost-benefit various analyses. If you can change how you look at certain events or circumstances, your feelings and the actions you take may also change. Week 7: Graded Exposure Graded exposure is a technique that involves gradually exposing oneself to a feared situation or object. During the seventh week of the DBT Nightmare Protocol, clients will learn about graded exposure and how it can be used to reduce the fear associated with nightmares. Week 8: Relaxation Training Relaxation training is a technique that involves teaching individuals to relax their bodies and minds. During the eighth week of the DBT Nightmare Protocol, clients will learn about relaxation training and how it can be used to reduce anxiety and other symptoms associated with nightmares. Clients will also have the opportunity to practice relaxation techniques with the guidance of their therapist. Week 9: Self-Compassion Self-compassion is an important component of DBT, and it can be particularly helpful for individuals who have experienced trauma. During the ninth week of the DBT Nightmare Protocol, clients will learn about self-compassion and how it can be used to reduce self-criticism and self-blame associated with nightmares. Week 10: Relapse Prevention The final week of the DBT Nightmare Protocol is focused on relapse prevention. During this week, clients will learn about the different strategies they can use to maintain the progress they have made in managing their nightmares. They will also be encouraged to develop a plan for how they will continue to manage their nightmares after the end of the protocol. The DBT Nightmare Protocol is a comprehensive and effective approach to managing nightmares. By incorporating a range of behavioral and cognitive strategies, clients are able to learn the skills they need to reduce the frequency and intensity of their nightmares. If you are experiencing nightmares, it may be helpful to speak with a mental health professional who is trained in DBT to see if the DBT Nightmare Protocol is right for you. Unsure about adapting DBT into your framework? -A randomized controlled trial of DBT for suicidal and self-injuring individuals with BPD found that DBT was more effective than treatment as usual in reducing suicidal and self-injurious behaviors (Linehan et al., 2006). -A meta-analysis of 11 randomized controlled trials of DBT for individuals with BPD found that DBT was effective in reducing suicidal and self-injurious behaviors, as well as other symptoms of BPD, such as depression and anxiety (Kliem et al., 2010). -A randomized controlled trial of DBT for individuals with binge eating disorder found that DBT was more effective than treatment as usual in reducing binge eating and improving eating disorder-related attitudes and behaviors (Safer et al., 2010). -A review of 17 studies of DBT for individuals with substance use disorders found that DBT was effective in reducing substance use and improving overall functioning (Linehan et al., 2002). Overall, research suggests that DBT is an effective treatment for a range of mental health conditions, including BPD, eating disorders, substance use disorders, and post-traumatic stress disorder (PTSD). It is worth noting that the effectiveness of DBT can vary depending on individual factors, such as the severity of symptoms and the level of treatment adherence. Perhaps you are a private practice in the mental health industry, or maybe a large agency trying to get your clinicians on the same page regarding Trauma Informed Care. Consider the Pioneer Counseling Trauma Informed Care Psychotherapy Tx Planner. It really is more than a tx planner, it is a guide and a point of reference. https://www.amazon.com/dp/B0BQ9FWFMT?ref_=cm_sw_r_cp_ud_dp_0MKBDBQ5PRD8G8NBEJ0B No alt text provided for this image Geries Shaheen is a Licensed Professional Counselor and Nationally Certified Counselor operating in and around St. Louis Missouri. Geries holds his MA in Professional Counseling from Lindenwood University, BA in Intercultural Studies from Lincoln Christian University, and holds a certificate in Life Coaching, Geries provides life coaching services to clients online globally. Geries is EMDR trained and DBT Certified, practicing from a Trauma Informed Care lens.e body content of your post goes here. To edit this text, click on it and delete this default text and start typing your own or paste your own from a different source.

Understanding Erikson's Stages of Psychosocial Development

By Geries Shaheen • 25 Mar, 2023

Erik Erikson's theory of psychosocial development is a widely accepted and highly regarded framework for understanding human development from infancy to old age. Erikson believed that individuals go through eight distinct stages of development, each with its unique set of psychosocial challenges and opportunities. In this article, we will explore each of Erikson's stages of psychosocial development and discuss ways to utilize this model in mental health counseling sessions. Stage 1: Trust vs. Mistrust (Birth to 18 Months) The first stage of psychosocial development occurs from birth to 18 months. At this stage, infants learn to trust or mistrust their environment and caregivers based on how their needs are met. If their needs are consistently met with warmth, comfort, and care, they develop a sense of trust in the world. Conversely, if their needs are neglected or met inconsistently, they may develop a sense of mistrust. Counseling Application: In therapy, it's essential to establish a safe and nurturing environment to build trust with clients. As a therapist, it's crucial to show warmth, empathy, and non-judgmental support. By providing a safe and caring environment, clients can begin to build trust and feel comfortable opening up. Stage 2: Autonomy vs. Shame and Doubt (18 Months to 3 Years) During this stage, toddlers begin to develop a sense of autonomy and independence. They want to do things on their own and assert their independence. If caregivers encourage this behavior, toddlers develop a sense of autonomy. Conversely, if caregivers are overly restrictive or critical, toddlers may develop shame and doubt about their abilities. Counseling Application: In therapy, it's crucial to acknowledge clients' need for autonomy and independence. Encourage clients to make their own decisions and take charge of their lives. Help them explore their strengths and abilities and provide positive reinforcement to build their confidence. Stage 3: Initiative vs. Guilt (3 to 6 Years) During this stage, children begin to explore their world and develop a sense of initiative. They want to try new things and take on new challenges. If caregivers support and encourage this behavior, children develop a sense of initiative. Conversely, if caregivers are overly critical or dismissive, children may develop a sense of guilt. Counseling Application: In therapy, it's crucial to help clients explore new possibilities and take on new challenges. Encourage them to set goals and work towards achieving them. Help them develop a sense of accomplishment and pride in their achievements. Stage 4: Industry vs. Inferiority (6 to 12 Years) During this stage, children begin to develop a sense of industry and competence. They want to learn new skills and take on more significant challenges. If caregivers support and encourage this behavior, children develop a sense of industry. Conversely, if caregivers are overly critical or dismissive, children may develop a sense of inferiority. Counseling Application: In therapy, it's crucial to help clients develop a sense of competence and achievement. Encourage them to explore new skills and interests, and provide positive reinforcement for their efforts. Help them develop a sense of pride and accomplishment in their achievements. Stage 5: Identity vs. Role Confusion (12 to 18 Years) During this stage, adolescents begin to explore their identity and establish a sense of self. They try on different roles and experiment with different behaviors to discover who they are. If caregivers support and encourage this behavior, adolescents develop a sense of identity. Conversely, if caregivers are overly critical or dismissive, adolescents may experience role confusion and a lack of direction. Counseling Application: In therapy, it's crucial to help clients explore their identity and develop a sense of self. Encourage them to explore their interests and passions, and help them identify their values and beliefs. Assist them in developing a sense of direction and purpose in life. Validate their experiences and provide a supportive environment for them to express themselves. Stage 6: Intimacy vs. Isolation (18 to 40 Years) During this stage, young adults begin to establish intimate relationships with others. They seek emotional and physical connections with others and form lasting bonds. If young adults are successful in developing these relationships, they experience intimacy. If they fail to establish these connections, they may feel isolated and alone. Counseling Application: In therapy, it's crucial to help clients develop healthy and meaningful relationships with others. Provide support and guidance in navigating the challenges of intimate relationships. Encourage clients to communicate effectively, set boundaries, and practice self-care. Stage 7: Generativity vs. Stagnation (40 to 65 Years) During this stage, middle-aged adults begin to focus on their contribution to society and the next generation. They seek to make a positive impact on the world and leave a lasting legacy. If they are successful in these endeavors, they experience generativity. If they fail to make a meaningful contribution, they may feel a sense of stagnation. Counseling Application: In therapy, it's crucial to help clients explore their values, passions, and goals. Encourage them to find ways to make a positive impact on their community and the world. Assist them in developing a sense of purpose and fulfillment in their lives. Stage 8: Integrity vs. Despair (65 Years and Older) During this stage, older adults reflect on their lives and seek to find meaning and purpose in their experiences. They may experience a sense of satisfaction and fulfillment if they have lived a meaningful life. Alternatively, they may experience despair if they feel that their life has been wasted. Counseling Application: In therapy, it's crucial to help clients reflect on their lives and find meaning and purpose in their experiences. Encourage them to focus on their strengths and accomplishments and find ways to continue to make a positive impact on the world. Provide support and guidance in navigating the challenges of aging and help them find ways to maintain their independence and quality of life. Erikson's theory of psychosocial development provides a comprehensive framework for understanding human development across the lifespan. By understanding the challenges and opportunities of each stage, mental health therapists can provide tailored interventions to support clients' growth and development. Utilizing this model in therapy sessions can help clients develop a sense of self-awareness, purpose, and fulfillment in their lives. Erikson's theory proposes that at each stage of life, individuals face a specific psychosocial crisis that must be resolved in order to progress to the next stage. When individuals successfully resolve the crisis, they develop a specific virtue or strength that enables them to navigate future challenges. Here are the virtues attained from each stage: Trust vs. Mistrust (Birth to 18 months) - The virtue of hope: If infants receive consistent and responsive care from their caregivers, they develop a sense of trust in the world around them. This trust allows them to feel hopeful and optimistic about the future. Autonomy vs. Shame and Doubt (18 months to 3 years) - The virtue of will : If toddlers are encouraged to explore their environment and make choices for themselves, they develop a sense of autonomy and independence. This allows them to develop a strong sense of will and self-control. Initiative vs. Guilt (3 to 6 years) - The virtue of purpose : If young children are encouraged to take initiative and explore their environment, they develop a sense of purpose and direction in life. This allows them to feel a sense of accomplishment and pride in their achievements. Industry vs. Inferiority (6 to 12 years) - The virtue of competence : If children are encouraged to master new skills and succeed in academic and social endeavors, they develop a sense of competence and confidence. This allows them to feel capable and successful in future endeavors. Identity vs. Role Confusion (12 to 18 years) - The virtue of fidelity: If adolescents successfully navigate the challenge of developing a sense of identity, they develop a sense of fidelity or loyalty to themselves and others. This allows them to develop a clear sense of values and beliefs that guide their decision-making in adulthood. Intimacy vs. Isolation (18 to 40 years) - The virtue of love : If young adults are successful in developing meaningful and intimate relationships with others, they develop a sense of love and connection. This allows them to form lasting bonds with others and experience deep emotional fulfillment. Generativity vs. Stagnation (40 to 65 years) - The virtue of care : If middle-aged adults are successful in making a positive contribution to society and the next generation, they develop a sense of care and concern for others. This allows them to feel fulfilled and satisfied with their accomplishments. Integrity vs. Despair (65 years and older) - The virtue of wisdom : If older adults reflect on their lives and find meaning and purpose in their experiences, they develop a sense of wisdom and acceptance. This allows them to feel at peace with their life's journey and to share their insights with future generations. By developing these virtues, individuals are better equipped to navigate the challenges of life and to find fulfillment and purpose in their experiences. Mental health therapists can help clients develop these virtues by providing guidance and support as they navigate each stage of development. Regression is a common phenomenon that occurs when individuals revert to earlier patterns of behavior or thought in response to stress, anxiety, or other challenges. When individuals regress, they may exhibit symptoms that are typical of earlier stages of development, even if they have already progressed through those stages. Here are some common symptoms related to regression: Withdrawal : Individuals who regress may withdraw from social situations, become isolated, and avoid social interactions. Tantrums : Regression may manifest as temper tantrums or outbursts of emotion that are typical of earlier developmental stages. Sleep disturbances : Regression may cause sleep disturbances, such as difficulty falling or staying asleep, nightmares, or night terrors. Regression in daily habits : Clients may stop doing things they were previously able to do, such as brushing their teeth, taking showers or dressing themselves. Regression in communication: Clients may use baby talk or simple language or lose their vocabulary altogether. Anxiety : Regression can cause anxiety or fear related to a particular situation or object, such as separation anxiety or fear of the dark. Helplessness : Clients may feel helpless and dependent, expecting others to do everything for them. For example, a client who is struggling with intimacy in their relationships may regress to stage 5 (Identity vs. Role Confusion) and struggle with developing a sense of self. This can prevent them from successfully navigating stage 6 (Intimacy vs. Isolation) and developing meaningful connections with others. If left unresolved, the client may continue to struggle with intimacy and become stuck in earlier stages of development. I n post-traumatic stress disorder (PTSD), regression is often seen as a way for the client to cope with the traumatic experience. A study found that 53% of patients with PTSD experienced symptoms of regression, such as avoidance or withdrawal. Similarly, a study on depression found that 42% of patients exhibited regressive behavior, such as clinging to others or exhibiting temper tantrums. In borderline personality disorder, regression is seen as a maladaptive coping mechanism that can lead to impulsive or self-destructive behaviors. I t's important for mental health therapists to be aware of these common symptoms related to regression and to help clients overcome them in therapy. By addressing regression, therapists can help clients progress through each stage of development and develop the virtues associated with each stage, leading to greater personal growth and fulfillment. It's essential for therapists to recognize when clients are regressing and provide support and guidance to help them move forward. Here are some ways therapists can help clients overcome regression: Validate the Client's Experience: It's important for therapists to acknowledge and validate the client's feelings and experiences. This can help build trust and provide a safe space for the client to express themselves. 2. Help Clients Identify Triggers: Identifying triggers that cause clients to regress can help them anticipate and prepare for potential setbacks. This can help clients develop coping mechanisms and prevent them from becoming stuck in earlier stages. 3. Encourage Clients to Practice Self-Care: Encouraging clients to practice self-care can help them manage stress and anxiety that can lead to regression. This can include activities such as exercise, mindfulness, and relaxation techniques. 4. Provide Tools for Growth: Providing clients with tools and techniques to manage stress and anxiety can help them progress through each stage of development. This can include cognitive-behavioral therapy, interpersonal therapy, and other evidence-based interventions. By addressing regression in therapy, therapists can help clients overcome obstacles and progress through each stage of development, developing the virtues associated with each stage. This can help clients live a more fulfilling and purposeful life, and achieve a sense of self-awareness and personal growth. Perhaps you are a private practice in the mental health industry, or maybe a large agency trying to get your clinicians on the same page regarding Trauma Informed Care. Consider the Pioneer Counseling Trauma Informed Care Psychotherapy Tx Planner. It really is more than a tx planner, it is a guide and a point of reference. https://www.amazon.com/dp/B0BQ9FWFMT?ref_=cm_sw_r_cp_ud_dp_0MKBDBQ5PRD8G8NBEJ0B Geries Shaheen is a Licensed Professional Counselor and Nationally Certified Counselor operating in and around St. Louis Missouri. Geries holds his MA in Professional Counseling from Lindenwood University, BA in Intercultural Studies from Lincoln Christian University, and holds a certificate in Life Coaching, Geries provides life coaching services to clients online globally. Geries is EMDR trained and DBT Certified, practicing from a TIC lens.The body content of your post goes here. To edit this text, click on it and delete this default text and start typing your own or paste your own from a different source.