Session Framework: what our sessions might look like

Initial session

  • Introduce myself and give a little information on my credentials.
  • Check your valid photo ID to verify that you are who you say you are.
  • Review the In Case of Emergency plan. I’ll also review who your emergency contact is with you and jot down your current location address.
  • Review the housekeeping paperwork that you completed, such as the Notice of Privacy Practices and Informed Consents.
  • Briefly talk about the SimplePractice platform and what’s available to you through your client portal.
  • I’ll answer any questions that you may have.
  • Review the Intake Questionnaire that you completed.
  • Collaborate on the Treatment Plan, covering issues or symptoms that you’d like to work on, goals and outcomes, and steps towards those goals and managing symptoms.
  • Discuss anything you could work on in between the initial session and the second session. If appropriate, I’ll probably suggest that you have a private journal or notebook to take notes during sessions and to use throughout the week.
  • Answer any questions that you may have.

Regular sessions

  • Hello!
  • Verify your current location address.
  • Check-in. Talk about how your week was and how you’re doing.
  • If we need to, review the Treatment Plan.
  • Talk about things going on and work towards your goals that reflect the Treatment Plan. How we work towards your goals is 100% unique to you. We will also identify your strengths and interests and where we can use them.
  • Discuss what you could work on over the next week.

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You Can Seek Help at Any Time: Rate Your Distress Scale

Use this distress scale to help you stay more aware of how you are doing. The scale is 0 to 10, where 0 is that you feel at peace and are completely calm, and 10 is distress that is so unbearable that you cannot function. Refer to the scale, as-needed. If you find yourself rated at 4, where negative thoughts begin to impact you, consider talking to a mental health professional because it is better to get help sooner than later. Don’t allow yourself to be in a distressful state for too long. When you feel change is needed, take action and contact someone.

Seek help from a mental health professional at any time, you do not need to be in distress to get help. A professional counselor can provide services for things such as managing stress and anxiety, examining thoughts and behaviors, support you in life transitions, and teach you how to strengthen your mind.

0: Peace and complete calm

1: No real distress, but a slight feeling of unpleasantness

2: A little bit sad or “off”

3: Worried or upset

4: Upset to the point that negative thoughts begin to impact you

5: Upset and uncomfortable

6: Discomfort to the point that you feel a change is needed

7: Discomfort dominates your thoughts and you struggle not to show it

8: Panic takes hold

9: Feeling desperate, helpless, and unable to handle it

10: Unbearably upset to the point that you cannot function and may be on the verge of a breakdown

Download this rate your distress scale below.

Red Rock Canyon, NV

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Reflective Listening for Couples

Practice reflective listening in your relationship for better communication.

A few reasons why couples argue and struggle to communicate well:

  • Real-world issues: different opinions on finances, family, raising children, and things going on within the home.
  • Attachment issues: this can be presented as couples fighting about how they fight.
  • Communication itself: a person has lack of empathy, when people don’t really listen, and when people are defensive.

Let’s just focus on addressing the communication itself:

In unhealthy communication:

If it’s important enough for couples to fight over, then it’s important to work on it.  A healthy couple listens to their partner’s concerns.  If it matters to one person, then it’s worth the time needed for the other person to understand.

In unhealthy communication, people spend a lot of their energy getting their point across and defending themselves. They don’t actively hear out the other person, instead they are figuring out what to say next.

Reflective listening:

Reflective listening is about finding out what’s actually occurring on a deeper level for the other person.

Think of it as being a third person, where you are no longer in the problem, you’re working together to solve it. “Us verse the problem,” not “me verse you verse the problem.”

An example, one spouse might say, in a relieved and uplifted tone of voice, “I didn’t you we’re thinking that.”  or “I had no idea, and it makes me feel disheartened to hear you felt that way”.

How to do reflective listening:

Reflective listening is a slowed down conversation, which requires time and paying attention. It increases awareness to the situation.

The couple needs to approach this exercise with a real desire to resolve an issue and a willingness to actively listen. Listen to learn and understand.

They need to be willing to try to experience what the other person is feeling as they speak, and being open and honest about those feelings. This might be the most challenging part; acknowledging, experiencing, and coping with the stronger emotions.

This exercise helps build trust.

The exercise:

Because it’s a conversation, one person is the speaker and the other is the listener. One chooses to speak first while the other listens. Later, the roles are swapped.

The speaker chooses a topic and may start with: “I’d like to talk about …”.

The speaker uses one short sentence at a time. It needs to be short because the other person has to repeat it and feel what it’s like, and it also prevents long-winded monologues and emotions from rising.

The listener only listens, and when the person who is speaking is finished with their sentence, then the listener repeats back what they heard: “What I heard you say was…”.

*The listener is not allowed to embellish or give their side to the argument, that comes later.*

The speaker continues and corrects the listener if what they heard wasn’t what they said.

“What I actually said was…” or “That’s not quite right, I said…”.

*The listener’s role is important, and they should stay aware and involved. Robotically repeating what the speaker is saying does not work.*  

The speaking and listening arrangement continues until the speaker has finished what they wanted to say and feels heard and understood.

Swap roles:

The speaker becomes the listener and the listener becomes the speaker.

Repeat the speaking and listening arrangement.

After the second speaker is finished and feels heard and understood, the first speaker may want to go again. This activity continues in an open-ended manner until they have completed what they wanted to say and feel they have been heard correctly.

Reflective listening is a way of checking-in with ourselves because the slowed down communication allows us to have the time to reflect on what is most important. We actively listen, giving time to understand and connect on a deeper level with our partner.

From start to end, this exercise may take 5 to 30 minutes.

What to avoid doing:

  • The listener should not be thinking about what you want to say while they’re supposed to be listening.
  • Don’t push for an outcome.
  • Be respectful, don’t interrupt.
  • Avoid summarizing or robotically repeating back what you’ve heard.
  • Avoid disagreement with the speaker, until it is your turn to be the speaker.

Practice this exercise:

This exercise becomes easier the more that it is practiced. Check-in when you are unsure that you understand what is happening for your partner; or you can ask your partner to reflect back what you have said, if you feel it is important and want to make sure they are not making assumptions or jumping to conclusions. It may take some time and practice at the beginning, but it is well worth the effort. Talking becomes safer and trust is built up.

Keep in mind, that when some people first start practicing reflective listening, they might have difficulty breaking their own negative habits like interrupting, dismissing, and rushing to fix a problem with a solution.

When this exercise becomes familiar, then it can be used just to check that you have really understood what is happening for the other person. Another benefit is that it saves you from arguing and the emotional pain that arguing causes.

Reflective listening is a way of showing that you want to problem solve together and improve communication.

Download this exercise below.

Gerard Hiking Trail, Oil Creek State Park, PA

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Potential and Possibilities on Bad Days

Your day is still full of potential and possibilities even if:

  • The weather is nasty and you’re stuck indoors.
  • Your car got a flat tire on the way to work.
  • You received a negative report that was out of your control.
  • You didn’t get the job or raise.
  • A major household appliance broke.
  • You received bad news.
  • It seems like you’re not getting anywhere, no matter how hard you try.
  • You feel like you will never be good enough.
  • You forgot to pay a bill.
  • It seems like multiple things are going wrong at the same time.
  • And this list can go on…

Tell Yourself

  • This day is full of potential and possibilities.
  • Your day can improve.
  • You can get outdoors another day.
  • A car tire can be replaced.
  • Good news will come soon.
  • You will find a job, this is only temporary.
  • Household items can be repaired or replaced, hang in there.
  • You have already achieved some goals, keep up the good work, you will continue to achieve.
  • Things can and will go right.
  • Not everything is bad, things are okay.
  • You have everything that you need right now, in this moment.
  • Come up with your own positive affirmation.

Take Action, Make it Happen

  • Adopt a positive mindset, it is a powerful tool.
  • Look for alternatives. Find the potential and possibilities. Write them down as a reminder.
  • Make a list of things that you can do and then start doing. You can use your creativity.
  • Focus on the things that you can control.
  • Remind yourself that ruminating on negative events and worries doesn’t help and that you can do something about it.

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Get In-Tune with Satiety and Hunger Cues: hunger scale tool and questions to consider

The hunger scale chart is one way to become more in-tune with your gut feelings and also, to have a better idea on whether or not you’re hungry and how much food to eat. Taking notes of how you feel will eventually lead to increasing your awareness and improving intuitive eating habits. The scale is 1-10. One, being that you’re feeling starving, weak, or dizzy and ten, is that you feel sick because you are so full.

When to Use

  • While deciding whether you should eat or not. Are you reaching for food because you’re hungry or because you’re feeling a particular emotion?
  • After eating a snack or a meal. Check-in with yourself to see where you are. Did you eat enough or did you eat too much?
  • Use this tool about twice per week, on a consistent basis, for about three to five months. This amount of time presents the opportunity to increase awareness and to settle into healthier habits.

How to Use

  • Pair this scale with practicing eating mindfully or intuitively.
  • Be non-judgmental of what number you are on the scale.
  • Feeling five or six after eating is appropriate. Seven is alright, every now and then, like during a holiday meal. The top goal is to feel comfortable.
  • Jot down in a journal or notebook your hunger scale number and a few other details, like what you ate, thoughts, and feelings.
  • Practice consistently, becoming more in-tune can take time. Practice being non-judgmental and patient with how long it might take you. It might take multiple changes and attempts, that’s alright.
  • Put the scale where you will see it and remember to use it. In a journal where you track habits, on the fridge, or on the dining room table. If you want to leave it on the dining room table, some people place it in a folder or a clear page sleeve.
  • Share what you’re working on with your dietician or mental health counselor.

Questions to Consider

An important point to mention is to notice thoughts and feelings while eating. A lot of times, we eat and are distracted by our phones, the television, or a conversation. Is this you? Are you feeling depressed or anxious while eating? Are you being judgmental or the food or yourself while you eat?

Another thing to notice is whether you are disassociated or non-present. Are you enjoying the food? Why or why not? Are you being mindful of the meal? Did you fly through the meal, eating fast? Did you eat at an abnormally slow pace? How big were your bites?

Be well.

Download the Hunger Scale below.

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“Unfinished Business” Letter

To help resolve any unfinished business that you have with another person, write a letter. This may be written to a person who has hurt or wronged you, and who is no longer a part of your life. DO NOT ACTUALLY SEND THEM (or anyone) THIS LETTER, this letter is for YOU. Keep it confidential.

I STRONGLY suggest doing this activity with a professional counselor and talking through the situation with them. They can support you.

Writing this letter will help you to:

  • Reflect and process
  • Feel emotions
  • Think more slowly
  • Problem solve
  • Maybe to forgive the wrong-doer
  • Forgive yourself, if you need to
  • Put your thoughts and emotions to paper
  • Release pent up thoughts and strong emotions, like pain, sadness, and anger
  • Find some peace, healing and resolution
  • Empowerment and improve self-esteem
  • Increase self-care and self-love

Format:

There are no set rules for writing this letter. You may find it difficult to start this process, just dive right in. The letter can be edited and re-organized to how you would like. Start with the wrong-doer’s name, like you are writing a letter. If you’re unsure of how long your letter should be, try aiming to write one to three pages just to get an idea. Once you have that, you will better know if the letter should be any longer. The letter is to benefit you and to help resolve any unfinished business, the length of the letter doesn’t matter quite as much. End the letter with your name.

Important things to think about including:

  • Things that you want the wrong-doer to know.
  • Anything that you want to say to them.
  • Talk about what they did to you.
  • Talk about how you feel.
  • Talk about your reaction to what they did.
  • Talk about the impact that it has had on yourself. What areas of your life have been impacted? How has it been changed?
  • Write about what you wish went differently.
  • Write about how you wish things ended with that person.
  • Is there anything that you could have done differently?
  • Allow yourself to be open to writing anything that comes up.

This is a challenging exercise, so take a break if you need to, re-visit it. *Self-care is very important through this process.* Work on acknowledging your thoughts and emotions, know that they are natural and occur for a reason, but let them roll away (not sticking in your mind) as you write. Utilize coping strategies to reduce intense stress, anxiety, emotions, etc. Try to make sure that you’re in a good “mental space,” not overly anxious or panic when you write this. It is helpful to be able to think clearly and be focused. After you finish writing this letter, read it out loud to yourself. Reading it to yourself might be emotional because your brain will be processing the information slightly differently, hearing your own voice read what you wrote is powerful. Read it to a counselor, they will listen and be able to guide you. If you think that it would be beneficial reading it a second or third time, then do so. Notice if your thoughts and emotions changed the next time through. Lastly, when you are ready, you completed the letter and read it out loud, destroy the letter for resolution (and confidentiality). There is symbolism in destroying the letter. It isn’t returning. Allow yourself to be healed and empowered. Love yourself. Notice how you feel while destroying the letter and afterwards. Do you feel physically lighter, like a weight has been lifted off of your shoulders? Do you feel empowered? Did you sigh in relief or smile?

Once again, please talk with someone if you need to, don’t hesitate to reach out. It is rewarding to speak with someone, brain imaging research shows that talk therapy (psychotherapy) can be impactful right away.

Download this exercise here

Red Rock Canyon, NV

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