Why Do So Many Therapists Not Accept Insurance?
In your search for mental health care, you may encounter a common theme among mental health counselors, websites reading "we do not take insurance" or "self-pay preferred." This can be very confusing and frustrating for clients in the already difficult process of finding the right care. This post aims to provide some information about the relationship between mental health counselors and insurance.
The search for a mental health counselor can sometimes feel like a scavenger hunt filled with confusing jargon and puzzle pieces that will not fit together, one of those pieces being insurance. So, take a moment to pat yourself on the back, take a deep breath, and thank yourself for putting yourself first and starting your process towards mental wellness. Of course, counseling is an investment, and insurance may not always be the best option. As counselors, we have to give you all of the information (informed consent), so let's look at this together.
Insurance Determines “Medical Necessity”
Insurance companies are rooted in and operate on a medical model. To receive support from insurance companies, a counselor often has to "prove medical necessity." This means that the insurance companies determine which diagnoses and which life circumstances are “enough” to need mental health treatment. Through this model, the following common reasons for treatment are not included: relationship issues (couples or family therapy), developmental/attachment trauma, existential issues, life transitions, personal development, or self-improvement. Since these common reasons for treatment are excluded from the diagnostic manual (the DSM-V), a therapist may have to give you a less accurate diagnosis that then becomes part of your medical record.
Wait a Second… Not all Mental Health Counseling is Covered?
No, not in the policies of many insurance companies. I would like to spend another moment to clarify that many insurance companies choose whether or not individuals’ therapy is covered based on the diagnosis (or lack thereof). At Obsidian Counseling and Wellness, we acknowledge that there are many reasons that one may benefit from mental health counseling, and each is important. It is unethical to deny an individual treatment based on their diagnosis. See below for a list of questions to ask your insurance provider when considering using insurance, and make sure that the care you are requesting is covered by your insurance plan.
Assumed Illness
As previously mentioned, insurance companies often require the clinician to provide a diagnosis, even if there is not a specific diagnosis that applies to you and your treatment. Through this, insurance companies assume that illness is the sole reason individuals receive counseling. You may be thinking, "that's not too bad." However, these diagnoses become a part of your medical record. Here's an example, you and your partner may seek counseling that focuses on communication or parenting. However, your therapist may still need to provide one of you with a diagnosis to receive reimbursement from the insurance company.
Less Confidentiality
Your privacy is one of the most important parts of building a therapeutic relationship. In your first session with your mental health counselor, they will remind you of your rights to confidentiality and the limits to confidentiality. This is discussed right at the beginning of treatment because it’s important that you feel safe and able to be open within your counseling sessions.
Insurance-Driven Treatment Plan
Often, insurance companies try to dictate treatment. This includes setting the number of sessions, frequency of sessions, and the type of care provided for the client. At Obsidian, we believe that these choices should be made by you and your therapist. Self-pay provides the flexibility that you need for your care. We acknowledge that each person's schedule and lifestyle are unique and that life is unpredictable. We would like to be able to cater our treatment to you and your needs. For example, an individual may begin counseling to address recent feelings of anxiety but suddenly lose a family member; in this scenario, we would shift our treatment plan to include grief to suit your present needs.
Burnout and Insufficient Pay
The unfortunate reality of insurance is that many providers who accept insurance are often overbooked and working overtime to keep up. Reimbursement rates are not always consistent with a therapist’s standard rate, which often makes therapists take on more clients than they may be able to handle in order to keep a sizable caseload. In addition, therapists need to apply individually to each provider panel, and each provider comes with its own complex billing process. This means that your therapist is often taking on a substantial amount of work (about 1.5 hours) and providing treatment that they are not being reimbursed for. This practice leads to therapists who are stressed, frustrated, tired and distracted from what matters most- the client and their treatment.
What Are Some Other Options?
Self-Pay
This option is just what it sounds like. You are paying for the treatment yourself. With this option, a lot of the power is returned to you; you are playing a role in your treatment with the freedom to find the right therapist and choose an individual who specializes in your specific problems and goals. You are also in control of the length of treatment and how often you attend therapy sessions, and your treatment records remain private.
Out-of-Network Insurance
Many therapists who do not accept insurance will work with you as an out-of-network therapist. For this option, you will pay the therapist directly, and then the therapist will provide you with a document called a "superbill." You then use this bill to seek reimbursement from your insurance company. If you choose this offer, it is important that you first check with insurance (see the list of questions for your insurance provider below). This option is the middle ground between using insurance and self-pay, with the added benefits of finding a provider that is the best fit for you, without the specific constraints of finding a provider paneled with your insurance.
Sliding Scale
Therapists understand that individuals may experience financial hardship or want to use their insurance for other reasons. Many mental health therapists use what is called a sliding scale. Sliding scale therapy refers to treatment priced based on each person's income and dependents. When a therapist uses a sliding scale, they consider the individual's financial needs, the therapists' licensure, experience, the type of therapy requested, and more. If this option sounds like a necessity for you, ask about this option when inquiring about fees.
Questions to Ask Your Insurance Company
For some, you may be thinking about your own insurance as you read this, wondering about some of your own policies. Here is a list of questions that you may consider asking your insurance company before starting your mental health counseling search:
For in-network:
· Is the provider in-network with my health insurance? (Make sure to double-check for your specific plan)
· Is there a limit on the number of sessions my plan will cover per year? How many?
· What length of session does my policy cover? (60 minutes, 45 minutes, etc.)
· Which diagnoses do you cover?
· What type of sessions do you cover? (Types of therapy)
· What is my in-network deductible for outpatient mental health?
· How much of my deductible has been met this year?
· What is my copay for outpatient mental health visits?
· Does my plan require a referral for psychotherapy?
For out-of-network:
· What is my out-of-network deductible for outpatient mental health?
· How much of my deductible has been met this year?
· Which diagnoses do you cover?
· What type of sessions do you cover? (Types of therapy)
· Is there a limit on the number of sessions my plan will cover per year? How many?
· Do I need a referral from an in-network provider to see someone out of network?
· How do I submit a claim for reimbursement?
Begin Mental Health Counseling in Chicago, IL Today
Learn more about our payment options here, and please contact us with any questions about details and fees. At our Chicago, IL, area therapy practice, we want to help you make the best decisions for yourself and your care. Our therapists are honored to help guide folks along their healing process. We offer services for anxiety, depression, parents, work stress,trauma and PTSD, and more. One of our more unique services is yoga therapy, which can also be done using online sessions. We also specialize in supporting LGBTQIA+ folks for a variety of issues. We hope that you take the leap to begin counseling with us. You deserve it.
Other Services At Obsidian Counseling
When you work with a therapist at our counseling practice in the Chicago, IL area, you will be met with compassion and authenticity. The team at our therapy practice feels honored to help guide folks along their healing process. Specifically, we help people in addressing anxiety, depression, trauma, and work stress. One of our more unique services is yoga therapy, which can also be done using online sessions. We also specialize in supporting LGBTQIA+ folks for a variety of issues. We hope that you take the leap to begin counseling with us. You deserve it.
Executive Dysfunction and Why It Shows Up Alongside Depression and Anxiety
Staying organized and being focused can be hard work! Have you ever noticed that during times of high stress your ability to stay organized can feel like rolling a boulder up a hill? Or maybe it’s more like, “I know I had that boulder somewhere, where- in the world- did I put it?”
During periods of extreme sadness, such as depression, or worry, a.k.a. anxiety, our ability to stay organized and problem solve is significantly impacted. You may struggle to remember to pull the laundry out of the dryer or even to feed yourself. Generally, we think of forgetting to do the laundry as a function of depression or worry, but it can also be something called Executive Dysfunction.
What is executive functioning anyway?
Executive functioning is a broad range of skills that affect our everyday lives. More specifically, the cognitive processes that help you organize thoughts, and activities, prioritize tasks, make decisions and manage your time well. For example, remembering to put that laundry away (and actually doing it), paying attention to your boss when they are telling you something important, planning ahead for your next vet visit for your furry friend, etc. When these skills aren’t being performed well, it is called Executive Dysfunction. If you’d like to learn more about executive functioning, you can visit our previous blog about why the easiest tasks are so hard.
The trouble is depression and anxiety are challenging enough. Depression can lead to fatigue, changes in sleeping and eating patterns, persistent sadness, and pessimism; while anxiety can lead to rapid breathing, feeling nervous, restless or tense, and having a sense of doom. That seems like enough for someone to take on at one time. However, just as your feelings shift when struggling with depression or anxiety your thoughts and cognitive processes change. That’s where executive dysfunction comes in (aka difficulty with any number of the functions listed above). Cue the dramatic music: dun, dun, dun.
Why is executive dysfunction important for me to understand when I talk about depression or anxiety?
For one, there are studies out there that suggest executive functioning deficits play a role in the onset, maintenance, or recurrence of depression. Yup, that’s right you read that correctly. Meaning, difficulty with those previously mentioned cognitive processes like:
working memory (where did I put that boulder again?);
organize tasks, (do I take the dog for a walk first or start making dinner?);
critical thinking (did the chicken or the egg come first?);
problem-solving (how do I help a neighbor that is not well?), etc. can lead to depression!
Researchers are still a bit at odds as to whether executive functioning officially leads to depression but one thing is for sure; depression and anxiety significantly impact your brain’s functioning. The higher-order skills, like executive functioning, will show more and more deficits as your depression and anxiety increase in severity. The sadder you feel, the less likely you will be able to plan a 6-course meal for your book club. Worry, too can clog up your memory and negatively impact your ability to get things done in a timely manner.
The “cure” for executive dysfunction and depression
Thankfully, if you are experiencing symptoms of Executive Dysfunction, Depression, and/or Anxiety the first line of defense is to seek out a mental health professional. Therapy is one of the most preferred treatment methods for all of the above. You can talk to your therapist about interventions aiming to improve coping skills and/or executive functions which have been proven to reduce the risk of depression recurrence.
Ready to Begin Depression Therapy in Chicago, IL?
We know that therapy can run to the bottom of the priority list when other things are affecting your life, especially when you’re experiencing executive dysfunction. However, we want you to know that it doesn’t have to be that way! And you deserve healing. That’s why the online therapists at our therapy practice based in Chicago, IL offer depression therapy in Illinois via online therapy. We want to help you connect with yourself and begin healing from the comfort of your own home. Take the steps below to get started.
Fill out a consult form here.
Meet with a depression therapist to see if online therapy is a good fit.
Start connecting with yourself and experience the healing you deserve!
OTHER SERVICES AT OBSIDIAN COUNSELING AND WELLNESS
When you work with a therapist at our counseling practice in the Chicago, IL area, you will be met with compassion and authenticity. The team at our therapy practice feels honored to help guide folks along their healing process. Specifically, we help people in addressing anxiety, trauma, and work stress. One of our more unique services is yoga therapy, which can also be done using online sessions. We also specialize in supporting LGBTQIA+ folks for a variety of issues. We hope that you take the leap to begin counseling with us. You deserve it.
Doomscrolling: When We “Need to Know,” Can’t Stop, and Find Ourselves Anxious
If you haven’t heard of it, you’ve probably done it. First coined in 2018 and leaping to prominence in 2020 both as a concept and a practice, “doomscrolling” is a new and unique phenomenon that has captured many, many people as they struggled to make sense of the Covid-19 pandemic and keep themselves and their loved ones safe. It continues now with the Russian offensive in Ukraine as the new doom darling of news media.
The current definition of doomscrolling in research circles is best summarized as:
The act of spending an excessive amount of time on social media newsfeeds with an obsessive focus on the absorption of negative news. Specifically, that which is distressing, depressing, or otherwise negative.
Put another way – in times of uncertainty people try to gather as much information as possible to better understand their situation. Unfortunately, the information they are trying to gather is usually bad and results in heightened distress, resulting in anxiety or depression, rather than less.
I recall way back on 9/11/2001 my family had CNN on the TV for the entire day. For hours there would be no updates, just the same information repeated endlessly, and yet we couldn’t turn off the TV. We felt a need to know as much information as possible, as soon as possible, and this was the best way to get it.
Then Facebook launched in 2004 and social media became a permanent part of our lives. Now, instead of keeping one ear open for the voice of Anderson Cooper saying “We have just received updates” we can snuggle into our couches or beds and scroll. And scroll. And scroll.
The psychology research community has, thankfully, taken quick interest in doomscrolling so that despite it being a new phenomenon we already have some answers. This study here has developed a technique for measuring doomscrolling which will allow future researchers to continue to study and make sense of this apparent obsession with negative news.
We’ve introduced doomscrolling, and we’ve defined it. Let’s talk more about it, and more importantly, what we can do about it.
Who Engages in Doomscrolling?
Initial research has identified doomscrolling as a distinct concept, although it appears to be related to other online activities such as online vigilance, problematic use of the internet/social media, fear of missing out (also called FOMO). Doomscrolling has also been linked to the following:
· Passive social media use
· Habitual media use
· Anxiety
· Poor self-control
· Multiple personality traits
If you recognize yourself in any of the above you may be more susceptible to doomscrolling. Additionally, men, younger adults, and the politically-engaged have been found more likely to engage in doomscrolling.
The truth is, though, most people have engaged in doomscrolling at some point in their life. We are, in fact, hardwired to do so.
Why Do We Doomscroll?
It should be noted that it is currently unclear whether doomscrolling leads to anxiety or if anxiety leads to doomscrolling. However, the current hypothesis is they feed off each other. That is where I place my money as always seems to be the way with psychology.
Doomscrolling, at its root, is a manifestation of our biological programming. We are programmed to scan for threats. Two-thirds of the cells in our amygdala are dedicated to scanning for threats. The more threats and challenges we encounter over a set span of time the more and more hyper-vigilant we get.
My clients who were the calmest about their Covid-19 hypervigilance where actually the ones with PTSD. Hypervigilance is a symptom of PTSD and indicates a person’s amygdala has gone “code red” and is scanning for threats constantly and without stopping just about every waking minute. They recognized it and knew it for what it was.
Back to that biology. We were designed for threats that we can confront – move away from or scare off a predator, chase a challenger off our land, etc. We were not designed for threats that we can do nothing about.
When the threat is a one-time event, such as a natural force like a hurricane, there is a time limit. We hurricane-proof our homes and seek shelter. At some point the hurricane will make landfall and pass through, and then we clean up. Doomscrolling, while still not productive, also then has a time limit.
A pandemic or a war, however, does not have a set time limit. It can feel inescapable. In these cases, like so many things in our world we are applying our outdated evolution to modern problems. We are trying to gather as much information as possible so we are as well-equipped as possible to confront the threat. Except it is a threat we cannot meet and neutralize in the way we did before civilization. Knowing everything about the Russian attack on Ukraine does not allow us to win the war. Knowing the most current by-the-minute information on Covid-19 does not actually allow us to beat it off with a weapon.
So, It’s Better Just Not to Engage with the News?
Certainly not. Being informed is beneficial. The difference is that doomscrolling goes well beyond the point of gathering useful information.
How Do I Stop Doomscrolling?
Set boundaries – limit when, where, and for how long you engage with your newsfeed. Maybe it is only at breakfast or only after work or absolutely not in bedroom (highly recommended). If you tend to scroll in the evenings absolutely set an alarm to put your newsfeed away at a certain time, preferably a few hours before bedtime.
Avoid confirmation bias – there is no shortage of poor-quality information out there. Social media platforms are also designed to push forward content that resembles what you have already engaged in. Look at the sources critically.
Try kindness-scrolling – Studies suggests that kindness-scrolling may give us those feel-good “hits” that are the opposite to doomscrolling’s feel-bad ones. That may be encouraging your social media friends to post funny pictures, or starting a “say something you like about X” thread. It can also be finding positive videos whether its uplifting TicToks or videos of pets getting adopted.
Remember how this is all designed – Current news media does not stop. It runs 24/7. It also plays on our negativity bias, meaning it specifically targets our brains’ bias for seeking out threats.
No matter how much media you consume there will always be more. There is no way to “catch up” on all the news anymore. So set boundaries. If something really important happens you will definitely hear about it.
Begin Anxiety Treatment for Doomscrolling in Chicago, IL
As said before, doomscrolling is anxiety provoking and creates a lot of negative thought patterns. You deserve healing from the worry that constantly bogs your mind. Find ways to be more present in life and gain tools to manage anxiety with our anxiety therapists. To get started for doomscrolling anxiety at our Chicago, IL-based therapy practice, take these steps:
Fill out a contact form.
Meet with an anxiety therapist to discuss their intervention treatments.
Start the healing you deserve!
OTHER SERVICES AT OBSIDIAN COUNSELING AND WELLNESS
With evidence-based therapy tools, our therapists help folks in addressing depression, trauma (including the treatment of complex PTSD), and work stress. Additionally, one of our more unique services is yoga therapy, which can also be done using online therapy sessions. We also specialize in supporting LGBTQIA+ folks and highly sensitive people for a variety of struggles. Additionally, we support new parents during times of transition. We know that healing takes time, and our therapists want to be a guide along that journey for you.
What Is Acceptance And Commitment Therapy and How Does It Help With Anxiety?
Anxiety is an experience anyone can identify with, whether it is thoughts racing at night or a stomach ache before a big presentation. Anxiety can be a normal part of life and even be helpful, like by alerting us to danger or helping us focus during a test. However, anxiety can also occur in bigger ways leading to impairments in every day functioning. According to the National Institute on Mental Health, 19.1% or 63 million Adult Americans are diagnosed with an anxiety disorder. This leaves many adults seeking therapy services in hopes to relieve their anxiety.
Luckily, anxiety is highly treatable and there are many methods of therapy aimed at helping those dealing with anxiety. Acceptance and commitment therapy, or ACT, is one of the many evidence-based treatments available for managing anxiety.
What is ACT?
The Association for Contextual Behavioral Science defines ACT as “a unique empirically based psychological intervention that uses acceptance and mindfulness strategies, together with commitment and behavior change strategies, to increase psychological flexibility.” Put simply, when learning ACT, clients develop mindfulness skills and learn to create a life aligned with their values. When working with an ACT therapist, clients focus on the six principles of ACT to develop skills to cope with anxiety. The Association for Contextual Behavioral Science explains these principles as:
Acceptance
The practice of making room for unpleasant feelings or thoughts without trying to get rid of them.
Cognitive Diffusion
Understanding that thoughts are bits of language and not inherent truths. Your therapist will help you practice defusion techniques such as imagining thoughts as clouds floating by.
Being Present
Focusing on the here and now, identify what is within your control. Your therapist will guide you through mindfulness activities to help develop this skill. If you know you are working on developing your mindfulness practice already, you might enjoy this blog post about places to take mindfulness walks around Chicago.
Self as Context
Tuning in to the ability to observe one’s thoughts without attachment to them. Notice your thoughts and the part of you that can just notice.
Values
Clarify what you find most important in life, learn to use values to guide decisions.
Committed Action
Take actionable steps to integrate values into everyday life.
What else is ACT used to treat?
ACT has been shown to be effective in treating substance abuse, psychosis, depression, chronic pain, and eating disorders. ACT has also been shown to be effective in treating tinnitus.
How Can I Use ACT?
Learn more about ACT via quick, entertaining YouTube videos with Russ Harris.
Engage in mindfulness practices informally by taking a moment to notice what you are experiencing in the present moment or by using an app like Headspace.
Take a moment to notice each thought or emotion you have without placing judgment or meaning.
Clarify your values through this online value sort.
Begin Anxiety Treatment in Chicago, IL
As said before, ACT is an effective treatment for managing anxiety. You deserve healing from the worry that constantly bogs your mind. Find ways to be more present in life and gain tools to manage anxiety with our anxiety therapists. To get started with ACT for anxiety at our Chicago, IL-based therapy practice, take these steps:
Fill out a contact form.
Meet with an anxiety therapist to discuss their intervention treatments.
Start the healing you deserve!
OTHER SERVICES AT OBSIDIAN COUNSELING AND WELLNESS
With evidence-based therapy tools, our therapists help folks in addressing depression, trauma, and work stress. Additionally, one of our more unique services is yoga therapy, which can also be done using online therapy sessions. We also specialize in supporting LGBTQIA+ folks and highly sensitive people for a variety of struggles. Additionally, we support new parents during times of transition. We know that healing takes time, and our therapists want to be a guide along that journey for you.
How to be an LGBTQIA+ ally: Tips from a Queer-Affirming Therapist in Chicago, IL
Every individual person holds many different identities, and it is likely that someone in your life identifies with the LGBTQIA+ community. Despite the increased support for the LGBTQIA+ community in recent years, members of this group still face barriers and discrimination in many aspects of their lives.
What does LGBTQIA+ mean?
The acronym LGBTQIA+ stands for all sexualities and gender identities, such as lesbian, gay, bisexual, transgender, questioning, queer, intersex, asexual, pansexual, and allies. While the message of this phrase is meant to include all sexual identities and the wide-scale of gender fluidity, it is understood that no one term cannot encompass all the individuals who challenge social norms and the experiences they hold. Therefore, terms that best describe each person’s romantic, sexual, or gender identity continue to be created and shared across this community.
What does it mean to be an ally?
Generally, an ally is a person or group that provides assistance and support in an ongoing way. An LGBTQIA+ ally is responsible for helping the members of a community to feel supported, included, and advocated for. As an ally, you must continuously work to learn more about individuals in the community and understand both their shared and unique experiences. This knowledge aids allies in their actions to address barriers and fight for equality and justice.
How to be an LGBTQIA+ ally
Listen, learn and educate yourself
Do your own research on the history of this community
Don’t rely on the people of this community to educate you
Remain up to date on trending terms and current slang
Confirm the correct use of these words
Language Matters
Always use a person’s preferred name and pronouns
If you don’t know, ask in a respectful manner
Apologize and acknowledge when you mess up
Own up to your mistakes
Do not make assumptions
Never assume an individual’s sex, gender, or orientation
If you’re unsure, use neutral terms and ask if appropriate
Determine where and when an individual is comfortable using their chosen name and pronouns
If you’re unsure, ask if appropriate
Show your support
Speak up if anti-LGBTQIA statements are made around you
Explain how the statement is offensive and harmful
Speak up about the harm of gatekeeping for trans folx
Confront any forms of oppression that you become aware of
Correct others if they misgender someone
Challenge stereotypes that you come across
Show your Interest
Ask appropriate questions about LGBTQIA+ people’s lived experiences
Remind the person they don’t need to share if they aren’t comfortable
Make sure these are done in a safe space and remain confidential
These conversations should be with people you have established relationships with already
You Don’t Need to be an Expert to be an Ally
It is okay to not know everything about the LGBTQIA+ community, but it is important to continue to learn how you, as an ally, can best support those who identify as part of this community. Remember to always be sensitive, open-minded, and accepting when addressing the experiences of LGBTQIA+ people. If you would like more information on the ways that you can become an LGBTQIA+ ally, here are a few additional resources:
Here at Obsidian Counseling, we love what we do and we always do our best to give you the best we possibly can. If you ever need help or guidance, please do not hesitate to contact us.
Begin LGTBQIA+ Therapy in Chicago, IL today
At our Chicago, IL area therapy practice, we are honored to provide space and a supportive environment for gay, lesbian, bisexual, transgender, and queer or questioning individuals. We provide LGBTQIA+ therapy services for youth, adolescents, young adults and college students, and adults. Get started with these steps:
Fill out a consult form here.
Meet with an LGBTQIA+ affirming therapist.
Start authentically connecting with yourself and living life to the fullest!
OTHER SERVICES AT OBSIDIAN COUNSELING AND WELLNESS
When you work with an LGBTQIA+ therapist at Obsidian, you will be met with compassion and authenticity. Our team feels honored to help guide folks along their healing process. Specifically, we help people in addressing anxiety, depression, trauma, and work stress. Additionally, we value the unique experiences of highly sensitive people and young adults and are happy to help them find balance in their lives. We hope that you take the leap to begin your healing journey with our team of specialized therapists whether online or in-person at our Chicago, IL-based counseling practice.
Evidence-Based Therapy
What is Evidence-Based Therapy?
And Why Should I Care or Confirm it’s What My Therapist is Doing?
“Evidence-based” is one of those terms that is all over the medical sphere but can sound ill-defined and unclear to anyone who is not involved in this stuff every day.
It is an important term to know and understand, however, because it has a direct impact on the health care you get. This includes mental health care. Here we will break down what evidence-based practice is and how you can advocate and confirm this is what you are getting in all aspects of your health care.
What is Evidence-Based Practice in Counseling?
Evidence-based practice (EBP) is any therapy that has been demonstrated to be effective in treating identified mental illnesses through peer-reviewed scientific research.
The American Psychological Association (APA) defines EBP has “the integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences.”
The American Counseling Association’s (ACA) Code of Ethics also requires licensed counselors limit themselves to EBP and “do not use techniques/procedures/modalities when substantial evidence suggests harm, even if such services are requested.”
So, What’s Peer-Reviewed Mean?
“Peer-reviewed” has the same definition no matter what science is being studied whether its biology, psychology, or physics. The United States Geological Survey provides an excellent definition:
“A peer-reviewed publication is also sometimes referred to as a scholarly publication. The peer-review process subjects an author's scholarly work, research, or ideas to the scrutiny of others who are experts in the same field (peers) and is considered necessary to ensure academic scientific quality.”
Put another way – if you remember how scrutinizing and judgmental your middle school peers where it is sort of like that just with more at stake. The short version is EBP is the end result of a grueling and frequently lengthy process involving many, many experts and field professionals.
The University of Washington has a quick guide on how to assess if something is peer-reviewed.
When Did Evidence-Based Practice Appear in Mental Health?
“Evidence-based treatment” as a phrase became popular in the 1990s as a result of the scientific method gaining more value within the mental health field. Previously mental health had relied more on subjective reports of treatment effectiveness both therapists and other mental health professionals began pushing in earnest for rigorous studies that could determine the effectiveness of treatments and how best to implement them.
This has resulted in a dramatic increase in the effectiveness of mental health therapy. As TheraNest.com observes “We’re no longer relying on guesswork.”
This also means new methods are discovered and established evidence-based therapies improved and expanded on safely without doing harm to the clients. This accountability is one of the largest benefits of EBP. It ensures clients only undergo treatments that have been proven to be both safe and effective for their presenting issue.
If It Isn’t Evidence-Based Does that Mean Counseling Doesn’t Work?
It doesn’t automatically mean counseling won’t work, but it does mean there are additional questions to ask. You may ask your therapist:
Has this method undergone peer-reviewed research? What was the result?
Why is it not considered evidence-based or validated?
Is this method currently being researched? By whom?
If your mental health provider is vague with any of these questions that is a sign something it not on the up and up. It is true that in order for any treatment method to become evidence-based the evidence has to be gathered. That requires research. Polyvagal theory, for example, is a relatively new method and thus supporting evidence is currently limited.
That being said, if you are being given an experimental treatment your provider is required to tell you this and give you the option to opt out in favor of a proven, evidence-based method. Anything less is illegal.
Is a Therapy Evidence Based if it’s Part of a Clinical Trial?
It is also unlikely a solo therapist or member of a small group practice would be participating in such research, called clinical trials. This is because research must be carefully controlled and monitored in order to be valid and useable. It is difficult to do so when the therapists involved in the study are not part of your research institution.
The National Institute of Mental Health provides further information on what mental health clinical trials are, why they are important, and how a person can sign up to participate in a clinical trial.
Please Note: If your therapist is using a method that is currently in the process of being fully validated as evidence-based you are within your rights to tell your therapist you only want to use fully validated methods. If your therapist refuses get a different therapist.
How Do I Find Out if A Therapy is Evidence-Based?
Thankfully we have the internet to help us answer this question. A quick search of “Is X evidence-based?” will get you the answer you need.
For example, “Is primal therapy evidence based” produces a top result with the following answer drawn from Wikipedia with its own list of supporting citations (citations 39-38, specifically):
“Primal therapy has not achieved broad acceptance in mainstream psychology. It has been frequently criticized as lacking outcome studies to substantiate its effectiveness. It is regarded as one of the least creditable forms of psychotherapy and has been classified in a 2006 APA Delphi poll as ‘discredited.’”
Or this video from Dr. Todd Grande that says, in brief “No.” Primal therapy is not evidence-based.
Primal therapy is one of those methods that has been researched and found to be ineffective. Polyvagal theory, as mentioned above, on the other hand is in the process of being determined effective or not.
Common Evidence Based Therapies
If you would like some additional scholarly information on Complementary and Alternative Healthcare and Medical Practices (CAM), a subject of frequent debate, try this article here.
If you are looking for a short list, however, here are some of the most common evidence-based therapies that you will encounter in mental health, though these are by no means the limit of EBP in mental health:
Cognitive Behavioral Therapy (CBT)
Dialectical Behavioral Training (DBT)
Narrative Therapy
Internal Family Systems (IFS)
Evidence Based Therapy & Mental Health Services in Chicago, IL
Here at Obsidian, our therapists love what we do and we always do our best to give you the best we possibly can. Therefore, at our Chicago, IL, area therapy practice, we offer evidence based mental health services for anxiety, depression, parents, work stress,trauma and PTSD, and more. Additionally, we offer yoga therapy, which can also be done using online sessions. Lastly, it’s also important to note that our therapists are LGBTQIA+ affirming.
Begin Evidence Based Therapy with a Skilled Therapist
So, if you are ready to begin therapy and looking for a therapist who can use truly evidence based practice in counseling sessions, we can help. Please, take the steps below to get started with in person or online therapy sessions.
Fill out a contact form or by calling our counseling practice at (224) 255-4411.
Begin therapy sessions with a skilled trauma therapist.
Start overcoming past experiences and creating a life you desire.
You deserve to find true healing. Going to therapy is never easy, but it absolutely can help and you working with a therapist using evidence based practice gives you the best possible route to feeling better. So, don’t stay stuck where you are right now. Reach out for support. Our therapists are here to help.
Covid-19 is Taking Away Our Mourning and Messing with Our Grief – What Do We Do?
Grief and mourning are two of the most difficult things to work through and are, in my opinion, categorically tragic. Grief frequently lays heavy on us and we may feel as if we will never feel happiness or normalcy like we used to. Mourning is the process through which we express and work through our grief.
Typically, when we speak of grief and mourning it is in regards to the passing of a loved one. While there is an unlimited number of other things that can be grieved and mourned, we are going to stick with this one.
Rituals for Mourning Help us Process Loss & are a Part of Healthy Grief
Every culture has a procedure for mourning and putting the deceased to rest. That is, funerals. For Midwestern European-Americans that can mean waiting up to a week for everyone to gather together followed by a wake, a funeral, flowers, and enough casseroles for the grieving family to feed a small army. For some Jewish families here in the US the deceased is watched over from death to burial as well as ritually washed and clothed in a white shroud being laid to rest. Mexican-American traditional can involve friends and family holding a vigil.
Funerals help with grief. Funerals allow for a community grieving process that is important for healing, and ensures individuals do not feel alone in their grief.
But what happens when there is no funeral? What happens when friends and other loved ones cannot gather around the mourning? The result is incredibly isolating. The result is prolonged grief.
An update to the Diagnostic and Statistical Manual (DSM-5), the document that codifies mental health diagnoses, is due this March. This new DSM-5-TR will include a revised diagnostic understanding of complicated grief under the name Prolonged Grief Disorder (PGD)
Instances of PGD have exploded since the beginning of the Covid-19 pandemic. Not only have Covid caused a staggering amount of death, restrictions on large gatherings in the interest of public health and safety have hijacked our mourning processes.
What is This Doing to Us?
Funerals have been integral to the grief process for, at minimum, 78,000 years. What does it do to us when we don’t have it? It arrests our grief. It inhibits our ability to re-engage with life. Grief should diminish overtime. While one does not “get over” a death, most of us are eventually able to integrate into a life without that person in it.
For some, though, that does not happen. Instead of grief diminishing over time it lasts without reprieve for years and sometimes decades. This is prolonged grief. As a result, sufferers may be unable to maintain their job, care for other loved ones or family members, or even leave their home because the grief has so incapacitated them.
Before the pandemic, PGD affected about 10% of bereaved individuals. Since then that number has skyrocketed. This study from China published in 2021 found an increased prevalence of PGD has high as 37%.
What is Prolonged Grief?
The Mayo Clinic describes complicated grief (soon to be reclassified as prolonged grief) as “painful emotions [that] are so long lasting and severe that you have trouble recovering from the loss and resuming your own life.”
The World Health Organization (WHO) describes prolonged grief as a pervasive longing for the deceased or a “persistent preoccupation with the deceased accompanied by intense emotional pain.” The feelings of continued grief will far exceed the social, cultural, or religious norms for that person’s culture and context.
A person experiencing prolonged grief will have difficulties enjoying their regular social activities and hobbies or interests. They will experience an overall reduced capacity to feel positivity and struggle to accept the death of the loved one.
What Are the Symptoms of Prolonged Grief Disorder?
Thus far, PGD can be identified by a combination of the following:
· Persistent/pervasive longing for or preoccupation with the deceased
· Severe emotional pain that can include
o guilt
o anger
o sadness
· Difficulty accepting the death
· Emotional numbness
· A sense that part of them has been lost
· An inability to experience positive mood
· Difficulty participating in social activities
If you are unsure whether you or someone you know is experiencing PDG, please contact a mental health professional.
What Can I Do to Help Myself or Another Grieving Person?
The CDC offers some advice on how to navigate grief and mourning in the absence of our normal procedures. Some of this includes:
Connect with Others in Whatever Way Possible –
1. Invite others to call you or have a conference call/FaceTime/Zoom with family and friends to stay connected
2. Ask family and friends to share stories, pictures, videos with you over the phone, through email, social media, etc.
3. Coordinate a date and time to gather friends and family to honor your loved one.
Create Memories or Rituals –
1. Create a virtual memory book, blog, or webpage to remember your loved one and ask others to contribute
2. Take part in an activity that has significant to you and/or the loved one who passed. This could be making a favorite meal, watching a favorite movie, planting a tree, etc.
Don’t Be Afraid to Ask Others for Help –
1. Find grief counseling or other mental health services
a. Including support groups or hotlines
b. **Support may be listed as “complicated grief”
2. Find spiritual support from faith-based organizations if applicable to you.
Who Can I Call for Help when I am Grieving?
You can, of course, contact our therapists here at Obsidian at either obsidiancounseling@gmail.com or at (224) 255-4411.
You can also try any of these grief resources:
1. Grief Recovery Institute Hotline: 1-800-445-4808
2. SAMHSA National Helpline: 1-800-662-HELP (4357)
3. National Crisis Text line: Text HOME to 741741
4. TAPS grief hotline for military: 1-800-959-TAPS (8277)
Where Can I Get More Information About Grief & Prolonged Grief Disorder?
If you would like to read more about Covid-19 and PGD here are a few places to get you stated:
Treatment of Complicated Grief: A Randomized Controlled Trial by Shear, Frank, Houck, et. al
Rochester Regional Health Grief and Loss Toolkit
The Center for Prolonged Grief
Counseling for Prolonged Grief Disorder During Covid & Beyond in Illinois
Here at Obsidian, our therapists love what we do and we always do our best to give you the best we possibly can. We often work with people who are grieving using evidence based counseling methods such as EMDR. If you live in the Chicago area or anywhere in Illinois and ever need professional mental health help or guidance, please do not hesitate to contact us.
What is EMDR and How Does It Help Trauma, Anxiety, and More?
Obsidian Counseling and Wellness is happy to offer EMDR treatment services to our clients. Our therapists value using evidence based practice in counseling & psychotherapy. And, we have chosen to provide EMDR because it’s a powerful form of therapy supported by the clinical research.
What is Eye Movement Desensitization and Reprocessing (EMDR)?
Eye Movement Desensitization and Reprocessing (typically just referred to as EMDR therapy) is an intense but brief therapeutic intervention designed to be used in conjunction with other forms of therapy. It is well-researched, safe, and has a proven track record with PTSD, trauma, and many other mental health challenges.
This link will take you to the two-page handout that we give clients to explain EMDR. If you would like to know a little more about what EMDR is and how it works, please read on.
History and Research of EMDR
The process behind EMDR therapy was initially discovered in the 1980s by psychologist Francine Shapiro. Over the course of her career Dr. Shapiro developed and refined a treatment modality she dubbed Eye Movement Desensitization and Reprocessing or EMDR.
The EMDR International Association (EMDRIA) describes EMDR therapy as “an extensively researched, effective psychotherapy method. It is proven to help people recover from trauma and other distressing life experiences. Some of these include PTSD, anxiety, depression, and panic disorders.”
How extensively researched? A Google Scholar search for “EMDR” turns up around 23,000 entries for books and research. As of 2021 we know of over 30 double-blind studies (the most rigorous type of scientific study there is) that have demonstrated at least some kind of treatment benefit from using EMDR.
Both the World Health Organization (WHO) and the Department of Veteran Affairs (VA) also validate EMDR as an effective treatment modality. This short news segment also shows Prince Harry of the British royal family engaging in EMDR to help process the trauma of his mother’s death. Take a look to see an example of the butterfly hug technique.
Is EMDR safe?
There are some people for whom EMDR is not a good choice. Clients with a bipolar disorder or personality disorder diagnosis are not good candidates for EMDR.
For everyone else, yes. It is safe. If performed by a licensed therapist trained in EMDR. One of the beauties of EMDR is that the client is in control. The client is allowed and welcome to stop a processing session at any time. A good EMDR therapist will then check in with the client and help them regain enough equilibrium to continue with the rest of their day.
EMDR Sounds a Little Scary
EMDR is intense, and clients can expect to feel a little drained immediately afterwards. The effects of an EMDR processing session can sit in the back of a person’s mind for multiple days. Clients report flashes of new insight up to several days after an EMDR session and sometimes even relevant dreams.
Again, a trained EMDR therapist will do all of the necessary prep work with you to ensure you have successful processing sessions and are able to go about your day afterwards.
So What exactly IS EMDR?
To keep it simple let’s go letter by letter.
E and M – Eye Movement. Your EMDR-trained therapist will use gentle physical or auditory stimulation to get your eyes to move back and forth (called bilateral stimulation or BLS). Yes, this can sound like hypnotism but please bear with us. This movement opens up both sides of your brain and primes it for the next phase…
D – Desensitization. EMDRIA explains this phrase as dealing with “all of the person's responses (including other memories, insights and associations that may arise) as the targeted event changes and its disturbing elements are resolved.”
Kari, our EMDR therapist, describes this phase as mentally picking up all of the papers that have been dropped and scattered across the floor.
R – Reprocessing. This is where the eye movement gets really important. This is where the client briefly focuses on the trauma or disturbing memory while simultaneously engaging in BLS. This is associated with a reduction in the vividness and emotional intensity associated with the disturbance being addressed.
Kari explains this as putting the papers in order, placing them in the correct filing cabinets, and then closing the drawers.
EMDR does not remove the memory but it takes the heat and the intensity out of it and moves it from a near re-lived experience to its appropriate place in the brain as a memory.
What Mental Health Conditions can EMDR Treat?
Originally designed as a trauma-processing technique, EMDR has also been found to be effective for
· Anxiety
· Panic attacks
· Stress
· Phobias
· Self-esteem and performance anxiety
Why Might EMDR Be a Good Choice for Therapy?
EMDR therapy is a short-term therapeutic intervention that is meant to be used in conjunction with other forms of therapy. Because it helps a client delve deep into the brain it can accomplish some kinds of healing faster than traditional talk therapy. And many people may find it easier than having to talk more in depth in traditional talk therapy. It can even be useful for treating complex PTSD (cptsd). However, this is still an intense form of therapy and not everyone is suited for it nor wants to do it. Again, the beauty of EMDR is that it is up to you.
Begin EMDR Therapy in Chicago and Online Throughout Illinois
Are you tired of struggling with PTSD symptoms, frequent anxiety, self esteem issues or grief? EMDR may be able to help! At our Chicago, IL area therapy practice, we are committed to helping people find healing and offering online EMDR therapy is one way we do that. Our therapists provide mental health services for youth, adolescents, young adults and college students, and adults. If you would like to explore whether EMDR is the right treatment for you or to begin EMDR in Illinois, please follow these steps:
Fill out a consult form here or call us at 224-255-4411.
Meet with an EMDR therapist.
Start finding healing from past pains and begin fully living in the here & now!
Other Mental Health Services in Chicago
While EMDR is a great treatment for PTSD, anxiety and several other mental health issues, it isn’t the only type of psychotherapy service we provide at our Chicago based counseling practice. We value providing a variety of evidence based counseling services so you can truly be your best self. Whether you’re looking for parent counseling, teen therapy, depression treatment, help navigating the world as a highly sensitive person, LGBTQ+ affirming mental health care or many other mental health concerns, we can help. So, if you’re ready to begin your counseling journey, please reach out to us today.
Ambiguous Loss: The Grief of What is There but We Cannot Have
The end of the calendar year is a time focused heavily on loving bonds and family. From November through the end of December 30 different religious holidays are celebrated across the world. With so much focus on togetherness the “holiday season” weighs heavily on anyone who is grieving a loss or missing the presence of loved ones.
Family estrangement comes into particular focus this time of year given the number of religious and secular holidays that emphasis family involvement and engagement. However, some are ostracized from their families. Some have separated from their families for their own safety or well-being.
These are still losses. They are nebulous and difficult to navigate, and they are seldom identified as what they are: ambiguous losses.
What is Ambiguous Loss?
Ambiguous loss is a loss that occurs without closure or clear understanding. This can include:
· Sudden break up/end of relationship
· Sudden death
· Miscarriages and stillbirths
· Family estrangement
· Divorce
· Death without funeral rites
In these types of cases the lack of closure and/or clear understanding of what happened delays or sometimes halts the grieving process.
Here in 2021 with the Covid-19 pandemic still ongoing the inability to either have or participate in a proper funeral has made working through the grieving process very difficult for many people. How are we to grieve when we don’t get to follow the script? Funeral rites are important and are there to help us with our grief.
Ambiguous loss also occurs when one loses something that still exists, or might still exist, but is inaccessible to you. This can include:
· Missing/lost pet
· Missing person or POW
· Refugee status away from home country
· Immigration
· Dementia
· Addiction
· Loss of previous lifestyle due to disability, medical loss, pandemic, etc.
With these types of ambiguous loss, the grief process can be stalled because the thing we are missing and grieving is still there, or might still be there. It is very difficult to know how to grieve something that is not actually gone but we cannot have.
What Makes Ambiguous Loss So Challenging?
The difficulty with ambiguous loss is it can leave a person with unanswered questions. This complicates and delays the grieving process and can result in unresolved grief. The big question is how to grieve when closure is not an option.
What Does Ambiguous Loss Look Like?
While the symptoms of ambiguous loss have some similarities to other kinds of grieving there are some key differences that therapists look for. Tikvah Lake recently did their own post and outlined these symptoms:
· Sadness about a situation/event but not knowing why
· Feeling others are minimizing your feelings
· Feeling unheard and unsupported
· Thinking you’re going crazy
· Thinking you are being “dramatic,” “overacting” or “making a big deal of nothing” (you aren’t)
· Experiencing guilt for feeling so sad, especially if a person may still be alive
· Vacillating being hope and hopelessness
· Survivor’s guilt
· Being consumed by uncertainty
· Symptoms of
Anxiety
Depression
Obsessive Compulsive Disorder
PTSD
Drug/Alcohol use to numb distress
What is the Healing Process?
The healing process with ambiguous loss is really best done with a knowledgeable mental health professional. We here at Obsidian are, of course, ready and happy to help you with any type of grief or loss you may be struggling with. But in addition to that, here are some other tips:
Give it a name – Knowing that what you are experiencing has a name and being able to identify it is the first step in building resilience to your loss.
I was once wisely told by a mentor, Mr. Bryian Winner, “If what you are experiencing has a name it means others have gone through it. If others have gone through it that means others have survived it. And if others have survived it there is no reason you cannot as well.”
Join a support group – Find others who are experiencing what you are. The healing power of shared experience cannot be ignored. Whether its online or in-person find a community of people where you can feel heard and seen.
Celebrate what remains – It will take time. Embrace the bittersweet, the happy-sad. Even while we grieve what is lost, we can still sometimes find good nuggets amidst the sadness. Maybe your crochet buddy can’t crochet anymore because of arthritis in their hands, but they can still be your lunch buddy or movie-friend. Or there may be a child or mutual friend that you can connect to in new ways.
Discover hope for the future – It is a little arrogant of me to say something like this while you, the reader, are likely grieving and struggling. However, once we can become comfortable with the uncertainty and ambiguity of these losses we are freer to think of and discover new sources of hope.
Dr. Pauline Boss, who first identified ambiguous loss, has more information on this healing process here. She identifies the following:
1. Finding Meaning:
· Make sense of the loss through naming it,
· Talking with peers,
· Continuing but changing family rituals and celebrations.
2. Adjusting Mastery: Modify the natural desire for control and certainty through
· Acknowledging the world is not always fair,
· Managing and making decisions,
· Addressing one’s internal experience through mindfulness, exercise, music, etc.
3. Reconstructing Identity: Knowing who you are now through
· finding supporting family, friends, or chosen family,
· Redefining your family’s boundaries,
· Being flexible as family roles are redefined,
· Identifying who is in/out of the new family system
4. Normalizing Ambivalence: Managing the anxiety from mixed emotions by
· Knowing conflicted feelings are normal,
· Talking about them with a professional
5. Revising Attachment: Letting go without certainty of loss through
· Recognizing that a loved one is both here and gone by
· Grieving what has been lost while also
· Acknowledging/celebrating what you still have, and
· Finding new human connections
6. Discovering New Hope: Finding new hope when your loss remains ambiguous
· Imagine a new way of being,
· Imagining new future plans or dreams,
· Identify your spirituality,
· Seek encouragement through family and friends
Here at Obsidian, we love what we do and we always do our best to give you the best we possibly can. If you ever need help or guidance, please do not hesitate to contact us.
Or, if you would like additional information on ambiguous loss, please visit any one of these resources:
Mental Health Technology Transfer Center Network – Covid-specific loss
National Council on Family Relations – Resources
For those of a scholarly mind, try these published research articles:
Ambiguous Loss Theory: Challenges for Scholars and Practitioners by Pauline Boss
Ambiguous Loss and the Family Grieving Process by Betz and Thorngren
Using Ambiguous Loss to Address Perceived Control During the COVID-19 Pandemic by Rosemary A. Leone
The COVID-19 Disappeared: From Traumatic to Ambiguous Loss and the Role of the Internet for the Bereaved in Italyby Testoni, Azzola, Tribbia, et al.
The Endless Grief in Waiting: A Qualitative Study of the Relationship between Ambiguous Loss and Anticipatory Mourning amongst the Relatives of Missing Persons in Italy by Testoni, Franco, Palazzo, et al.
Toxic Positivity: Too Much of a Good Thing
Good vibes only. Other people have it worse. Being negative isn’t going help you.
Toxic positivity is a problem and a phenomenon that just about everyone has experienced—anyone on social media has definitely experienced it—but few people know it. It is increasingly prevalent and, as such, is garnering increasing attention in the psychology field.
Toxic positivity may seem like an oxymoron. How can positive be bad? Positivity becomes toxic when it is empty and excessive and when it ignores the necessity and reality of negative emotions. There are multiple definitions of out there but this one from The Psychology Group is a favorite:
“…the excessive and ineffective overgeneralization of a happy, optimistic state across all situations. The process of toxic positivity results in the denial, minimization, and invalidation of the authentic human emotional experience.”
Medical News Today describes it as “an obsession with positive thinking…a belief that people should put a positive spin on all experiences, even those that are profoundly tragic.”
Why Does Toxic Positivity Happen?
The short answer is discomfort.
Sometimes a friend or loved on just doesn’t know what to say and so tries to find something pithy and positive to feel like they’ve contributed or supported you. A word of advice for all – if you don’t know what to say it is perfectly acceptable, and advisable, to say just that.
“I don’t know what to say to make this better.”
“I wish I had the words to fix this.”
Other times your friend or loved one does not want to be confronted with your negative emotions because it makes them uncomfortable.
And that is okay.
It is okay to be uncomfortable with someone’s negative emotions. But avoiding them communicates negative emotions are unacceptable, which brings us right into our next topic.
What Toxic Positivity Ignores and What it Creates
The problem with toxic positivity is that it denies the very existence of negative emotions. When a person is suffering, they need to know their emotions are valid and accessible. Instead, toxic positivity creates shame, guilt, and inauthenticity.
Shame – toxic positivity tells us our negative emotions are unacceptable.
Don’t get me wrong. Negative emotions are not fun, and they are frequently difficult to navigate. But they are natural and a necessary part of being human. I tell my clients every emotion they feel is valid and that they are feeling them for a reason. The difference lies in what we do with that emotion, but that is for a different conversation.
Guilt – toxic positivity also sends the message if you are not finding a way to feel positive, all the time, even in the face of tragedy, that you are doing something wrong.
Positivity all the time is not just unnatural it is also just not possible. There are some things that are just not positive and will never be okay no matter which way the situation is looked at. There are others that will only look positive in hindsight if everything does happen to turn out as a result. That’s as a result, not in spite of.
Here is what I mean: say you get fired from your job and ultimately you are hired somewhere new with better pay and a better work environment. In hindsight being fired was a good thing because you wound up with a better job because of it. But at the time being fired was still awful.
Inauthenticity – toxic positivity avoids authentic human emotion.
At its root toxic positivity is an avoidance mechanism. When someone engages in toxic positivity it allows them to circumvent emotional situations that make them uncomfortable whether the situation is yours or their own. As a result, these uncomfortable emotions are discounted, dismissed, and denied.
Emotional Junk Food
I see toxic positivity as emotional junk food. Junk food fills you up but it’s empty calories. Toxic positivity, likewise, is empty positivity. I often see it expressed as a short, pithy statement that allows the giver to quickly move on—because of that discomfort we mentioned earlier—rather than sit with the receiver and support them through their difficulty. This seems to be particularly true in both uncomfortable situations and times when the giver does not know what to say.
Here are some examples and some things you can say instead. These suggestions are lifted directly from Science of People’s excellent and extensive article on the subject:
Instead of…. Say…
“It’ll all be fine.” “How can I help you?”
“You should smile more.” “Is everything okay?”
“Don’t worry about it.” “What can I do to make it less stressful for you?”
“It could be worse.” “This is tough; can I do anything?”
“Don’t be so negative.” “It must be hard. Tell me about it.”
“Always look on the bright side!” “It’s so hard to see the good in this situation, but we’ll
make sense of it when we can.”
“Everything happens for a reason.” “Do you want to talk about it?”
Replacing Toxic Positivity with Tragic Optimism
Dr. Scott Barry Kaufman provided an article for The Atlantic positing that the solution for toxic positivity is “tragic optimism,” a term first coined by Viktor Frankl an existential-humanistic psychologist, Holocaust survivor, and one of the giants of 20th century psychology.
Tragic optimism is the search for meaning amid the unavoidable tragedies of human existence. It is accepting the bad and through that seeing and being grateful for the good. Frankl himself defined tragic optimism as the decision to say “yes” to life despite all of its pain, guilt, and death and to counteract these negative inevitabilities with hope, faith, and love.
The BBC has a quality article from earlier this year on using tragic optimism to combat toxic positivity.
How to Avoid Toxic Positivity
To wrap up here are some strategies for avoiding toxic positivity directed at oneself or imposed by others.
Avoiding self-directed toxic positivity –
· Recognize negative emotions are normal and a natural part of being human.
· Identify and name emotions rather than avoid them.
o If you’re not confident with this go here to find an “emotion wheel” and how to use it. My clients love the emotion wheel.
· Talk to trusted people about emotions, including the negative ones.
· Find support from nonjudgmental people including trusted friends or a therapist.
Avoiding toxic positivity from others –
· State to them you need to work through these negative emotions.
· Validate your emotions to them.
· Verbally communicate they can walk away if this makes them uncomfortable
o but you are going to work through these negative feelings rather than ignore them.
· Walk away/find someone more validating if this person cannot be authentic with you and your negative emotions.
Here at Obsidian, our therapists love what we do and we always do our best to give you the best we possibly can. If you ever need help or guidance, please do not hesitate to contact us at the following:
References Related to Toxic Positivity
Campbell-Sills, L., Barlow, D. H., Brown, T. A., & Hofmann, S. G. (2006). Acceptability and suppression of negative emotion in anxiety and mood disorders. Emotion, 6(4), 587–595.
Ellard, Kristen K. et.al. April 11, 2017. Neural correlates of emotion acceptance vs worry or suppression in generalized anxiety disorder. Social Cognitive and Affective Neuroscience, Volume 12, Issue 6, June 2017, Pages 1009–1021,
Levitt, Jill T. et al. The effects of acceptance versus suppression of emotion on subjective and psychophysiological response to carbon dioxide challenge in patients with panic disorder. Autumn 2004. Behavior Therapy. Vol 35.4, pp 747-766.
Lukin, Konstantin Ph.D. Toxic Positivity: Don’t Always Look on the Bright Side. August 1, 2019. Psychology Today.
Scully, Simone M. ‘Toxic Positivity’ Is Real — and It’s a Big Problem During the Pandemic. July 22, 2020. Healthline.com.
Revenge Bedtime Procrastination: The Reason You’re Staying Up Way Past Your Bedtime
Many of us did it as children. Under the covers armed with a book and a flashlight or a gaming system we put off bedtime in order to finish one more chapter or get to the next level. Now, as adults, we are doing the same thing except this time we really want to go to bed but we just…don’t.
This is revenge bedtime procrastination, and its prevalence increased sharply with the onset of the Covid pandemic and quarantining measures. According to the National Sleep Foundation revenge bedtime procrastination is “the decision to sacrifice sleep for leisure time that is driven by a daily schedule lacking in free time.”
Based upon my clinical observations over the course of the pandemic I am adding meaningful free time because many found more time on their hands but there was still an increase in revenge bedtime procrastination that does not fit the above definition precisely.
Why “Revenge”?
Adding “revenge” to idea of bedtime procrastination began on social media and is an English-language translation of 報復性熬夜 “bàofùxìng áoyè” a phenomenon observed in China wherein young, stressed Chinese employees sacrifice sleep for meaningful leisure time even knowing it is ultimately unhealthy.
This practice of delaying sleep in order to eke out some sort leisure time is seen as getting “revenge” on the daytime activities, chiefly work and other obligations, that rob the individual of free or “me” time while the sun is up.
This idea, as said above, has gained global traction in the face of the stress caused by Covid-19.
Why Do We Do It?
The psychology science behind sleep procrastination is still relatively new. As a result, there is not yet a definitive answer on what drives us to do this.
One train of thought looks at the intention-behavior gap. This is the gap between someone’s desire or intension to change their behavior and the actual follow through. It is the difference between “I want to lose weight/stop smoking/reduce my drinking, etc.” and actually enacting the behavior changes that make this happen long term.
One explanation for this gap with revenge bedtime procrastination is a failure of self-control given that our capacity for self-control is at its lowest at the end of the day after the demands of work/school, etc. reduce our reserves of control available by nighttime.
Not everyone agrees with this explanation, however, because of the emphasis it places on self-control. Others argue it may have more to do with natural circadian rhythms with night owls trying to adapt to a schedule that is designed for early birds. Additionally, revenge bedtime procrastination also not be so much a failure of self-control but more an attempt to recover from stress.
While more research needs to be done, anecdotally this is what I am seeing more of in my office. Recall I added meaningful to the definition of revenge bedtime procrastination. Within the context of Covid-19, I believe the reason I have seen more of this reported in my practice over the past 18 months is the lack of both meaningful daytime activity—while work may not be fun it has a purpose, and thus meaning—and positive anticipation.
By that I mean good things to look forward to. Overall, there were no trips to the movies, weekends away, cook outs, holidays with families, sports to attend or play. None of the positive rhythms by which we mark our lives. Even for those who live for the weekend (which I do not recommend, by the way) after five days the weekend and all its positive potential arrives. During the pandemic the weekend meant…sitting at home. Even the “introverts” got tired of it.
As a result, more and more people began to search for daily meaning and human contact through the only avenues available. For many this was the internet. Endlessly scrolling through social media and the news, dubbed “doom scrolling,” in a simultaneous attempt to “stay ahead” of the virus and its dangers while also seeking anything that could assuage our anxiety or bring a little spark of joy.
I, myself, was subject to this many, many times to the point where I now have an alarm on my phone to stop looking at all news and social media at 9pm. Granted, in my own revenge bedtime procrastination that just meant endless YouTube documentaries, anime, or my umpteenth playthrough of “Legend of Zelda: Breath of the Wild.”
How to Combat Revenge Bedtime Procrastination
We know the what, and we know some of the why. So now let’s see what we can do about it.
As with all things involving sleep, good sleep hygiene goes a long way. This includes creating good sleep habits and an environment conducive to sleep. This means an inviting bedroom that is dark, comfortable, and not associated with other activities. If you have a desk, TV, or game system in your bedroom I strongly recommend moving it if possible.
This also means no electronics for no less than an hour before bedtime.
I am willing to bet your doctor has told you this but probably not why. The blue light emitted by our screens is processed by our brains as something akin to sunlight. As far as our brains are concerned this means its “awake time.” Even if you turn off the screen and immediately fall asleep the quality of the sleep is poor because a part of your brain is still up and active. This essentially loses hours of good “night time” sleep and is closer to a nap rather than actual sleep for all intents and purposes.
Just like my “no doom scrolling” alarm I have another one on my phone for an hour before bedtime. I use this hour to get ready for sleep and read in bed via regular lightbulb or my Kindle depending. All of the lights in my home have a light color under 4000K so that I don’t wind up with the same blue light problem anyway. This is the one thing I miss about my old warm white florescent lightbulbs.
For an excellent article on how different lightbulbs effect our eyes, our sleep, and overall health please go to this blog post from Natural Eye Care.
The other best practices for quality sleep hygiene and combating revenge bedtime procrastination are creating routines that can be done semi-automatically. A regular, consistent bedtime all seven days of the week, and a consistent nighttime routine can help with impulses to stay up later instead of heading to bed. We are, after all, creatures of habit.
In addition to teeth brushing and all that many enjoy reading a book via lightbulb or Kindle. Relaxation routines such as gentle stretching or guided meditations from YouTube or a sleep support app are popular with some of my clients.
Where Can I Learn More?
For some more information on revenge bedtime procrastination try these articles from WebMD and Healthline.
Here at Obsidian, we love what we do and we always do our best to give you the best we possibly can. If you ever need help or guidance, please do not hesitate to contact us at the following:
What is Self-Care, Really, and What Can it Look Like?
“Self Care” As a Term is Getting Popular
Interest in self-care has been growing of late. According to Google Trends, the number of searches for “self-care” have doubled since 2015. This month the term was at the center of Olympic discourse with Simone Biles withdrawing from her events for her self-care. “Do your self-care” is a mantra in the mental health field. Its meaning is relatively easy to figure out: take care of yourself.
But what does self care really look like?
But what does that mean, really, and what does it look like? The World Health Organization (WHO) defines self-care as “the ability of individuals, families and communities to promote health, prevent disease, maintain health, and to cope with illness and disability with or without the support of a healthcare provider.” As you can see, self-care is actually a broad concept that encompasses all aspects of a person’s life including hygiene, nutrition, and even environmental and socioeconomic factors.
In simpler terms, as the medically reviewed everydayhealth.com describes it, self-care is taking care of yourself so you can be healthy, well, do your job, help and care for others, and accomplish the things you want to in a day. As Brighid Courtney of the Wellness Council of America say:
“When self-care is regularly practiced, the benefits are broad and have even been linked to positive health outcomes such as reduced stress, improved immune system, increased productivity, and higher self-esteem.”
Self Care is Not Just “Treating Yourself”
Let’s start by making one thing clear: self-care is not the same as self-indulgence. The rallying cry of social media self-care seems to be “treat yourself!” While treating oneself is certainly an aspect of a solid self-care regime, spa days, booze, and retail therapy are not the end all and be all of self-care. Especially if they are just too expensive for you to do on the regular.
Self-care requires having some understanding of what makes yourself tick. What sorts of things make you feel recharged, replenished, and happy?
Maybe its cooking. Maybe it’s definitely not cooking. Maybe it’s living it up Friday night and then taking Saturday to yourself. Maybe it’s time with your kids and time without your kids. There are those opposites again. I have yet to meet a parent who does not savor both time with and away from their children.
Types of Self Care
As you may have gathered from the WHO definition above there are different types of self-care. Let’s take a look at a few so we can get closer to that answer of what self-care can look like:
Emotional Self-Care
This can include positive self-talk, a monthly massage, weekly bubble bath, saying “no” to things that cause unnecessary stress (including work requests!), scheduling a regular lunch date with a friend, or giving yourself permission to take a break.
Physical Self-Care
Physical self care can mean getting enough sleep on the regular, eating nourishing foods, finding some sort of exercise/physical activity routine that you can actually stick with (make it something you like rather than a chore), and getting your annual physical with your doctor.
Spiritual Self-Care
Spiritual self-care can be attending religious services but it can also be taking time to meditate or find a “guided imagery” video on YouTube, identifying three good things that happen each day, or keeping a gratitude journal or photo series. This can also include spending time in nature or any place that is peaceful for you.
Temporary Self-Care
These are acts or activities wherein you will benefit but the act but the benefit does not last for long after you finish. This could be the social connection of time with a friend or the calming effect of listening to a favorite playlist or taking a ten-minute break at work.
Enduring Self-Care
These acts have longer-term effects. This could mean reducing or quitting cigarettes, regular exercise that maintains muscle tone as you age or strengthens your heart. This could also mean mindfulness practices that over time lead to physical brain changes. Identifying three good things every day is one of my favorite mindfulness practices to teach clients because it is simple to do, takes little time, and has had demonstrable positive effects.
A Quick Aside for Three Good Things
I feel I should explain what this activity is as I have mentioned it twice. “Three good things” is any good thing that happened throughout the day. They do not have to be big like the completion of a project at work. And they are certainly not negatives wrapped in a positive like “My boss didn’t yell at me today.”
They are little things like:
· The sky is blue today.
· I saw a dog.
· I made it through that light before it turned yellow.
· A song I like played on the radio.
· A meme made me laugh.
I encourage clients to write these things down at first. Not necessarily to keep but to take note of and make sure they hit three a day. Over time one becomes able to find the three good things automatically, and frequently it becomes far more than just three things.
Let’s Summarize
At the end of the day, self-care is anything that helps you de-stress, carve out time for yourself, and bring you happiness. Even if it is just stepping outside to take a deep breath – that is quality self-care!
It can also be making daily tasks more enjoyable. You can pick a soap you particularly like the smell of and focus on the physical sensations of showering: the feeling of water hitting your skin, the sound within your shower, the smell of your soap… for even 10 minutes in the shower this is a more mindful and centering way to go about it rather than letting your brain run hog wild over all the stressful things awaiting you today.
Self Care Resources
If you would like more resources on the various ways you can do self-care here are just a few to get your started on this extensive topic:
Self-Care and Self-Compassion from U. of Toledo
9 Signs You Need Better Self-Care and May Be a Trauma Survivor
Taking Mindfulness Walks in the Chicago, IL area
Why Does Self-Care Sometimes Feel So Hard?
Why Self-Care Can Help You Manage Stress
7 Elements of Self-Care from Silver Hill Hospital
Here at Obsidian, our therapists love what we do and we always do our best to give you the best we possibly can. If you ever need help or guidance, please do not hesitate to contact us at the following:
Genderfluid Makes it to the MCU – Why that’s Important and What is Still Left to Be Said
Last month Marvel Cinematic Universe (MCU) fans where abuzz with the official revelation that Loki, a god of Asgard from Norse mythology and purveyor of curved and pointy hats, is genderfluid and/or non-binary. Various publications have used either or both terms. For this post I am going with genderfluid based on this interview with actor Tom Hiddleston who has brought Marvel’s Loki to life for us.
Now, as a fan of mythology more than the MCU, I could not help but think of Sleipnir, Odin’s eight-legged horse, and chuckle. Sleipnir was Loki’s son after he turned in a horse, a female horse specifically, and birthed the mighty stallion. While I am all here for it, this corner of Norse mythology is probably one too far for the MCU.
My own amusement aside, this in-canon statement is significant for many, many people. Before we get to that let’s take a look at terms in play. Gender is a socially constructed expression. It is different from sex. The World Health Organizationsummarizes gender beautifully.
Non-binary (also spelled nonbinary) or genderqueer is an umbrella term for any gender identity that does not fall strictly into a male/female dichotomy. That is to say, a gender identity that is not strictly female or strictly male. From there the terms become more specific such as…
· Having two or more genders: bigender or trigender,
· Having no gender: agender, nongendered, genderless, genderfree,
· Having no name attached to gender: third gender or other-gendered,
· And fluctuating along the gender spectrum: gender fluid,
This is another reason I am going with genderfluid in this post – it appears to be most specific to the character. Granted, the mythological Loki may have been more species-fluid than genderfluid but, again, that is probably pushing the MCU a little too far. So, let’s get back to MCU Loki and why his gender identity in one of the most popular and expansive cinema franchises is so important.
Loki is an extremely popular character within the MCU. Many enjoy and identify with the trickster god of Asgard. Having such a popular character be genderfluid rather than writing him off as a shape-changing mischief maker opens many doors for fans and viewers.
For one, the validation this provides is huge. Loki is not a side character. He is not a footnote. He is so popular he has his own TV show. His gender identity is accepted and acceptable. It is a fundamental part of Loki’s identity and character just as it is for genderfluid fans. There will be viewers who are seeing themselves for the first time in Loki, have a name for their experience for the first time, or have had their experience validated for the first time.
For another, this is an entry point for difficult personal discussions. Representation always makes these conversations easier. A genderfluid individual can now use Loki as both a positive example and a jumping off point for conversations with the people in their lives.
There is, however, still much to be done. This is regrettable. Given Loki’s popularity so much could be done with and said about this character. I spent an hour with every search variation I could think of to find news articles exploring the importance of a main stream character outside of the gender binary. I was surprised that I could not find a single major or moderate publication that said anything more than “MCU Loki is genderfluid. It says so in the comics and mythology so here we are.”
I also checked with queer colleagues who are watching the show to confirm what is being done with this fact in the show. I was saddened to learn the answer is nothing, really. Loki is presenting as female but that appears to be it. This makes what was originally an exciting announcement feel more like token representation.
Tokenism is the practice of making a minimal effort or concession, particularly to a minority or oppressed group. This is regularly enacted when a company, property, etc. wants to give the appearance of being inclusive or accepting. The Guardian had two particular articles this year that highlighted companies that fund anti-LGBTQIA+ activities while also selling themed merchandise during Pride month. These articles can be found here and here. Dance Magazine also published a pointed and accurate article on tokenism earlier this year.
Tokenism is cheap. It is not a starting point so much as a throw away, and given Marvel’s justification that Loki is genderfluid in both the comics and the original mythology this new canon, while important, does not put the company at much risk. There has been nothing, so my research tells me, that cannot be edited out for foreign markets, such as China, were the MCU is also popular, as pointed out by The Federalist.
When all is said and done, Loki’s gender identity is important but as media consumers we should not stop at one-off token representation. We must continue to demand meaningful content and representation. Maybe we need to have the birth of Sleipnir in the MCU after all.
Are you looking for gender affirming mental health support in the Chicago, IL area?
Here at Obsidian, our therapists love what we do and we always do our best to give you the best we possibly can. We are LGBTQ+ affirming and want to provide a safe environment for people of all genders in Illinois struggling with trauma, parenting stress, anxiety, depression or other mental health concerns. If you ever need help or guidance, please do not hesitate to contact us at the following:
Telehealth is Here to Stay: What Should I Know and Can I Voice a Preference?
Mental health professionals in Illinois were all abuzz last month because the Illinois government approved what is to us a groundbreaking bill: insurance companies in Illinois are required to cover telehealth mental health sessions at the same rate as in-person sessions. The measures put in place during the pandemic quarantine are here to stay.
If you want to read the bill the full text can be found here.
Now that telehealth is going to be a permanent fixture of mental health in Illinois, we thought we would try to address some of the likely questions people will have about doing mental health therapy via telephone or video.
Is Online Counseling as Good as In-Person Therapy?
The research has long show that telehealth is just as effective as in-person therapy for many issues, though certainly not all. Obviously, personal choice also plays a large factor. There are also differences between a session delivered via phone call and a video.
Research About the Effectiveness of Online Therapy for Mental Health Concerns
For those of you who are inquisitive, curious, or maybe just looking to pass the time here is a small sampling of research that has been done demonstrating telehealth to be effective for many mental health issues. As you will see, research on this subject goes back nearly 20 years:
The Effectiveness of Telemental Health: A 2013 Review
The Current State of Telehealth Evidence: A Rapid Review – published 2018
Telemental Health Care, an Effective Alternative to Conventional Mental Care: a Systematic Review
Benefits and Challenges of Conducting Psychotherapy by Telephone
What are the Benefits of Online Therapy or Telehealth for Mental Health?
The benefits to clients seeking mental health treatment are manifold and vary from the clinical to the practical. Here are the top ones that I have seen in my therapy practice:
· Clients can have therapy in a place they are comfortable in.
· Accessibility for anyone who cannot make it to a physical office for whatever reason.
· Less commuting time!
· Which then means more scheduling options outside of the after school/work hours that are always in high demand.
· Sessions can be held even while out of town, assuming you are still in-State.
What are the Challenges of Telehealth?
While my clients and I have found many benefits to telehealth during the pandemic quarantine there are still challenges. These are the top four my clients and I discovered:
· Connectivity issues – an interruption to the phone or internet connection takes up valuable session time or could disrupt an important moment in session.
· Distractions – a dog barking, a family member walking in, a child needing attention, etc.
· Client protection of confidentiality may be limited or compromised.
· The therapist may miss non-verbal cues.
There is something to be said for the energy of being in the same room as your therapist. Telehealth can lose that element that is important for some clients.
Even when conducting a video session, the therapist may miss non-verbal cues such as fidgeting that are out of camera view or an odor that suggests the client is under the influence of a substance or has not been able to wash themselves and/or their clothing. Additionally, the jury is also still out on whether telehealth is an effective mode of treatment for severe conditions such as psychosis or for social skill training.
The APA lays out some of these most important challenges here. There is also the simple fact the vast majority of therapists were trained to conduct in-person sessions. Those skills may not necessarily translate into confident and competent telehealth care.
I encourage you to advocate for your care by talking to your therapist about what they have done to increase their knowledge and competency around telehealth if they continue to offer it post-quarantine.
Is Online Therapy Secure and HIPAA Compliant?
Extra steps need to be taken to ensure telehealth is secure and confidential. A therapist’s office has a certain level of confidentiality built in given it is a separate location away from your home and family members.
From the therapist’s side – besides being in a private location everything needs to be HIPAA compliant. For traditional telephones that means a secure landline. For cell phones this means a secure connection with client contacts either saved elsewhere or behind an additional level of password protection. If the therapist is using a cell phone they will ideally use a HIPAA compliant app such as iPlum which markets itself as the #1 HIPAA compliant second line phone app.
For video sessions either a practice management software with a built-in HIPAA compliant video feature (such as SimplePractice) or an independent but still HIPAA compliant video software. Doxy.me rose through the ranks as a compliant and secure alternative to Zoom for all sorts of virtual health visits.
Tips for Privacy During Online Counseling Sessions
For clients – the key is privacy. This can be difficult when at home with family members. During the pandemic our clients utilized these methods:
· Scheduling sessions for when other family members are out of the house.
· Having family members leave the house for that hour.
· Participating in the counseling session from a vehicle.
· Reserving a conference room/closed office.
Another concern for clients is safety. It may simply not be safe to do therapy while inside or near the home. If that is the case, talk with your therapist to identify safe alternatives. Telehealth may not be the best option for you.
Who May Telehealth Be Particularly Suited For?
There are multiple life styles and situations that may be particularly suited to telehealth. This includes those living in rural communities or anyone with limited access to transportation such as those with disabilities, the homebound, or those without access to child care. And, of course, anyone who simply does not have the time to commute to an external office at any point in their day.
This brief from SAMHSA goes into the various challenges connected to mental health in rural areas. In totally it is somewhat beyond the scope of this article, though still worth a read. For our purposes here it points out the accessibility barriers to mental health – chiefly time and availability of resources. There are simply not many mental health resources in our rural communities. It is not unusual for the nearest therapist to be an hour, or even two, away. A three-hour weekly commitment it just not viable for most. But a phone call or video session that is only 50 minutes can be.
Here is just one study showing the efficacy of telehealth for homebound individuals. For anyone with transportation challenges telehealth can be essential as all that is needed is a secure, confidential place to talk and a secure phone/internet connection. The same can be said for anyone who has children old enough to be unsupervised in the other room but not old enough to be left home alone.
Do I Have to Use Online Therapy Services Now?
No. Per the new legislation, you cannot be forced to do in-person or telehealth sessions. Your therapist may have a preference, for example, if sessions will be over the telephone the therapist may want to see your face at least once.
However, that being said, if a given therapist only does in-person, or only does telehealth, or only on certain days that do not work for you then the relationship with that specific therapist may not work. If you have already been working together the ideal is you find a solution together. If this is your first time working with this therapist then finding someone who better fits your scheduling needs may be preferable.
Which Should I Choose: Online or In Person Therapy?
It all comes down to personal preference. Some clients will love the convenience of sessions from just about anywhere. Others will want to feel the connection that only comes from being in the same room as your therapist. If you are not sure which to choose talk to your therapists or the ones you are thinking about working with.
Here at Obsidian, we love what we do and we always do our best to give you the best we possibly can. If you ever need help or guidance, please do not hesitate to contact us at the following:
Kari Holman –
(847) 450-0460
kariholmancounseling@gmail.com
Ilyssa Lasky –
(224) 255-4411
Emotional Support and other Assistance Animals: It’s More Complicated Than That
Human-animal relationships are older than human civilization itself. From dogs (about 10,000 years ago) all the way to cattle (latest being around 6,000 years ago). Humans and domesticated animals have been living side by side for so long our neurochemistry has changed. Studies have been done on both dogs and cats that have demonstrated oxytocin (colloquially called the “love hormone”) is released in both the human and the animal when they play, cuddle, look into each other’s eyes, etc.
It is natural then that we love and want to be with our animals as much as possible. It is completely understandable. And it causes very big problems. The misuse of the emotional support animal (ESA) letter is widespread. The internet is rife with scam websites promising ESA letters for hundreds of dollars to individuals who want to bring their pets with them on airplanes, take them to restaurants, or keep them in housing that does not accept animals.
It has gotten so bad that the US Department of Transportation (DOT) has banned all ESA animals from aircraft cabins as of December 2020. The famous incident of the emotional support peacock was the final nail in the coffin for this abuse of the system. The only animals that cannot be barred from the cabin are service dogs.
In this post we will cover the following:
1. The differences between emotional support, therapy, and service animals,
2. Where each kind of animal is allowed to go in public,
3. The legal and social ramifications of falsely representing an animal,
4. What lay people and businesses can and cannot ask about an animal
We will talk later about both the social and legal consequences of misrepresentation a pet as either an ESA or a service animal. First, we will lay out the differences.
The Differences
Emotional Support Animals
An emotional support animal is an animal whose presence offers comfort to it owner. Two common conditions ESAs as used for are anxiety and depression. It is not trained to provide this service nor is training required. Because of this they have significantly fewer access rights than service animals, as discussed below.
What if I still want an ESA?
The title of this post is “It’s more complicated than that.” We mentioned the scams. The growing number of legal consequences are below. If you still think an ESA may be right for you, good form dictates:
1. Regular therapy with a licensed professional for a minimum of six months
o to adequately determine if an ESA is the right choice for you
2. Updates to the letter at a minimum of every six months.
If you are faced with legal actions having a letter dated within the past six months offers you better protection than one dated a year or three ago.
Therapy Animals
Instead of providing comfort to a single owner, therapy animals work in conjunction with a handler to provide comfort to large groups of people.
Therapy animals can include animals that visit hospitals or nursing homes, animals that participate in animal-assisted programs such as Sit, Stay, Read, or animals that assist in a therapeutic process such as horse-assisted therapy.
If you think your pet would make a good therapy animal and you want to help others in your community here are a few resources to help you get started:
Rainbow Animal Assisted Therapy
AKC Recognized Therapy Dog Organizations
Friends for Therapeutic Equine Services
Service Animal
According to the American Disabilities Act (ADA) “a service animal is defined as a dog that has been individually trained to do work or perform tasks for an individual with a disability. The task(s) performed by the dog must be directly related to the person's disability.”
Therein is the key difference between service and emotional support animals. Service animals are highly trained to work for a single, specific individual. Service animals do not double as family pets.
Where Each Animal Can Go Public
Any animal, including service animals, can be removed from any public setting at any time if any of the following occur:
· The animal becomes unruly or distracting to other patrons.
· The animal poses a threat to others through demonstration of aggressive behaviors.
· The animal becomes destructive of property.
· The animal fails for any reason to be under the control or supervision of its handler.
Emotional Support Animals
If you take nothing else away from this post, please remember this – ESAs are not an all-access pass.
ESA are, by law, only allowed in spaces where pets are also allowed. They can be barred from any and all other locations without penalty. The only exception is housing. An ESA letter from a licensed professional prevents a landlord from evicting a tenant from that living space because of the animal. This applies more to individuals in subsidized housing. It does not apply to someone who brings a pet into a “no pets” apartment and then gets caught.
This means any business can legally allow or bar an ESA from their premises at their own discretion, just as the DOT has done. Businesses can also ask for the animal’s ESA letter and the owner must provide it.
Remember, even if your ESA animal is allowed into a business if it becomes in any way disruptive and you are unable to curb this behavior the business can have you leave. This applies to service animals, as well.
Therapy Animals
Therapy Animals require verification from each individual facility they are working at prior to entering. Meaning, a therapy animal may work at multiple hospitals but will require verification from each of them. This is the only place therapy animals are allowed to be. Otherwise, they can only access places that are already pet-friendly.
Service Animals
A service animal cannot be barred from any public setting.
The Ramifications of Misrepresentation
Falsely claiming your pet is a service animal just to bring it with you to a restaurant, the grocery store, or on the bus, etc. is incredibly detrimental to every person who relies on their trained service animal. It is thoughtless and, increasingly, illegal.
Doing this not only inconveniences those around you who have to tolerate your animal, you are also poisoning public attitudes towards genuine service animals. As a result, service animal users have been harassed, accused of “faking it” and barred from places where they are legally allowed to be.
On top of this, if you encounter an actual service animal your untrained pet may jeopardize the safety of the service animal and its handler. Pets masquerading as ESAs have attacked and injured service animals. Now their handler not only has to cope with having an injured animal but their own lives are now hampered and/or put at risk because their animal cannot perform its job.
You may also be breaking the law. Leave your pets at home. Allow service animals to do their jobs unhampered.
What Can/Cannot Be Asked
Do not approach a person asking about their animal unless you are a) representing the business/public space the animal is in or b) the animal is being disruptive.
If you are in a position where you need to ask about an animal’s qualifications here is what you can ask here in Illinois per the state attorney general and the ADA:
1) Is this a service animal?
a. remember, you cannot ask for proof unless the animal is identified as an ESA.
2) What tasks has this animal been trained to perform?
If the answer to question 1 is “Yes” then question 2 can follow. If the answer is “No” then follow your business’s policies. Also, remember, even service animals have to behave themselves. Any animal that does not can be asked to leave the premises
Conclusion
The subject of assistance animals is a complicated and currently evolving state of affairs. In addition to the links provided throughout the post here are a few more that will help you navigate this subject:
ADA FAQs about Service Animals
American Veterinary Medical Association
American Psychological Association – Is that a pet or a therapeutic aid?
Michigan State University Animal Law Info
Here at Obsidian, we love what we do and we always do our best to give you the best we possibly can. If you ever need help or guidance, please do not hesitate to contact us at the following:
Kari Holman –
(847) 450-0460
kariholmancounseling@gmail.com
Ilyssa Lasky –
(224) 255-4411
What Do You Mean My Life Coach Isn’t My Therapist?
Clarifying the Differences Between Various Mental Health and Related Professionals
In our February, 2021 post “How to Find the Right Therapist” we talked, among other things, about what all the various licensing abbreviations mean. This time we are going to clarify the differences between various mental health and related professionals including training and certification/licensure.
We will be looking at therapists, psychologists, psychiatrists, and life coaches. We hope this information will help you determine what kind of care you need.
What is a Therapist?
A therapist must hold a master’s level degree from an accredited academic program as well as a license to practice in their state. If a person only holds a master’s degree but not a license, they are not legally able to provide you with therapy although they are able to provide other sorts of mental health services. Therapists are also legally bound to observe HIPAA and other health privacy laws as well as the Code of Ethics of their governing body – the American Counseling Association.
Why Might You Want a Therapist?
Therapists are trained to help you with a vast array of life challenges and mental illnesses. These can include making career changes (such as a licensed therapist with career counseling expertise), overcoming depression, family issues, or severe mental illnesses such as Bipolar I disorder or Schizophrenia.
What is a Psychologist?
A psychologist is a person who has earned either a Ph.D or Psy.D in psychology. Like a therapist, a psychologist must also be licensed before they can practice therapy. Clinical psychologists have an even more advanced and sophisticated level of training than therapists. Psychologists are also legally bound to observe HIPAA and other health privacy laws as well as the Code of Ethics of their governing body – the American Psychological Association.
A non-clinical psychologist also has an advanced level of training but may adhere to the American Counseling Association’s guidelines.
Why Might You Want a Psychologist?
Whether or not you want to choose a psychologist or a therapist depends on what challenges you are facing as well as the training of the specific professional. A therapist with 10 years of experience may or may not provide better care for your issue than a newly minted psychologist with less experience.
What is a Psychiatrist?
Above all, psychiatry is a medical degree. Unlike a psychologist, a psychiatrist has an MD or “Doctor of Medicine.” A psychiatrist’s education is in mental health medication. There are many places you might find a psychiatrist working. For a person who is seeing a therapist or psychologist in an outpatient setting—meaning one or twice a week in a therapist’s office—they may also work in conjunction with a psychiatrist for mental health medication.
A psychiatrist must also be licensed. A psychiatrist must obtain a certification from the American Board of Psychiatry and Neurology and as well as a medical license, as outlined here by the American Psychiatric Association, in order to prescribe you medication. If you haven’t guessed already, psychiatrists also have their own Code of Ethics that they must abide by.
Why Might You Want a Psychiatrist?
A psychiatrist’s bread and butter is mental health medication. While your general practitioner or primary care doctor is legally allowed to prescribe mental health medication this is not their area of training or expertise. Nobody knows the ins and outs of prescribing and monitoring mental health medication like a psychiatrist does.
What is a Life Coach?
I went to certified coach Sasha Davis, founder of Mercury & Kolb life coaching, to get the answer. As she describes, proper life coaching is not toxic positivity on Instagram. A proper life coach is someone who can help you set and reach your goals, support you so you accomplish more than you would have on your own, and improve your focus so that you can produce the results you want faster.
Sasha explained life coaching is not regulated in the same way the other professionals identified here are. “Anyone can hang their shingle” (Davis), however, there is a gold standard of life coaching that has been set by the International Coaching Federation (ICF). The ICF has its own Code of Ethics, framework, and strict standards for accrediting their member coaches.
There are four levels of recognized ICF coach accreditation and each requires more education and hours practicing life coaching than the one before it. These are:
1. Certified Coach
2. Associated Certified Coach
3. Professional Certified Coach
4. Master Certified Coach
Because of this ICF associated life coaches are the way to go. Additionally, clients can file complaints with the ICF if they believe their coach has done something inappropriate. While this does not include legal actions, a coach can be stripped of the ICF accreditation.
Why Might You Want a Life Coach?
The practical difference between a therapist and a life coach is that a therapist helps you “dig really deep into your backstory” (Davis). As we discussed above, a therapist helps you to process, sort, and resolve all manner of mental health challenges.
A life coach, on the other hand, may be a good choice for next step after therapy as a life coach can help you identify what is getting in the way of achieving your new post-therapy goals. Questions Sasha has seen among her clients post-therapy have included:
“What do I do now?”
“How do I take what I learned and apply it?”
“What steps do I need to take to maintain the progress I’ve made?”
If you want to find a life coach Sasha recommended The Academy of Creative Coaching for their focus on diversity and actively pairing you with a coach they think will be a good match. You can also go to the ICF website to search for credentialed life coaches.
Here at Obsidian, we love what we do and we always do our best to give you the best we possibly can. If you ever need help or guidance, please do not hesitate to contact us at the following:
Kari Holman –
(847) 450-0460
kariholmancounseling@gmail.com
Ilyssa Lasky –
(224) 255-4411
Your Rights as a Client
Last month we talked about finding the right therapist. Now that you’ve hopefully done so (and if we’re lucky you chose one of us here at Obsidian!) I think it is time to discuss your rights as a client.
That’s right! You have rights as a client. We always talk about being a knowledgeable and informed consumer, and while the relationship between a client and their therapist is not really a “business-consumer” relationship, it is still helpful to know how to advocate for yourself.
You are NOT Stuck with Your First Therapist
If something is not working in your sessions tell your therapist. We do not invest our egos in this job, or at least we shouldn’t. This is all about your care. Tell your therapist. Then you can work together to determine if an adjustment can be made.
What might not be working? The therapist’s approach might not be the one for you. Maybe you need someone who gives you strict deadlines on tasks. Or perhaps Cognitive Behavioral Therapy (CBT) does not click for you and a different evidence-based approach is a better fit.
You might also just not connect with this therapist. While therapists are professionals, given the very personal nature of our work together it is not a surprise that sometimes two people just don’t mesh. That’s okay!
If after a few sessions you are just not connecting with this therapist go ahead and tell them. Again, we do not invest our egos into this job and no offense will be taken. In fact, if you ask, your therapist may even be able to help you find a better fit.
You Have a Right To…
1) A licensed therapist or supervised intern. The name and abbreviation for licensure differs between states, however, you are absolutely encouraged to ask your therapist what their licensure is and the qualifications to earn it. You absolutely want someone who has earned at least a Master’s degree in psychology.
If you are working with an intern you should be informed of that fact. An intern works under the supervision of a licensed therapist. However, if you are in any way uncomfortable working with an intern you are within your rights to request a fully licensed clinician.
2) You also have a right to ethical treatment practices as outlined in the Code of Ethics of both the American Psychology Association and the American Counseling Association. This means any treatment method or modality used in your therapy has been researched, tested, and validated as safe when applied by a trained clinician. Your therapist should never use a treatment they have not been trained to use.
3) You have a right to confidentiality. This means files are locked and secured, no identifying information is given to anyone without your written permission, and informed consent and the limits of confidentiality are observed.
Informed consent and the limits of confidentiality involve situations wherein your written permission is not required for the therapist to break confidentiality. This includes a reasonable belief that you might hurt yourself or another person, or the safety of children, adolescents, or elders are at risk. In these cases, your therapist is required by law to break confidentiality.
4) You also have the right to a safe environment during your counseling sessions. This means the location is reasonably secure and confidential (typically an office with a closed door).
This also means you are safe from flirtations and sexual advances from your therapist. You are also safe from coercion to provide gifts, favors, skills, access to other people, etc.
5) You have a right to continuity of care. This means your therapist will not abandon you (i.e., suddenly stop seeing you or responding to you) and that there is a backup plan for known absences such as a vacation or leave of absence. This also means that advanced warning of such changes is provided. The last session you have together is not advanced warning.
This also means if your therapist is no longer able to work with you for any reason—the therapist is moving away, changing practices, or is not trained in your newest presenting issue—they will provide you with resources for finding a new therapist.
If you would like some more information on continuity of care these studies provide summaries of their findings:
“Continuity of care as experienced by mental health service users - a qualitative study” by Biringer, Hartveit, Sundfor, et al
“Continuity of care in mental health: understanding and measuring a complex phenomenon” by Burns, Catty, White, et al
“Defining continuity of care from the perspectives of mental health service users and professionals: an exploratory, comparative study” by Sweeney, Davies, McLaren, et al
How to Report a Therapist for Violations
Reports of violations are taken very seriously, and thus making such a report is a serious matter.
If you think any of the above rights have been violated please talk to your therapist first. Just as you talk to a company or business if you are not satisfied with the services they provided talk to your therapist. Do not report a violation if you are angry at your therapist for something that was said. Talk to your therapist first, just as you would a friend or family member.
It is likely the two of you can reach a satisfying resolution whether that is making your therapist aware the current mode of therapy is not working, that you are angry or hurt by something that was said, or finding someone else who can treat you either permanently or until the therapist is able to return to regular sessions with you.
If you do not reach a resolution together you can also talk to the therapist’s supervisor or practice owner. If none of this brings a resolution, or if you feel sexually exploited in anyway please make your report.
To do so look up the professional State Board they are licensed with. In Illinois this is the Illinois Department of Professional Regulation.
Here at Obsidian we love what we do and we always do our best to give you the best we possibly can. If you ever need help or guidance please do not hesitate to contact us at the following:
Kari Holman –
(847) 450-0460
kariholmancounseling@gmail.com
Ilyssa Lasky –
(224) 255-4411