FYI- Many insurance companies are waiving copayments for their clients who would like to receive online counseling at this time. Please connect with your mental health insurance provider to see if you are eligible.
Have you ever spoken to a friend on FaceTime? Participated in a Zoom meeting for work? Chances are you have virtually connected with someone via video at some point. The world is becoming more virtual as technology improves and many have smartphones that allow you to reach out to someone quite easily.
Now that much of the nation is practicing social distancing or are in places that many non-essential services are shut down due to COVID-19, we are staying home to flatten the curve and protect those who are more vulnerable to the virus. In the past, this could mean weeks of skipped therapy or inability to access help when we all need it the most. Online therapy can provide treatment while also addressing the anxieties, stressors, and fears this pandemic has caused.
Recent research reflects that online therapy can be just as effective and sometimes, more convenient in our busy lives. Also, virtual therapy can feel more comfortable for some as it is conducted while you are in your own environment. As with traditional therapy, you receive the same treatment and can discuss what you need to with your therapist as if you were face to face.
Let’s talk about the benefits of online therapy
1 It doesn’t just have to be on video
If you aren’t comfortable with video, online therapy offers other methods. Some therapists offer text-based therapy and allow you to contact them throughout the week. This can be especially useful for those with social anxiety, panic and agoraphobia. Second, there is audio therapy – in this method, you and your therapist will meet on Zoom or the telephone.
2 No commute
Commuting for therapy appointments can be cumbersome. Add the costs associated (transportation, parking, childcare and missing work for appointments) it can become a financial and scheduling burden. Many people don’t begin therapy or stop going because of the difficulties in traveling to their therapist. Online therapy removes these hindrances and makes it easier to find a time that is convenient for yourself and your therapist.
3 Great if you are uniquely abled
If you have accessibility issues or physical limitations including being housebound, online therapy is an excellent choice for you.
4 Still covered by insurance
Many insurances cover online therapy sessions, however, it always good to contact your healthcare insurance to see if they are covered under your policy.
5 As always, it is confidential
As with your visits to your therapist are private and confidential, so are your online visits! Online therapy is completely confidential and the same rules that apply offline are still applied online. The therapy itself can sometimes cause stigma around mental health; online therapy reduces this. That way you are more comfortable with the sessions and your communication during them.
Also, communication online is encrypted through an HIPAA compliant platform called VSee. VSee is free for the you and can be downloaded onto your phone or computer.
6 Your therapist must be licensed in the state you live in
Some may be licensed in more than one state. So, you know you are getting quality healthcare by a reputable and credited provider to meet your mental health needs. This also means they are aware and comply with all Health Insurance Portability and Accountability Act (HIPAA), ethic and legal practices.
7 You can have access to a specialist that you cannot find locally
You may want a certain type of therapy such as cognitive-behavioral therapy (CBT), dialectical behavioral therapy or other evidence-based treatment. Oftentimes, therapists formally trained and specialized in these modalities for panic, anxiety, and other diagnoses are much easier accessed virtually. You may more likely to find a suitable and qualified therapist if you go beyond the location you would stay in to visit a therapist in an office.
Online therapy isn’t the best choice for everyone, and some mental health disorders may be better treated in person. Clients who are actively at risk of harm to self or others are not suitable for teletherapy services. If you are feeling suicidal, it is better to be seen in person. That said, during the quarantine many therapists are allowing for online sessions regardless.
Many of my clients are finding that treatment for their anxiety and worry during this time of uncertainty has been surprisingly easy, and it is a great way for your counselor to see where you live, meet your pets and maybe even family members. If you’re interested in learning more- please don’t hesitate to reach out!
Here’s to all of us taking great care of ourselves, and making it through to the other side stronger and thriving!
Ambiguity, a sense of uncertainty about what’s going on or what might happen, is part of life. This blog post explores dealing with the unknowns in life and how to handle them.
When Your Environment is Unpredictable
Wow, what a week. Coronavirus or COVID-19 is all over the news and it seems that panic has set in. It is understandable to be anxious when uncertainty is all around us. Our world has been thrown off, and a new normal is here for the near future.
Human distaste for the unknown is well-grounded in experimental psychology, and research has shown that when given the choice, most of us feel calmer knowing that something bad will happen in the near future vs. it possibly happening. This phenomenon is apparent even if it causes us intense stress. Daniel Gilbert, author of the best-selling book Stumbling on Happiness writes:
“Consider an experiment by researchers at Maastricht University in the Netherlands who gave subjects a series of 20 electric shocks. Some subjects knew they would receive an intense shock on every trial. Others knew they would receive 17 mild shocks and 3 intense shocks, but they didn’t know which of the 20 trials the intense shocks would come. The results showed that subjects who thought there was a small chance of receiving an intense shock were more afraid — they sweated more profusely, their hearts beat faster than subjects who knew for sure that they’d receive an intense shock”.
WAYS TO HANDLE ANXIETY
We can’t eliminate uncertainty in our lives, but we can manage our reactions to the unknown in healthy ways using one technique that the best cognitive behavioral therapists employ:
REST Technique or Radical Acceptance
When you become overwhelmed or feel anxious, your first instinct may be to act impulsively or panic. There is a healthier method – Take a REST.
Relax
Evaluate
Set an intention
Take action
Relax
Step one is to literally freeze and stop whatever you are doing. Breathe. Step away from the situation for a few seconds. Try to find a different perspective on what is happening and create a space between yourself and the impulsiveness you may feel. You can even tell yourself out loud to “Relax” or “Rest”. Slow your breathing down and calm down before you decide on another course of action.
Evaluate
Ask yourself what is going on – what are the facts in the situation? You don’t need to solve an ambiguous problem or discover any answers right now. You only have to evaluate what is happening to your physical, mental, and emotional self. Move on to looking at other people around you. At this point ask yourself “How do I feel?” and “Are the people around me in immediate danger?” Think right here, right now.
Set an Intention
“Step three is to set an intention to do something.” You can also treat an intention as a goal or plan. Decide what you will do, pick a distraction or self-soothing skill and ask yourself “What do I need right now?” Whatever you choose isn’t permanent, it is only for right now.
Distractors and soothers that help get you out of the uncertainty trap do not have to be expensive or time-intensive. Good examples of immediate coping skills are:
Count all the greens or blues in your vision.
Describe a wall or other item in detail.
Alphabetize movies, songs, cities, etc. in your head or on a sheet of paper.
Breathe 4 seconds in, hold for 4 seconds, and out for 6.
Pay close attention to the living things around you
Clean, fix something, do anything where you move your body for 5 minutes.
Take Action
Lastly, take action. Mindfully move ahead slowly and meaningfully toward what you are doing. Slow and deliberate often helps us get what we want to be done faster than rushing through. Even if this is not the final solution to your problem, it is a healthy and effective way to thwart any impulsive behaviors or panic that may set in when uncertain.
Once you start getting used to using the REST technique, you will begin to identify when you are distress and can implement these steps in a few seconds. You will be ready to spring your new habit into motion and “REST” when you feel like you are in a similar situation again.
QUIZ: HOW WELL DO YOU MANAGE UNCERTAINTY?
Everyone has a different level of tolerance for ambiguity. Wondering how good you are at tolerating ambiguity? There is an easy way to find out. The Tolerance for Ambiguity scale will tell you. You will respond to a set of 16 statements about your attitudes and behaviors. Whether your score is particularly high, or lower than you expected, it is interesting to know where you stand. This information might also be helpful to a therapist who you consult to help you manage anxiety.
Of course, if you follow the directions given by healthcare professionals for the coronavirus, you will feel like you have some control and they are good precautionary habits to have in our current environment.
Also, make sure you stay connected with your support system via phone and video and limit your use of social media, which is less interactive and in turn, increases our anxieties.
References
Matthew McKay Ph.D., Jeffrey C. Wood PsyD, et al… The Dialectical Behavior Therapy Skills Workbook: Practical DBT Exercises for Learning Mindfulness, Interpersonal Effectiveness, Emotion Regulation, … (A New Harbinger Self-Help Workbook) New Harbinger Publications; Second Edition, Revised edition (October 1, 2019) Print.
As the world has been inundated with news of the coronavirus, I want to share this great post by fellow therapist and gifted writer, Brianne Rehac, LMHC in how we all are coping with anxiety differently. Take good care of yourself and your loved ones this weekend! Warmly- Karen
“This week, I have spoken to many people about their heightened emotions since the outbreak of coronavirus disease 2019 (COVID-19).
Everyone has a definition of what is a stressful event for them. And everyone reacts to those events differently. If you find that you have not felt impacted at all by reports of the coronavirus outbreak, that is a perfectly okay response. If you find that you have been more anxious, sad, irritable or angry lately, that is completely normal, too. Our reaction to stressful events is a product of a multitude of factors including, our proximity to the event, socioeconomic status, personal history, and personality. Some people who may respond more strongly include individuals who are managing a mental health condition (like anxiety), children, and first responders/healthcare professionals.
Sometimes responses to a stressful event don’t present as emotions. Instead, you may notice a change in sleep patterns; change in appetite; difficulty concentrating; worsening of a chronic health problem (like GERD or chronic pain); change in behavior (stocking up on essentials or changing your routine); or increased use of alcohol or other drugs.
It is really important that during stressful times, you continue to take care of your physical and mental health. That means sticking to your treatment plan, including taking medications as prescribed; attending routine appointments; adhering to any special diet you may have. It also means reaching out to your supports—family, friends, doctors, therapists, and support groups. You’re connecting to them not just for yourself, but for them, too. Let’s all check in with each other on this, okay?”
—Brianne
Hotlines:
SAMHSA’s Disaster Distress Helpline
Toll-Free: 1-800-985-5990 (English and español)
SMS: Text TalkWithUs to 66746
SMS (español): “Hablanos” al 66746
TTY: 1-800-846-8517
National Suicide Prevention Lifeline
1-800-273-8255
Nacional de Prevención del Suicidio
1-888-628-9454
Options For Deaf + Hard of Hearing
1-800-799-4889
Veterans Crisis Line
1-800-273-8255
Text 838255
Your mental health is important, why mental health apps? Sometimes you cannot afford to see a therapist, do not have time to go to one, or one isn’t accessible where you live. Perhaps you aren’t ready to see one but would like to see what therapy all is about. Maybe you see a therapist, but need help to put the helpful techniques they have given you into practice. Mental health apps can be very beneficial, free, low-cost or affordably priced, and offer a way to help give you therapeutic help on the go. So which ones are best? There are so many out there!
Mental health apps that I recommend:
1. Headspace
Headspace is an app that just about anyone can use, whether you are dealing with stress, anxiety, lack of focus, or sleeping difficulties. It teaches you to “meditate and live mindfully”. Meditation has been shown to reduce stress, lessens anxiety, support emotional health, and enhances self-awareness. This app provides small meditation modules to accommodate people’s busy schedules and “SOS exercises in case of sudden meltdowns.” You can take advantage of their free trial and if you like it, you can make the jump to a monthly subscription.
2. Youper
Youper is an app that is powered by AI – “your emotional health assistant”. This app allows you to have conversations, guidance through meditations that are personalized for you and trackers that help you monitor your emotional health and mood. This technology created by doctors, scientists and engineers;focuses on the science and pursuit of happiness – helping those with depression and anxiety live happier lives with treatments personalized for them. This app also works in conjunction with seeing a therapist, as you can ‘share’ your information. Many of my clients use this app as complements many of the CBT techniques we use right in session.
Youper is free to download and have some free features; more advanced features are based on a subscription plan.
3. FitMind
This app offers meditation training as part of a “mental fitness” approach. FitMind uses traditional techniques used since ancient times with western science. Using daily challenges, along with access to meditation instructors; FitMind can help you learn to meditate in a way that works for you. Again, meditation is a useful tool for improving mental health because of all of the health benefits you get from practicing it. This app is free and offers in-app purchases.
4. Sanvello
Sanvello is an app designed for stress, anxiety, and depression using strategies and resources that can help you with the symptoms and situations you are dealing with at the moment. You can customize goals; like mindfulness, building confidence and thinking positively. Based on clinically proven techniques, this app offers tracking for mood and sleep, tools for relaxation and meditation and you can connect to a group of your peers for further support. Free to sign up and install.
5. MoodKit
This mental health app uses four tools that are designed to enhance your mood, identify and change unhealthy thinking, track mood, and create journal entries. Managing negative feelings thoughts by identifying situations that cause stress, changing how you think, monitoring your mood through tracking, and developing self-awareness through writing is all of the ways MoodKit is designed to help you improve your mood and mental health. This app is only available on the iPhone and iPad, but is just $4.99.
Mental health treatment is no longer limited to the office and self-help books. Whether you are on the road, want quick help, or establish a daily cognitive behaviorally based self-care routine, there has never been so many options on how to start. It’s good for you, and most apps have a free trial! Jump in and let us know how it goes.
Earning your clinical license opens up a world of possibilities, so you want to begin gaining ASW supervision hours as soon as possible. Regardless, the process can be confusing for the best of us. Throughout my years of providing ASW and LCSW supervision, there are certain questions that I’m asked on a regular basis. Here’s a nice compilation of many of these inquiries, as well as one vital tidbit that is often overlooked:
I have all of my hours, but I’ve been putting off the exam for months/years. Is there a timeline?
So, there are a couple of key points to remember:
The 6-Year Rule-
You can spend 10+ years earning IMF/ASW supervision hours, however, the only ones that count are the ones accrued during the last 6 years.
Abandonment of Application-
You don’t want this to happen! The consequences of abandonment can range from paying a new application fee to starting from square one. Per the BBS website, the criteria for abandonment are the following:
Associate Social Worker does not submit the remaining documents or information requested in the application deficiency letter within one (1) year from the date of the deficiency letter
Applicant does not complete the application within one (1) year after it has been filed
ASW does not sit for an examination within one (1) year after being notified of initial eligibility to take the examination
Applicant does not take an examination within one (1) year from the date the applicant was notified of failing an examination
The applicant fails to pay the initial license fee within one (1) year after notification by the Board of successful completion of ASW requirements.
I’d like to obtain my ASW/LCSW supervision through video conferencing. Am I eligible?
Per the California Business and Professions Code section 4996.23 videoconferencing can be used for LCSW supervision when an intern works/volunteers at one of the following:
Any government entity
A school, college, or university
An agency that is both charitable and non-profit. You can find out if your workplace meets these criteria by checking if they are considered a ‘501(c)(3); by the IRS
The ASW supervisor is responsible for ensuring client confidentiality, including a HIPAA compliant platform for video sessions. Skype is not HIPAA compliant, but there are other programs that are- your supervisor should be able to tell you what platform they are using and how they know it’s in line with privacy regulations.
My hours are complete, and my exam is scheduled! Am I still required to maintain weekly LCSW supervision?
Until you have your license in hand, you want to complete an hour of individual or two-hours of group LCSW supervision.
Do I really have to sit for the Law and Ethics exam? Is this something I need to retake annually until I earn my license?
Yes! There are no loopholes on this one- no matter how much training and classes you have taken.
Once you pass the Law and Ethics exam, you have completed your requirement as long as you keep your license active. Get this done quickly, as you may not be able to complete your annual renewal without a passing score.
Which study guide do you recommend?
The majority of my interns recommend the Therapist Development Center (TDC) programs for both the exams. TDC not only provides materials on content but also test taking strategies that will help IMF/PCCI/ASW interns approach the exams in a logical and educated manner.
When can I start collecting LCSW Supervision hours?
It’s exciting to finally earn your graduate degree, and you’re probably chomping at the bit to start collecting hours. Many have contacted me and said, ‘I’m waiting for my BBS number, but I want to start supervision this week!’
In this case, patience is the key. Don’t spend time and money on clinical supervision until you have that intern number in hand, as hours won’t count until then.
My former supervisor can’t be found. How can I verify my hours?
At the beginning of ASW intern supervision, it’s critical that you and your supervisor create and sign the following documents, all located on the BBS’s website.
Supervisor Responsibility Statement
Supervisory Plan
Any letters of agreement or other documentation agreeing to the ASW Supervisor/ Intern relationship.
Just as important, discuss how you plan to document logged hours. I encourage all of my supervisees document their hours in detail and have me initial and sign it each month.
As soon as your time with each supervisor is complete, print out the Experience Verification Form and complete this together.
ASWs are fully responsible for all original paperwork. If you follow these guidelines, you will be in good shape if for any reason you can’t connect with your previous supervisor(s)
I am the only social worker/counselor at my job. How can I earn my hours if I don’t have a clinical supervisor at my agency?
There are a lot of ASWs in a position where clinical supervision is not readily available. Fortunately, your intern supervisor does not need to be employed by your agency.
If you are the lone ranger in your company, I recommend searching out some group supervision to expand your support system, increase your exposure to new opportunities, and see what others in the field are doing. Several of my interns that were in group have helped connect one another to jobs, resources, and even have partnered in private practices!
There’s one question I’ve never been asked, but what everyone should know……
The 104- week rule
Several years ago, an ASW Intern I had been supervising for a year came to my office to get her last hours signed. She had been working with several supervisors throughout her time and worked hard to get her hours wrapped up as soon as possible, often putting in 60+ hours a week so that she could meet that 40-hour clinical max.
As we were finishing up her paperwork, we came to the realization that although she had easily met 3200 clinical hours, she was two months under the 104-week requirements. She was terribly disappointed, and we spent two more months getting those last few weeks in.
The story has a happy ending- Margaret Miller, LCSW now has a thriving private practice at my office- you can check her website out here. So now you know- in addition to the 6-year window, interns have to meet a minimum of 104 weeks of ASW supervision, so expect to spend between 2-6 years gathering your experience.
If you find this article down your alley, check out some similar blog posts:
