The Special Education Evaluation Process at School

In my last post, I discussed developing intervention plans when you notice a concern with your child at school. Today’s post will discuss the special education evaluation process and what to expect as a parent/caregiver. Where we left off: the child did not make expected progress with the intervention, so you made a request in writing asking for a case study evaluation. The school agreed and scheduled the first meeting as part of the process.

Domain Meetings

The first meeting is a domain meeting, where the school team looks at what information is known about the child, what further questions people have, and then what assessments will be used to get that information. Eight different domains will be looked at to see if information needs to be collected in that area; not all areas are looked at for each case study, it depends on the student’s specific needs. These areas are:

1. Academics: The school team will look at classroom data, intervention data, unit test scores, district test scores, and classwork samples to see how a student is progressing. In many districts, the school psychologist will conduct academic assessments using a standardized test battery to see how a child is doing academically compared to a nationally normed sample of other students. Whatever information is collected, there should be multiple pieces of data so the team is not relying just on classwork or standardized tests to determine if academic areas need remediation. 

2. Functional performance: This area looks at how a student is doing in class, with more of an emphasis on behaviors. School psychologists typically do a classroom observation, speak with the teachers to get a sense of strengths and challenges (academic and behavioral), and, if needed, behavior rating scales. When I give a rating scale to teachers, I want to obtain information about behaviors that could impact a child in school. I also provide a version of the rating scale for parents to complete to get information about the child's behaviors at home. If a child is old enough, I will give a self-report form to get a sense of what they see in themselves. Then, I look at similarities and differences across settings and see what that tells the team. This is also the domain where teams might look at ADHD or autism-type symptoms if those are concerns. If there are significant behavior concerns, a team may decide to do a Functional Behavioral Assessment (FBA) to help develop a Behavior Intervention Plan (BIP). This will be a topic for a future post, but in sum, it is information gathering to figure out what a child is gaining by doing an undesirable behavior and then how to use that information to get them to do something you want them to do that fulfills the same function. For me, the most crucial part of this domain is the student interview; I always want the child’s voice to be part of my evaluations.

3. Cognitive: This is the area for an IQ test if one is needed. In my prior practice in schools, we rarely opened this domain unless we were considering an intellectual disability. An IQ score in and of itself does not tell a school much. It would not impact whether or not a child qualifies for a learning disability, for example. Still, the scores from the various subtests could help a team know how a student works with information. As a private practice school psychologist, I can help you to explore this information. As schools only sometimes rely on these measures, valuable information may be missed or lost when solely depending on a school evaluation from the district. 

4. Communication: This is the area for speech/language pathologists. If there are concerns in this area, a speech pathologist would attend the domain meeting. They might look at expressive, receptive, and pragmatic language skills, articulation, and fluency. If there are no concerns, they will not attend, and no information will be collected in this area.

5. Health: In my prior role, school social workers would discuss a student’s health history with the family to see if something could be impacting them at school. 

6. Hearing and Vision: We always want to rule out these when considering eligibility for special education; if a child has difficulty reading, could it be a problem with their eyes? Or do they have trouble paying attention but cannot hear the teacher? Schools want to make sure of these things!

7. Motor: If a child has challenges with gross motor skills (running, jumping, etc.) or fine motor skills (handwriting, tying shoes, buttoning/snapping clothing), then an occupational therapist or physical therapist may be part of the IEP team. OTs do observations to see how a child uses their motor skills and then may recommend testing to see what their visual motor integration skills are like. Additionally, they may look at sensory processing and how that can impact a child in school.

8. Social/Emotional: This critical area is another one for the school social workers. They talk to families about the child, looking at early developmental milestones up to the current school year. They may ask you about family history and whether significant family events affected the student. This is where your voice gets heard in the evaluation, so the more you can share with the school, the more information they can consider. There may also be rating scales in this domain, which would help the team determine if this is an area to be addressed on an IEP.

Is my Child eligible for accommodations?

So that’s a lot. But again, not all domains are looked at for all evaluations; it depends on the child. What’s next? You, the caregiver, would sign consent for the school evaluation as outlined in the domain paperwork. Suppose you are not in agreement with the evaluation components. In that case, you and the school can discuss it further until it is all agreed. Then, once you sign the consent, the school team has up to 60 school days to complete the evaluation and, if eligible, write an IEP. They will schedule a meeting with you where you will review the evaluation components and clinician reports as a team. They must give you drafts of the report and IEP goals three days before the meeting so you have time to review them and can come in with questions. Eligibility categories will be reviewed, and if your child meets the criteria for one or more categories and disabilities adversely affecting their education, they will be eligible for special education. Some schools will have another meeting to review the IEP. In contrast, other schools will do both eligibility and the IEP in one meeting.

This process of domain meetings, evaluation, and eligibility happens every three years once a child is initially made eligible to check up on progress and functioning as they grow. What does the IEP give your child? Specific, measurable goals that a special education teacher is responsible for implementing, plus classroom accommodations, to help them succeed. These goals and accommodations are based on the testing done in the evaluation process.

What if my child is found not eligible for special education services?

This is a possibility, and it is ok! If a child is making progress with the interventions in place, then maybe they do not have a disability and instead need a boost of instruction, but not to the level that they need a special education program to help them be successful. It could also be possible that an evaluation showed a student has a disability, such as ADHD or autism. Still, their academics are at grade level, and they do not need a special education teacher to modify their work. Then, they would be eligible for a 504 plan of accommodations if they need accommodations because of their disability. Either way, whether or not a child qualifies for special education, the evaluation process gathers a lot of helpful information that a school and family can use.

That’s a lot of information, so I’ll leave it there. Next, I’ll talk about whether or not you need a diagnosis for services…the answer may surprise you.

What are the steps to take before my child gets an IEP or 504 plan?

For this blog post, we’ll discuss how to ask for meetings when you think your child might need academic support for ADHD, dyslexia or another learning disability. You need to know that there is a process, driven by Federal law and state regulations, that spells out timelines and procedures for getting extra support at school. As a school psychologist in the public schools, I worked frequently with families navigating this process. To help you understand what is involved with seeking student support services, let’s break it all down.

I have a concern about my child’s Academic abilities

You are the parent. You know your kid best. Something is concerning you, and some common things pop up. You notice they are not acquiring academic skills as quickly as their friends (trouble reading, not memorizing math facts, etc.). Social skills need to catch up. Their attention wanders at home, and the teachers tell you they have trouble paying attention in class. Your child has received many office disciplinary referrals, and you feel the teachers/administrators call you almost daily about behavior challenges. You know something is getting in the way of their education, but you don’t yet know what it is. And the school may not know yet, either. You’ve heard about learning disabilities, dyslexia and ADHD, and from what you’ve read, your kid exhibits some of the behaviors and symptoms of these diagnoses. You wonder if the school is being proactive, getting educational supports in place, and keeping you informed. If they’re not, here is what you can do.

Step 1: talk to your child’s teacher

Set up a meeting with your child’s teacher, or if your schedule does not allow that, summarize it all in an email. At the meeting or in the email, it is important to ask for an MTSS intervention plan. What is MTSS? It stands for Multi-Tiered Systems of Support. This gives a student an intervention to address what is concerning, whether it is additional academic support, behavioral support such as counseling, or implementing executive functioning strategies to help them focus. The MTSS plan might not be written at that first meeting, but your request kicks off the process. Also important, copy the administration on your correspondences with the teacher so it is also on their radar, and they can help hold the teacher accountable for addressing your concerns.

Step 2: Developing an MTSS plan

Schools often develop plans without parents being directly involved, and that is ok; they should at least share the plan with you. MTSS is part of general education and is available to all students. But you have every right to be involved in the plan’s development, so do not hesitate to ask to have input. Plans will first define the problem; what is it that is concerning? What does it look like in terms of observable behavior? Or what do academics look like? Compare that to what is expected. This helps develop a specific goal for the intervention plan. Where should the kid be? Now, how to get them there. The school team needs to select an intervention that matches the problem. For example, if a student has trouble decoding, then they need to receive supplemental instruction for decoding; an intervention addressing reading comprehension would not be appropriate. Interventions should be scientifically validated, meaning someone did a study and concluded that the intervention is effective; you don’t want schools doing something ineffective! Once the intervention has been selected, the school team needs to tell you how they will track progress.

Step 3: Stay Informed

Ask for what data collection method they will use to help them know that your child is seeing success with the intervention. Let’s go back to a decoding intervention. Perhaps the data collection is how many new sight words a student knows each week. Next, they will implement the plan and collect data. MTSS plans typically run for six to eight weeks, and the team will then analyze the data and see if the intervention worked. If it did, great! If not, they may select another intervention or look at the possibility of special education if the school suspects a disability. Something you can ask along the way is whether or not the intervention is being implemented with fidelity; that is, are school people doing it the way it was intended to be done. There needs to be a meeting after the intervention cycle to see if it was effective, and you can ask to attend.

What if nothing changes?

My kid has been receiving MTSS interventions, and they are not progressing; what next? Suppose a student has gone through an intervention (or two) and is still not making expected gains. It may be time for a full case study evaluation to see if they qualify for special education and related services. As the parent, you have the right to request an evaluation at any time, and the school has to respond to your request within 14 school days. If you request an evaluation for special education, put it in an email so there is a record of it. The school may say no, we do not suspect a disability, and they would have to give you a reason why; this could include they are seeing progress with interventions and that an evaluation is not appropriate at this time. If they agree to an evaluation, you will have a domain meeting with the special education team to discuss what is known about the student, what questions people have, and what data will be collected as part of the evaluation. 

What happens next is the evaluation process, a topic I’ll talk about in-depth in my next blog post.

As a parent, it can be difficult to watch your child struggle academically. There is no need to do this alone. As a school psychologist, I have helped many families through this process. Please don’t hesitate to contact me with questions.

Breaking down the IEP referral process

Summer can be the best time for academic assessments

Summer is here! For your kids, it means a respite from the work and studying of school, and long, fun days filled with outdoor play, movies, video games and friends. However, as a parent, you know its only a few months until your child returns to school. As it happens, for many parents who requested academic testing and assistance over the school year, the assessment and services are postponed over the summer months. I want to help you become more acquainted with terms and processes involved with academic assistance.

Last post, I talked about Section 504 plans. This time let’s discuss IEPs.

What is an IEP?

An Individualized Education Plan is a legal, living document that describes what a child’s learning challenges are and how the school is addressing them. It spells out what modifications to the curriculum (i.e., what is being taught) a child needs for their education in order to be successful in school. It includes present levels of performance, annual goals and benchmarks for measuring success, accommodations, and minutes per week of services.

Why do kids need IEPs?

When students have an identified disability that adversely affects their educational achievement, then an IEP is required by Federal law, the Individuals with Disabilities Education Act (IDEA). Students in every state can have an IEP. It is for students who need the curriculum substantially modified from the general education curriculum in order to be successful.

The list of disabilities under the IDEA include:

• Autism

• Deaf/Blindness

• Developmental Delay (for ages 3-9)

• Hearing Impairment

• Orthopedic Impairment

• Speech/Language Impairment

• Visual Impairment

• Intellectual Disability

• Deafness

• Emotional Disability

• Multiple Disabilities

• Other Health Impairment

• Traumatic Brain Injury

• Specific Learning Disability

How do kids get an IEP?

A parent, teacher, or special education team member could request an evaluation if they suspect a disability. Once an evaluation is requested, the school must respond within 14 school days whether or not they agree to an evaluation. The team will come together at a domain meeting to discuss what they know about the student, what further information is needed, and who will be collecting the information. Team members include the parent, general education teacher, a special education teacher, an administrator, school psychologist, and school social worker. Depending on the student, other clinicians may be included in the evaluation, such as an occupational therapist, physical therapist, vision specialist, hearing specialist, school nurse, or speech/language pathologist.

Parents have to sign consent to conduct the evaluation. The next step is for the team to conduct the evaluation, and they have up to 60 school days to carry it out and write an IEP if the student is found eligible. Parents are provided with draft reports prior to an eligibility determination meeting, where the evaluation results are presented and discussed as a team. All team members, including the parents, have a say as to whether or not they feel the child needs specialized services and under which of the above mentioned categories. What category depends on what the student needs, and the needs will drive the services in the IEP.

What happens once a kid has an IEP?

When a child has an IEP, they get the modifications and accommodations that they need (identified in the evaluation) in order to be successful in school. A special education teacher serves as a case manager, and will keep track of progress and share data with the parents at report card times. At minimum, the IEP team will meet and discuss the annual goals once a year, where new goals will be written based on progress and current needs. Every three years, a student will undergo a reevaluation to see if they still qualify for special education services (the goal is to close the gap and catch the student up to their same age peers’ academic levels). Important: a parent has the right to request an IEP meeting at any time if they feel there are issues impacting their child and they want to get the team back together to discuss.

I think my child has a disability, what do I do next?

Stay tuned for my next post, about how to ask for IEP and 504 meetings. There are some key people you need to talk to to get the ball rolling. I look forward to helping you out and making sure your child gets what they need from your school.

If you have any questions, or need any support with anything IEP, 504 or accommodations related, please contact me at richard@chinpsyd.com

A little about me:

In addition to being a licensed psychologist, I am also a rower. If you are unfamiliar with rowing, its primary objective is to get into a 27-foot long boat (or longer) that’s about 14-15 inches wide, and using two oars to move from one point to the next along a river or other body of water. It’s a sport that takes a lot of practice to even be able to get into the boat and then a lot more row it well. I have rowed for a long time; in my life and in my practice, I relate a lot to it. It’s something that makes sense to me and it's something that I believe that I can use to help others. I’ve taught a lot of lessons on it, and I feel like I have a pretty good handle on how to get someone focused, motivated and moving. That’s not to say that rowing is easy, or life for that matter.

Rowing can be a particularly tough sport. This is especially true if you have a fear of being out on a body of water by yourself, not always seeing where you are going or worry about what is beneath the water. Then, you have to deal with wind, waves and other people. This can be incredibly challenging! Sometimes even daunting. I remember one brutal practice that we had while I was training in Chicago. Our coach wanted us to go out, as we were preparing for an upcoming race. The temperature was probably hovering around 37°, I remember that I could see my breath throughout the practice. But on top of that, there were probably 20 miles to 25 mph winds. I remember that before we got into the boat and shoved off, we were all standing around, huddled together trying to find some amount of warmth. We weren’t sure what the workout was going to be, but we anticipated that it was going to be tough. In the end, it was. It was probably one of the hardest we had that year. But we made it through...it wasn’t enjoyable, and we didn’t look back on it and say, “wow that was fun.” But we made it.

I see therapy and rowing as a lot alike. You may not know what I’m going to say in a session, or what you will get from it. But, if you stick it through, and persevere, those things you really want to get out of therapy can happen. During our practice, we made it through...and so can you. Now in therapy, I won’t treat you as a novice, or someone who is just now stepping foot into a boat. I’m not going to make you wear a life preserver. In fact, you’re more experienced in your life than I am, and that makes you an expert in your life. I’m going to approach you as such. You’ve made it this far. Your path ahead, whether a road toward recovery, or a more fulfilled you, may not always be enjoyable, but it is yours. I look forward to rowing alongside you in therapy.

#DADpression

#DADpression. Have you ever heard of this term?

 You’re usually a superhero. You are up with everyone else, you make the coffee and prepare for the day. Even though you spend your day at work and weekends on chores, you are ready to tackle any household problem; together with your drill driver and a few bits, you could build that new shed or repair the broken drywall if you wanted. But lately, it’s been tough to keep going.

  Your partner gave birth to your first child a couple of months ago - you were ecstatic and joyous. It seemed like that feeling would never fade as this new being entered into your life. You had a lot of jive and boogie about the little one, but just a few months later, you’ve found it’s been hard to get out of bed, to focus, and you’ve just felt down. There are days, too, where you worry about everything, from large important things in life to the small irrelevant ones. 

I’m a dad and struggling

 It doesn’t get a lot of press and talk, but there is a phenomenon that can occur, typically starting a few months after the birth of your child, termed paternal postpartum depression. Research has shown that anywhere between 1.2 to 25.5% of new dads will experience this within the first year of parenthood. While you may try to pass it off as a “funk,” or that you’re “just tired,” (in reality you probably are…) this can often be much more. Although, as fathers or men, we may try to double down and push through it, there can be several consequences on the family and infant or child, including distress for the child, tension in the marital relationship, and longer-term behavioral or emotional consequences for the child.  

 Why am i struggling?

Evidence has shown that there are two major categories that can act as risk factors, including biological risk factors, such as low hormone levels or a predisposition to depression or anxiety, and ecological risk factors, like the drastic change in lifestyle, changes in social supports and connections, or even the changes in your marital or partner-relationship. In short, this means the things that were given to you, latent in your genetics and makeup, and the things going on around you, both play a role in paternal postpartum depression.

 It can be easy to feel that you are alone when experiencing this. It is important to know, though, that you aren’t. When asked, the fathers involved in this study reported feeling an increase in dissatisfaction with their partners, potentially due to a lack of intimacy and changes within the sexual relationship. Additionally, your beliefs regarding gender roles may be at play. It is often the case that men have a perception that they must be the breadwinner and leader of the family, and as a result, put a great deal of effort into work after the birth of their child. The natural consequence of this is that you have less time to spend at home with your family, and maybe a sense that you don’t have as close of an attachment with your child. Further, long-term implications of a depressed dad have also been identified (e.g. your kid has a higher chance of experiencing depression). 

 There is help

It is important to recognize that this is not a situation where you need to “just get back to it.” #DADpression is real, and you need to take it seriously. If you connected with anything here, or are a new or soon to be father with a history of depression or anxiety, it's a good idea to get in touch with a professional, even if only for a tune-up. If you are not connected with a professional, feel free to give us a call or email. 

 Share your comments and thank you for reading!

Three Ways to Macguyver Your Dad Brain

As a father, you are faced with responsibilities every day: figuring out how you will divide your time between family and career, parenting, completing your “honey-do” list or other household tasks, or maybe you are training for a marathon or triathlon or are trying to lose weight. Balancing these responsibilities can be like having to juggle flaming torches with a blindfold while walking across a tightrope. At times, it might feel like it wouldn’t take much for it all to come crashing down. Even Macguyver could find it difficult to figure this out. When these things are unbalanced, it can be difficult to experience joy and satisfaction. It can seem that as a father, it is a requirement to perform a balancing act between what you need to do, what others ask you to do, and what you want to do.

The result? Less enjoyment and satisfaction in your life - You stay up late to get more work done, skip lunch in order to make that extra run to the store, show up late to work because you forgot your briefcase. Maybe its none of those, and instead simply high levels of strain and stress, which can impact other areas of your life (i.e. decreased libido). The myth that you need to be a super-dad in order to be a good dad, I think, can weigh on any father; you may find yourself toiling through the week to get everything done, and as Macguyver was often forced to do, solve a complex problem using only a few tools. So, dads before you brew another pot of coffee to help you stay up later tonight, here are three things you can do to help Macguyver your brain to experience more enjoyment.

Sidebar: Did you know that in the pilot episode, Macguyver not only short circuits a missile using a paperclip, but he also makes a rocket thruster out of a flare, uses a fire hose to move a large steal beam, and relays a message, using Morse code, through a facilities’ lighting system, to send a warning signal to stop a missile. All in a days work.

1. Drop the all-or-nothing thinking. This approach can cause you to see extremes, rather than the middle ground.

It can be a father’s nightmare to have no progress, whether on a project at home or work, or even in your own exercise plan. Consider this as the example: you wanted to get a workout in, but your child woke up from his/her nap early. You might get moody and frustrated since you were looking forward to your workout. Your partner and kid(s) notice, and an argument ensues. In this case, all-or-nothing thinking might include a thought of, “if I miss this workout, my training will be a bust,” or, “I have to get this training session in, otherwise I’m going to gain weight.” This type of thinking leads you to the conclusion that you’re stuck and that you will be less prepared for your next workout or competition.

First off, not true. Second, what good does it do you to focus on the supposed outcome, when you aren’t even there yet? You aren’t laying the foundation to a new home, because sure, a delay there could cause a big backup in future work. In this sense, allowing yourself to be stuck in an all-or-nothing thought pattern can definitely cause a decrease in immediate enjoyment. Staying up late to get that workout in may not be the best thing for you, your weight, or your training. Instead, focus on those things within your control and think about how acting in those areas can benefit you.

2. Don’t jump to conclusions. You might remember the 1988 movie, Big, starring a young Tom Hanks. Central to the movie was Zoltar, the magical wishing machine, to which Tom Hanks’ character makes a wish that ultimately comes true. This machine is similar to a fortune telling machine, which can, you guessed it, predict the future. Now…sorry to burst your bubble, dads, you can’t tell the future, try as you might.

Here’s an example. Its been a busy day at work, and all you want is some intimate time with your partner. You get home, your house is a mess, the kids need baths, and you hear your partner yelling about how the youngest painted your walls with mud. You say to yourself, there is no way this is happening. Your heart sinks, as does your libido; both are replaced with frustration and irritability as you just know that what you played out in your imagination will not happen. This style of thinking, fortune telling, can lead us to predict that all the mess, the kids and the fresh mud paint will inhibit any and all sexual intimacy. By putting an end to the fortune telling, you can cut down on the frustration and irritability that arises from our negative expectations, and you can exist in the present, one which may or may not lead to the sumthin-sumthin.

3. Do…separate your opinion from fact. As a father, what do you consider your job to be? Is it to guide and lead your family? To set good examples for your children? In both of these, or any role you might have as a father, the potential for you to mix, or mistake, fact with opinion is there. By the way, the answers to those two examples are facts.

For example, you may think to yourself that in order to be the best dad, “I need to get in my daily workout,” or as a father, “I deserve to be catered to by my spouse/partner.” Both of these statements are opinions. No, you don’t always need to get in a workout, and you certainly don’t need to be catered to by your spouse/partner. However, separating the two can be challenging. Maybe you want or would like those things, but they will not make you a better or more complete dad. But, if you hold to them as though they are fact, and they don’t come true, how do you think you will feel? Here’s another one, “my kids require my attention when they are talking to me.” That is a fact. Your children require your attention. That means getting rid of the phone or tablet, and spending that one-to-one time. No opinions there.

Here’s an exercise that can help to Macguyver out of the unrealistic standards or beliefs created by the mix-up of statement and fact: create a list of statements you believe about yourself, or bonafide experiences, (e.g. I am bad, Others must cater to me, I yelled when I got angry) and label them as fact or opinion. Doing this can help us to distinguish between the two when they happen in our own thinking, which can help you to experience greater satisfaction and enjoyment in your life.

Have any other ideas? Feel free to comment below about what has helped you.

Thank you for reading,

Dr. Alex

Please note, by reading this or replying you acknowledge that this does not constitute a therapeutic relationship or agreement to receive treatment. None of the content provided replaces a therapeutic relationship.

Ch-ch-ch-changes

As David Bowie sang, “turn and face the strange.”

Are you currently going through changes in your life? Or facing the reality that things are starting to change for you?

I think when we begin to “turn and face the strange” in our own lives, it can seem a little daunting. Or maybe a LOT daunting. Change is hard. Like, really hard sometimes. Change requires us to be flexible and to give up control and to be adaptive. All of those things sound good in theory, but most of us are creatures of habit. We often like routine and consistency and structure, though some of us might be loathe to admit that fun fact.

At the end of the day, change is one of the MOST consistent things we will face during our lifetimes, and so for that, it’s best to start to befriend it. Or, at the very least, get a little more familiar with it. What do you usually do when change is coming your way?

Run from it? Hide away in a dark corner somewhere and cope through denial?

Do you self-destruct to avoid having to go through the changes that you’re facing?

Do you bravely look it in the face and agree to all of its uncertainty, your fear, and the unknown?

Uh, yeah, me too - I definitely do the third one.

Hah. Just kidding.

Like I said before, change is hard. It’s tough to know it’s coming, to know that you’re being asked to bend and grow and stretch and cope. To know you need to be more flexible to adapt to what the future will hold, which is generally unpredictable. I think most of the time, the unknown is what really freaks us out. We don’t know what to expect, so we make up scenarios and stories - and our imaginations are quite extreme at times. Then, rather than recognizing that our imaginations might be playing tricks on us, we take those imagined scenarios and start to look at them through the same lens that we view our reality - like it’s already happened, or it’s fact. And that, my friends, can lead us into some dark and scary places.

Fear is a total liar, even though he tries to manipulate you into believing he’s truthful and honest and trustworthy.

But he’s not.

So, changes are hard because there’s the unknown, the fear of what’s to come (or not come), the anticipation of waiting and not knowing, and just the mere fact that things won’t continue on like they have been.

How can we cope with this in a more grace-filled or productive way?

I say, lean on others during changes in your life. Make sure you’re processing through all of these big changes (and all of their accompanying emotions and thoughts and reactions) with your therapist, and your friends, and your confidantes. Make sure you are leaning on others, rather than trying to handle it all yourself. We were never meant to shoulder the burdens of life alone, and no one should take on that kind of weight on their shoulders. Talk, reach out, write to a pen pal - whatever you need to do to connect with others in a real, authentic way.

Process it yourself, too. There is power in the skill of journaling, being able to be self-reflective through writing and expression. This allows us to connect with our deepest selves, and can sometimes allow thoughts and emotions that were buried underneath a bunch of other garbage to emerge. Write about what you’re going through, and the changes that are taking place in your life right now. Write about how you feel about it. You might start to find that it makes you feel a little better, or it at least gives you a little more clarity into your experience.

And remember, maybe more importantly, that you don’t need to have all the answers. You can be afraid. You can feel challenged. You can be scared of the unknown and worried about what will happen and freaked out. You can feel totally out of control. It’s just NOT normal to go into change feeling totally calm and in control - so remind yourself of that. Nothing is wrong with you for being scared, and for feeling fear, and for not knowing what will happen next. Just know too that you’ll get to the “other side” eventually, and the journey is worth more in the end than the destination. How we choose to cope with that journey is what is inevitably the most important part.

Surrendering

I have been thinking about this topic a lot recently, especially as I near my due date for my third baby. I have been striving toward maintaining an attitude and perspective of “letting go” and surrendering to the events that may unfold as I bring my son into this world. I also think that this idea of surrender is one that we talk about frequently in the therapy room, though usually under the auspice of “acceptance.”

The Merriam-Webster dictionary defines surrender in a number of ways:

transitive verb

1a : to yield to the power, control, or possession of another upon compulsion or demand (i.e., surrendered the fort)

b : to give up completely or agree to forgo especially in favor of another

2a : to give (oneself) up into the power of another especially as a prisoner

b : to give (oneself) over to something (such as an influence)

intransitive verb

: to give oneself up into the power of another : yield

When you look at these definitions, it can feel daunting and scary to surrender to anything. Surrendering may potentially feel like losing yourself or giving up - both things that get a bad rap in our society. Because power is something we often try so desperately to hang onto, it can seem like a complete opposition to give it up.

When we think about and talk about surrendering to our emotions, too, it might seem like I’m advocating for listening to and responding to your emotions - i.e., allowing them to control you. But this is actually not what the surrendering process looks like. At all. In fact, the act of accepting and surrendering to our emotions is a ‘letting go’ of controlling them. It’s a letting go of whatever those emotions might spark in you - whatever urges you might feel or whatever thoughts they may bring to the surface. It’s letting go of the judgment of the emotion - allowing yourself to be in your experience fully without expectations or harsh criticisms of yourself (or the experience itself). It’s deciding that acting from the place of your emotions is really not all that effective, and so instead, I’ll sit here awhile instead and allow that emotion to exist without driving the bus.

What’s the benefit to this, you might ask yourself? Why would I choose to surrender to my emotions or experiences? Well, precisely because there is a lot in this world, in your lifetime, that is out of your control. If we look at what IS within our control, the list is quite short:

In Your Control

-Some thoughts

-Behaviors (actions, words)

Out of Your Control

-Emotions

-Automatic thoughts

-Bodily sensations

-What other people do, say, think, react

-How situations unfold or are created

While we can certainly do things to influence others and the world around us, we are not responsible for how and why other people do what they do. Thank goodness! I wouldn’t want to take on that kind of responsibility!

Surrendering to the situations that are out of our control and allowing ourselves to move freely, unencumbered through them, without judgment and with openness, we actually open ourselves us to potentially creating more change and positive impact than we might if we were resistant to what’s happening.

If you’ve never heard the Serenity Prayer, its message is powerful:

"God, grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.”

It’s easy to fall into the trap of feeling like we need to control it ALL, but it is so much more freeing to acknowledge what is out of our control. Surrendering to this for you might look like surrendering to your higher power, God, or the universe. Surrendering to your hope or faith, or maybe even your belief in the power of good in the world. Whatever it is for you, I hope you can find peace within it. I know that is my goal as well.

Why do we give others more credit?

I suppose this title could bring about quite a few thoughts…

We give others A LOT of credit. We look at others in comparison to ourselves, and often feel that we don’t measure up, that we are lacking in some way, or that we have more growing to do. Sometimes, this social comparison can add a little bit of pressure that helps us to succeed. Other times, this comparison and self-annihilation leads to feelings of low self-worth, self-doubt, and sadness or anxiety.

We also give others credit for successes we see by applying their successes to internal factors. There is a social phenomenon that occurs that accounts for this: when we apply others’ successes to their internal abilities and skills, whereas we look at our own successes as being attributable to outside forces or external factors. This fundamental attribution error often causes us to look at Bob over there, leaving a nice big tip for your server, and say to ourselves, “Wow, Bob is a really generous guy.” Whereas, you might leave a big tip and think to yourself, “Well, I’m generous sometimes but honestly wanted to impress our friends with my generosity.”

We also give others a lot of credit when it comes to our thoughts and feelings. I’m sure you’ve been in a conversation before (or, let’s face it, an argument…) where you have said something along the lines of, “You made me feel _____!” Fill in the blank with the emotion of your choosing. (Hint: It’s generally one that we don’t like or don’t want to take credit for having.) Why do we give others so much credit when it comes to how we feel? It seems like such a loss of power when we think of it this way. Almost as though we could be swayed in any emotional direction, given whatever the situation is that arises.

The truth is, we do get “triggered” (a.k.a., we have a response that is emotional, cognitive, and oftentimes behavioral) by our environment and the others we are surrounded by. But, does that mean that we should give others power over our choices and how we handle our emotions? Should we give credit to them in the first place for how we experience and manage our feelings? I think this is dependent on a number of factors, one being how we choose to experience our feelings in the moment. When we look at our emotions as scary and out-of-control things - things that feel we are unable to manage or cope with - of course it makes more sense that we would want to attribute them to someone or something else. It’s hard to take ownership of things that feel all-powerful, scary, and monstrous!

However, we DO have a choice in this matter, in terms of the perspective we take toward our emotional experiences. Are our emotions really these big, scary, awful things that we are just experiencing at the whim of everyone and everything around us? (Goodness me, this sounds like an absolute horror film - being completely powerless over all of your emotions and experiencing feelings and actions that are actually controlled by others…) Or, is it possible that - while our emotions are not always necessarily within our control 100% - we are still able to experience them as chances for learning, ways of being a student of self, and as welcome visitors?

Sometimes when I use these terms, like “emotions as welcome visitors” with my clients, they look at me like I have a third eye right in the middle of my face. Sometimes this is because they express a disbelief that emotions could ever be welcome in their eyes. A “welcome visitor” makes it sounds like something you’d want to have come and visit you, and many of my clients are actively trying to AVOID experiencing or recognizing their emotions. That makes sense. I absolutely get that it is a foreign concept. But, just bear with me.

If we were to try and see these emotions as welcome visitors, we’d be able to greet them at the door (“Oh hello, anxiety. Didn’t know you were showing up today. How are you?”), let them come in (“Well, you’re here anyway, so why don’t you come in and sit on the couch.”), and then after you’ve had a little time to visit and sit together, send them on your way (“I don’t usually enjoy your visits all that much. You usually make me feel kind of bad about myself and you rile me up. I acknowledged you were here and now it’s time you were on your way.”). By the way, no one said you had to actually enjoy these welcome visitors during their brief stays. If you practiced this enough, I’m sure that with some time, these visitors might only stay for 10 minutes, 5 minutes, a couple of minutes tops - down the road.

However, we lose the ability to let our emotions be our own and take ownership of our experiences when we give others credit for how we feel. By being a victim to our circumstances and to others around us, we’re constantly in that sea of emotions that makes us feel like we’re drowning. It’s like wave after wave of emotionality coming in our direction, and we are without a surfboard or life preserver, or even a tiny little inner tube. When we can prepare and recognize that we are responsible for our feelings (aka, what we DO with them when they arise), it becomes a lot easier to remember your inner tube or surfboard. And then, you’re not caught so off-guard next time that big wave comes. I would imagine that once you ride that wave in, and all is said and done, you’ll feel more proud of yourself than you did before you caught that sweet surge.

How do you handle stress?

We all handle stressors in our life differently. Sometimes, we internalize and take it all on silently. Meanwhile, our emotions are crushing us inside and our thoughts may be swirling to negative places, spiraling into the dark crevices of our mind. This may be invisible to anyone in the outside world, but it may start to lead to feelings of resentment or hurt, when others do not recognize this very real pain that we are experiencing on the inside. Or, we may externalize. Maybe when you’re stressed, all of that energy comes out of you and lands onto the other people in your lives - your spouse, your friends, your kids. Maybe you yell or scream, get panicky or controlling, or try to boss around others. Maybe you turn to more destructive behaviors, like self-injury, drugs or alcohol, food, or sex as a way of coping with the stress that you’re feeling. Sometimes, it may be difficult altogether to even recognize when stress has such a death-grip on us, until we start to parse it out and really look at what is happening in our lives.

It’s also easy to blame our behaviors on “stress.” Everybody nowadays is STRESSED. Everyone is busy, overwhelmed, going a million miles an hour. It’s more rare in fact to find folks who are content. Peaceful. Experiencing a sense of calm in their lives. Sure, their Instagram might be all white and glowing and the perfect resemblance of serenity and grace, but that may be a facade, hiding the all-too-real anxieties and stressors that many (let’s face it - MOST) of us face.

Why has stress become our new normal? I could gripe about how our culture has shifted into one of convenience and instant gratification, and wax nostalgic about how things were different before smartphones (and I’m only in my early 30’s!). I could go there, but they would be mere speculation and not really based on anything other than my observations and biases. Or, I could point out a simple fact: cortisol in any high or consistent levels is actually damaging and toxic to our brain. So, this is not a healthy state to be in. The why IS important, AND it is also important for to us to figure out a different way of being in the world.

How could you start to introduce more peace into your own life? Do you desire to have less stress? What stressors are you currently facing? Would your life look different if things were slowed down? If you slowed down? And what does the stress ADD to your life? Does it help you to avoid or not approach things that may be difficult to face? Because let’s face it, it must do something for us - it doesn’t feel good and yet we often stay here, in this place of high stress, so what is the catch?

We’d love to hear your thoughts on any of the above! And as always, if you want to discuss these issues, or any other issues, further - please don’t hesitate to reach out.

Ending emotional eating, part 3

Okay, so a few weeks ago, we talked about what emotional eating is and how to begin identifying the differences between emotional vs. physical hunger.

Today, we are going to start thinking about fueling our bodies and really setting the stage for the different things that might make us more vulnerable to emotional eating. Later on, as we continue this series, we’ll also talk more about ways of coping with emotions in a healthy way that starts to diffuse the need for finding comfort through food.

Now that you can identify a bit easier what physical hunger feels like in your body, from Part 2 of this blog series, you likely have a better sense of when you feel hungry throughout the day and maybe even what foods you start to turn to when you’re feeling hungry. One vulnerability to emotional eating can be when we let ourselves get SO hungry that we are making impulsive and rash choices around food. This can also cause us to overeat and become uncomfortable, which only continues that cycle of again allowing ourselves to become too hungry. Have you ever heard that phrase, “I’m so hungry, I could eat a horse!” Not a good place to be when we are trying to make mindful, intentional decisions around food.

One way of decreasing that vulnerability is by staying within that range I proposed, between a 3-7 on the hunger-fullness scale. How do you stay within that scale? Well, for starters, that might look like eating every few hours, so that your blood sugar levels are never dropping off or spiking in drastic ways throughout the day. It can also look like balance, which may mean eating appropriate, recommended portions of your foods (remember, ALL foods fit into this philosophy!) rather than too little or too much. It will look like eating breakfast, lunch, and dinner, as well as a few snacks throughout the day, and getting a balance of different foods from the various food group families. It means not depriving yourself, or “saving up calories” or even counting calories or macros at all. Intuitive eating comes from listening to your body, not calculations or numbers or even the time on the clock.

That may be a difficult thing for many people to accept, knowing how the diet culture influences so many things in our society today. Calories are posted on pretty much every menu you see, and we’re so aware of what is “bad” or “unhealthy” in foods around us. This next step really involves a conscious effort and choice at removing these judgments and removing the influence of some of these other food qualifiers.

When you go to Starbucks or to a restaurant for lunch or dinner, can you honestly say that you order what you WANT on the menu, and that the calorie postings next to the food options you choose don’t influence what you pick? It can take a while to get to that place, and it takes a lot of hard work to retrain your mind to see ALL foods as important and necessary.

When it comes to intuitive eating, we are teaching our bodies and our minds that food isn’t what holds power. Food by itself is not special - WE make it that way. Food is food. We ourselves place important and emphasis on it, and THAT is what creates these ideas of food being good or bad. I sometimes say to my clients that I wouldn’t recommend someone only lives on cake, the same way I wouldn’t recommend that someone only lives on carrots. Everything in our lives must include moderation, flexibility, and a healthy dose of forgiveness. Anytime shame starts to enter the picture, especially when it comes to food, we find ourselves in a dangerous place where polarization can start to take place. It’s in that place of judgment and shame where emotional decisions and black-and-white thinking around food (and our bodies!) can really evolve. Over time, learning to identify those tendencies with a good eating disorder therapist and dietitian, AND learning how to re-train your brain to have a positive and healthy relationship with your body and with food, you can start to see that shift from judgment and shame to acceptance and compassion.

How have you been doing this holiday season? I’d love to hear what your challenges and successes have been. Please leave us a note below in the comments, and don’t hesitate to reach out to make an appointment, if you’d like to discuss any of these topics further.

Ending emotional eating, part 2

So, we defined what emotional eating is in a prior blog post. I think this can genuinely be a confusing topic sometimes because food IS attached to emotion. We all have experiences with food that give us positive (and maybe even negative) feelings. When food is so intricately tied into our holidays, birthdays, and other celebrations, it DOES take on an emotional quality. There is nothing wrong with this, and the first myth I want to dispel is that eating should be done in a robotic or controlled, rigid way. It’s not just fuel; it is so much more. And, the beauty of having a healthy relationship with food is being able to experience these positive emotions without letting them control how we act around food.

Now, how do we dive in to tackling this and addressing issues related to emotional eating?

Well, we need to build awareness. Awareness of what, you might ask yourself.

Good question!

We need to find out WHAT is going on when the urge to eat hits. Do you know how to gauge your hunger and fullness cues? This is an amazing gift that we are given as babies and children. Then, along the way, this gauge can start to get a little distorted. Rather than reading what is happening within the body, we start to look to the clock, to others, and to society to tell us when we’re hungry, what we’re hungry for, when we’re full, and so on and so forth.

If you have little kids or have ever been around them, you’ll see that their eating patterns can sometimes look erratic. Yes, it IS true that if you only let a child eat popsicles and mac ‘n cheese, they will start to develop some not-so-healthy habits. AND, it’s also true that if you let them eat when they are hungry and stop when they are full, their eating may differ from one day to the next. Heck, one hour to the next! They can listen to their bodies in a very intuitive way because they are still so present in their bodies. This is a natural-born gift that we all come into the world with. We’ve seen with breastfed babies specifically that there is a symbiotic relationship that happens between child and mom; the child eats to fullness, and then mom’s body adjusts to make the appropriate amount of milk that baby says he needs. We have this very special gift that often falls away as we age, due to all of the other pressures and emotions that start to infiltrate our relationship with food and the act of eating.

To get back to this, it’s important to begin to identify what physical vs. emotional hunger feels like. Physical hunger has physical cues. When you notice that your tummy is growling, you’re feeling faint or weak, or maybe you start to get a headache - these are all physical signs that your body is in need of food. Emotional signs of hunger may come in the form of cravings, thoughts about food, and emotions around food. When we are physically hungry, there isn’t much pickiness that occurs. If you need fuel, you will take that fuel in the form that you can get at whatever moment in time it is. This is why it’s also important that we don’t allow ourselves, in trying to become an intuitive and mindful eater, to really get too hungry where we end up making ineffective choices around food. A good range to stay between on a 1-10 hunger to fullness scale would be staying between a 3-7. A three on the scale might look like a little bit of stomach talk, some thoughts about food and eating, and a physical sensation of hunger. It shouldn’t feel like a starving, gnawing hunger, which might look more like a 1 or 2 on that scale. A seven would be equivalent to being satiated, satisfied, full but not uncomfortable. When we begin to feel bloated, uncomfortable, sleepy, and perhaps in pain, we might find that we are between an 8-10 on that hunger-fullness scale.

Every person is different, so beginning to identify what hunger and fullness feels like in your OWN body is a great start to ending emotional eating. This first step won’t guarantee that you’ll stop engaging in emotional eating behaviors right away…that takes time and practice. However, beginning to differentiate between what physical and emotional hunger feels like is definitely the first step. One question to ask yourself, if you suspect that you are feeling emotionally hungry, is:

What else am I craving in my life right now?

Are you looking for connection from others? Intimacy? Closeness? Space or self-care? Are you currently in need of some quiet, alone time? Some time to slow down and relax? Time to be active?

When we can start to identify our needs - our needs in relationships, interactions with others, and emotional, spiritual, and psychological needs - we can start to find that maybe we’ve been using food as a way to meet those unrelated and very real needs. We can fall victim to emotional eating when we start to confuse these needs with our physical need to eat, and because food is never a substitute for relationships, connection, belonging, self-care, and beyond - we may find ourselves trapped in that vicious cycle of endlessly using food as a way to fill that hole. Once we start to become aware of this, we can start to meet those other emotional needs in the way that will truly satisfy them.

Stay tuned as we continue to identify ways of tackling our emotional eating through this month of November!

Ending emotional eating, part 1

I’ve been thinking about starting a small series of blog posts on emotional eating, especially as we are coming into this holiday season. Food is plentiful during this time, and often we categorize these holiday foods as “bad” - candy and sweets after Halloween, turkey and all the fix-in’s for Thanksgiving, and the cookies, cakes, and breads that adorn the month of December.

How do I relate to food?

Do you think it could be possible that you could have a relationship with food that allows you to eat ALL of these things, in moderation, and without guilt, shame, or judgment? Do you think it’s also possible to stop looking at foods as “good” or “bad” and start to just see them as fuel?

Whoa.

I feel like for some of us, that may feel like such a foreign concept that you might be laughing at your screen. Out loud. Wondering what kind of crazy pills I’m on.

Some of you may also be saying to yourself that you don’t want to eat foods in the “bad” category. You may be equating these particular foods or holiday events with fear, anxiety, or dread - feeling like having to eat them is a punishment or hurdle. Perhaps you can’t even see the value in having an “everything in moderation” approach to your relationship with food.

Emotional eating

Emotional eating, in its definition, is when we allow our emotions to control or decide our behaviors around food. That could mean restricting our intake of food, due to fears or avoidance. It could also be binging or overeating food, due to other emotions that we might be working to soothe through the comfort that food can often bring us. Either way, when we attach emotions to food as our primary means of relating to it, we end up moving away from allowing our intuition to drive the bus. Instead, we end up in a distant relationship with our intuition - not really knowing what we’re thinking, feeling, or craving - and finding that we are hard-pressed to make mindful decisions about what we choose to eat.

mindfulness

Mindfulness is really the act of intentionally being present, without judgment. When we pair that with behaviors around food, it’s about choosing foods, thinking about foods, and eating foods in an intentional, present-focused, and nonjudgmental way. Can you think of the last time you thoroughly enjoyed food in this way??

There is a lot that goes into mindfulness when it comes to emotional eating. Emotional eating, in its full range, also encompasses a lot of other topics that I will have to probably make later blog posts or a series on - topics like body image, self-compassion, and weight bias. But for now, I hope that by introducing this idea of emotional eating we can start to explore it through this month in ways that will be helpful to you - to help you start to change your own perceptions about and behaviors around food, to ultimately lead toward a more nonjudgmental and intuitive approach to your eating patterns.

What is a psychological evaluation or assessment?

Has your son or daughter’s teacher recommended that they be assessed for ADHD? Have you ever thought you were depressed or anxious, but just weren’t sure? Maybe you’ve been in therapy or counseling for some time, and feel like you’ve hit a wall. It sounds like a psychological evaluation might be helpful.

A psychological evaluation, or what we refer to in the field as psychological testing, is a battery of tests that helps the clinician to better understand what and how the client understands and deals with emotions, others, thoughts and the world. Sometimes testing will answer specific questions, like “do I have ADHD?” or “why do I always expect the worst to happen?” Psychological testing can be equated to blood testing or blood work. Doctors will often recommend you get blood work done when there is a concern about nutrient deficiencies and disease. It can provide valuable insights to what is affecting your body, from the inside, and that may be less apparent from the outside. In psychology, our form of blood work is psychological testing.

As a psychologist, I have found psychological testing helpful as it provides a thorough understanding about how one thinks, feels, perceives and works with information. This data can be invaluable in therapy. Sometimes psychological testing is required for school accommodations because of issues related to ADHD, anxiety or ODD. Other times therapists or psychiatrists might need a more definite diagnosis that is supported by objective findings. For example, a psychiatrist or PCP may be uncomfortable prescribing a stimulant medication before having a definite ADHD diagnosis, or to determine a possible treatment regimen for a bipolar disorder. In each of these cases, psychological testing can help to get the treating clinician more information, which can help their confidence in prescribing a certain treatment.

If you are interested in or have been told to seek psychological testing, give us a call or send us an email, and we will determine if we be of help!

What is therapy and do I need it?

I still think therapy gets a bad rap sometimes. I DO think we are moving, collectively as a culture and society, toward more acceptance of mental health issues (most of the time). I can sometimes see how the stigma that has surrounded even the terms “mental health” or “therapy” is starting to lift, and how we are beginning to speak more in mainstream culture about accepting help from licensed professionals.

However, I still think we have a long way to go.

I often tell first-time patients - the ones who have never sat in a therapist’s office and who are completely green to these process - that there is “no man behind the curtain” a la The Wizard of Oz. There are no “tricks” up my sleeves, and I am not here to dupe you. But, for some reason, we sometimes have some suspicions about what therapy is all about, and I’m here to hopefully clear some of those up.

First, we’ll start with a list of what therapy isn’t:

• It isn’t magic. There IS research-proven evidence that just coming to a therapist’s office and sitting in the room for that hour is generally anxiety-relieving and helpful. Most people leave their therapy sessions feeling a bit better, so there is truth there. However, there’s no magic wand (as much as I wish there was). You won’t be “cured” by coming to one, two, or even six sessions. Your symptoms and issues will not magically disappear.

• It isn’t a time that therapists sit and judge you for whatever brings you in. We are human beings, too. We recognize that judgments are natural and a part of what we are taught to do from the time we are young. However, we receive years of training on how to cultivate a variety of ways of approaching individuals and conceptualize what brings you in holistically. In short, we won’t ever laugh at you, judge you, think less of you, or ridicule you for what you share. (And if that EVER happens in a therapy room, please get a new therapist - ASAP!)

• Therapy isn’t a band-aid approach. Yes, sometimes we talk about reducing symptoms and improving the present. This is mostly when we are talking about life-threatening and life-interfering behaviors that are putting you and your life at risk. In those instances, we absolutely need to problem-solve and figure out how to relieve the distress that you are experiencing. But, overall, therapy is about long-term change. We work on changing things like behaviors, thoughts, perceptions, and ideologies that might not be serving you anymore. We are tackling some BIG things in therapy. It’s not easy because of this.

• It isn’t the same thing as talking to your friend. We want you to think of us like you might think of a close friend - someone who is a confidante, trustworthy and personable. However, we are trained and licensed professionals. We have gone through years of supervision and learning to precisely approach you in a way that your friend will likely not be equipped to do. Friends are really important - don’t get me wrong. You NEED friends and social supports. We will help you get there if you’re currently longing for those connections. Just please know that this investment in your health is more than just talking about the issues you’re facing. We don’t just dole out advice and listen (though sometimes this can be helpful and is warranted); we will also work through your stuck points with you and challenge you to move in directions that might be uncomfortable or difficult.

Now, you might be thinking to yourself…”Well, what IS therapy then?” I’m glad you asked:

• Therapy is learning how to change. It’s learning how to be flexible, how to be self-aware, and how to be accepting.

• It’s really, REALLY hard work sometimes, and you won’t always leave our offices feeling better. Sometimes, you might actually feel worse. We don’t want you to feel bad, but we also want you to FEEL. That means feeling all of your emotions without checking out.

• With that, therapy is about learning to feel in a healthy way. We are often taught that our emotions are not okay, that they are too big, or inappropriate. We are here to squash that and help you learn how to feel your emotions without feeling like they are running your life.

• Therapy is talking. It might also include more creative outlets. I know, personally (and my clients can attest to this), that I use metaphors a lot to illustrate concepts that might be relevant to what you are tackling. So, it is a lot of words, but can also include things like writing, drawing, role-play, examples, and movement. In addition, therapy is about using what you are learning IN your sessions and taking them OUTSIDE of the therapy room. So, you might also be doing “homework” and practicing what you are learning in your real life. This is where you can start to see the changes taking place.

• Please also know that we want you to put us out of business. The goal is to not need therapy forever. We celebrate each achievement and success you have through this process, and while we enjoy working with you and learning about you, we also have lots of hope for you that you can do this - eventually - on your own, too.

There are probably a ton of things I’m leaving out. Therapy has a real special quality to it that also cannot be summed up in words. If you’re a spiritual or religious person, you might describe it as a soul connection that occurs between two people. I think the best way of truly understanding it and comprehending it is by experiencing it.

I may be biased, but I think everyone would benefit from a little therapy. If you’re interested in learning more or setting up an appointment, don’t hesitate!

Mindfulness, a primer

There is a lot of buzz today about mindfulness. You may hear about it in the media, and if you’re connected with a therapist or PCP, you may even have heard about it from them. A quick google search for the keyword “mindfulness” returned 213,000,000 results, far more than the 108,000,000 for CBT (cognitive behavioral therapy) and many more than the 23,900,000 for the term DBT (dialectical behavior therapy), from which the therapeutic use of mindfulness has grown. Mindfulness, in essence, is the state of being in the present. Not the future. Not the past. The here and now. When you are mindful, you are focusing you attention to the present. A fun way to approach mindfulness is adopting a curious perspective, examining the present as though it is something entirely new and unique. More on this later.

We are finding that you can receive a lot of benefit from practicing mindfulness. Research has linked mindfulness to an increased ability to manage stress, better work-life balance, and benefits to mental and physical health. Recent research has also shown a connection between mindfulness practices in the workplace and improvements in attention and focus, with some benefits proposed for more short and longer-term use or practice. Further, a large analysis of current research literature indicates that mindfulness-based therapy (MBT) can be effective when used to treat anxiety and depression, and really do support the use of MBT in therapy. It is important to note, that in comparison to other treatment methods, MBT still has a way to go. More research is needed to further validate it; this is happening, and the potential outcomes are promising.

I use mindfulness as a part of my practice, and many have reported finding it helpful to deal with their symptoms coming from anxiety and depression. However, it is not an easy practice, and many have also reported that it can be difficult to engage in. It is also not a panacea, and just like most things, won’t “cure” your problems immediately. When used in the course of therapy, mindfulness practices can become a powerful tool in your toolbox. Working together with a therapist, you might find ways that MBT can be helpful. Dr. Ashley will be creating some videos on mindfulness, which you might also find helpful in deciding whether you would benefit from scheduling an appointment with us.

Why should I come in?

Seriously, I think people wonder this all the time. I often hear phrases like, “I should be able to handle this on my own,” or “Why is it helpful to talk to someone else about my problems? I need to just get over them.” It's completely understood that coming in for therapy can actually increase anxiety and possibly other symptoms initially.  And for a small amount of people, talking about their issues may not help them to gain insight or change their behavior in a way that is effective. I would say that in my anecdotal experience (which pretty much falls in line with what the research suggests), most people benefit from therapy in the long-term, even though it may be uncomfortable in the short-term.

I am a visual person and I love metaphors, so I will use an analogy with you. Say you are going hiking in the mountains. You've got a huge pack on your back with all your belongings, you are setting out for a 100+ mile hike, and you're on your own. Maybe when you first start out and you're on your first 20 miles, things are going well. You feel strong, you notice all the beauty that is our outdoors, and you're feeling happy and content. Then, something happens – maybe there's a huge rainstorm and your boots are soggy, you get blisters, maybe you even have a fall and hurt yourself. Maybe a bear steals all your food, and you're left without any until the next time you get into town. Maybe you just start feeling lonely and sad because you haven't seen anyone else on the trail yet. Whatever it is, this “something” is tough to handle on your own.

You might even feel lost or scared, wondering which direction to take or second-guessing yourself.  Most people, at this time in the hike, are relieved when they run into a fellow hiker or when someone acts kindly, just because. Ideally, what will happen is maybe you'll meet up with someone who helps bandage you up, shares their food, and hikes with you to the next apex. Once you both summit together, you can stand around, share the beautiful view, and then maybe you go on your separate ways after that point – when you're strong enough to be back on your own.

So, I'm sure you guessed it, but the hike is life, and those missteps along the way are all the struggles that we ultimately go through, because – well – we're human. They are an inevitable part of life. I know that so much stigma exists around coming into a therapist's office and bearing your vulnerabilities, and I understand why. We are afraid that we will be judged, laughed at, or maybe we're even scared that what is going on for us isn't "enough" to warrant therapy.  But I'll tell you what - most of us, the good ones at least, are here to help you mend, heal, and we really want more than anything for you to not need us. We don't judge you, we certainly don't think you're weak, and we don't talk about your struggles outside of our office doors.  Whatever is bringing you into our office is valid and deserves attention and compassion.

​ I'm curious to know what people's experiences have been with therapy – has it been helpful? Do you fear coming in and talking about what is going on for you? I often let folks I'm meeting for the first time know that sometimes shopping around and finding a good fit is necessary. We don't all click with the first person we meet. So, shop around if you need to, and know that there is a therapist out there who is excited to hear your story and help you reach your next mountaintop.

A good ole' sit & think

I started thinking about this topic while I was rocking my youngest son back to sleep this morning (5:50AM). While rocking back and forth in the glider hoping that my son would go back to sleep long enough that I could have a dream, I started to envision all of the things I needed to do today. Church, cleaning, paperwork, taking care of the kids, taxes, mortgage, the nature of string theory and how it could relate to the human mind... In my early 20's this kind of processing would have required two, maybe three, cups of dark-roast coffee. Alas, this was not to be in my morning. Instead, my son looked up at me, eyes wide, as if saying, "I'm ready to go, why aren't you?" The silence we enjoyed together was ended by his near-toddler egging and grunting. "Time to go," it meant.

As much as I would have preferred for my son to have willingly fallen back asleep, there is a silver lining to our quiet time together. I believe it is pretty well accepted that we live in a noisy world. Cars, airplanes, music, construction...all noises most of us experience on a daily basis. This is a modern phenomenon, though. Imagine 100's of years ago when we did not have the same level of noise. What would you experience at night? Silence. Today, when we experience that it can be somewhat uncomfortable and unsettling. Where did the noises go? Why aren't there cars driving down my street, or the noise of my neighbors yelling in excitement? Did something happen? 

Some research has linked the experience of noise, or noise pollution, in the office and community, to increased stress, sleep loss, and psychological symptoms, but not with psychiatric disorders. Interestingly, it also leads to increased levels of chatecholemine secretion - this is a hormone that is helps us respond to stress (think fight or flight). Scientists and clinicians have been aware of this for awhile now. The research on this subject is amazing - noise pollution, coming in the form of airplane and jet noise, has an impact on children's neurodevelopment, and can lead lower reading scores and slower development of cognitive and language skills!

Now, I am not saying that you should cancel your plans to visit New York City next summer. Rather, as a psychologist in clinical practice, I would encourage thoughtful exploration of the amount of time you, and your family, spend in quiet thought and exploration. Do you have the television on as soon as you and the kids get home up until dinner, and even during? Try to see what it is like without it on. For a long time I had gotten used to having the news on 24/7 - it helps me focus and provided useful distractions during my years in school. I know it can be hard to make such a shift. The television can become a part of the family, always there when you need it. If this is the case, try a week without it, and instead turn on the radio. "Alexa, play my 'keep my mind off the fact I am not watching the latest episode of Game of Thrones' radio." 

Although it may seem small, the importance of adapting to this change is significant. Thanks to advances in technology, any show that I want to watch is available to me. Type it in online, or enter the channel number into my remote, and voila, my desire is satiated. This is also known as instantaneous gratification - the opposite of our childhood archnemesis, delayed gratification (actually a hero). For children especially, the development of the ability to delay gratification can lead to positive outcomes in school and in life. The same can be said for us as adults. Our ability to delay gratification is synonymous with impulse control. Having media and electronic stimuli available nearly everywhere really may not promote the development of impulse control. The practice of sitting with our thoughts, without acting, without avoiding, without judging, even, is tough. Yet, doing so can be good for our health. 

As I finish writing and researching this post, the sun is now up. My youngest son has now eaten his way through his breakfast. I have not gotten back to sleep. I am grateful for that. I was given this gift of extra time with my son that I otherwise would not have. I look forward to see what other aspects of my day this will change. 

Give it a try, today, tonight or tomorrow. Spend some time in thought. In silence or quiet. One of the shows my oldest son loves is Sarah and Duck. In it, Sarah, the main character, and duck, her pet, spend time in thought. They call it, "sit and think." I would encourage you do the same. Give yourself the time and space to have a sit and think of your own. See what happens.

For some more information and helpful tips on mindfulness, consider scheduling an appointment with us.