Meditations / Pixabay

For the entire time I’ve been a therapist, I have always taken a strong interest in life transitions. As someone who has gone through many such transitions myself, I have been well aware of how people going through big changes can get stuck.

Over time, however, I have begun to realize more and more how one of the big sticking points has been trauma. As such, I found that I could not effectively address life transitions without looking at traumatic experiences. I also began to realize that trauma was affecting other aspects of life besides life transitions. Because of this, my specialty has broadened from life transitions to treating all kinds of trauma.

All of us have dealt with trauma on one level or another, though we might not always call it “trauma.” I look at trauma as a “Great Interruptor.” I define trauma as a event that is so severe that it causes a person to go into “survival mode.” In such cases, our minds put all focus on responding to a perceived threat to our existence, at the expense of being able to think about a situation rationally. This threat might trigger a “flight or fight response,” which is a physical reaction involving the release of stress hormones. Such responses can be the result of perceived threats, regardless of how real they might actually be. Similar events that come up later can re-trigger such responses, thereby acting as a barrier to responding to the event in a rational and productive way.

Because of this, trauma can act as an enormous stumbling block to solving many sorts of problems. I kept encountering this in the therapy sessions I offered, I realized I needed to find ways to address trauma.

At the same time, I realized that my mother, who herself was a therapist and social worker (but who passed away a few years before I myself decided to become a therapist) had become a practitioner of EMDR. Standing for Eye Movement Desensitization and Reprocessing, EMDR seeks to overcome the crippling effects of trauma by reconnecting our rational mind with the part of our mind that has a survival/fight or flight response to past events. An EMDR treatment has many aspects, but a big part of the treatment involves revisiting the traumatic events by using a series of eye movements (or other types of stimulation) while going over past events that are often triggering.

While the treatment doesn’t require any equipment per se, I was surprised to discover in a Christmas visit to my father that he had my mother’s old light tablet and audio/tactile pulser (sometimes affectionately referred to as “tappers” or “buzzies”) still in a hallway closet eleven years after her passing. (He was happy to clear out the space in his closet).

That sealed the deal for me and I became determined to learn EMDR. As I went through the training, I I discovered to my pleasant surprise that EMDR fit neatly into my own experiences and beliefs about what can cause psychological distress. I have now completed the training and I am ready to offer it to anyone who wants to try it as a means to overcome past traumas.

geralt / Pixabay

As such, I now want to focus more on trauma. I have restructured my website to reflect this change in focus. Life transitions are but one area of life that can be stymied by past trauma. According to the EMDR International Association, EMDR can treat anxiety, grief, Post-Traumatic Stress Disorder, addictions, phobias, and disturbing and intrusive memories, as well as other issues.  So if you are dealing with any of these issues and want to try EMDR, contact me!

geralt / Pixabay

A class action lawsuit has been filed against Stanford University by students alleging that the university discriminated against them due to mental health status. Many students said that they were forced to take leaves of absence from the university rather than have their needs addressed on campus.

The details of this lawsuit is outlined in this New York Times article. The article discusses the question of students mental health needs as a dilemma many universities face, and describes an the number of students facing mental health issues as an “epidemic.” Advocates for students argue that universities underreact or overreact to mental health issues that arise with students.

Universities can sometimes be a rather strange settings for mental health departments. Student services have grown over the last several decades at universities. Universities bolster their services in response to identified student needs, and they probably also do so in order to be competitive with other universities. But being under the administrative structure of a university means that mental health system administrators might find themselves reporting to bosses who have other priorities besides their students’ mental health.

In reading between the lines of the NYT article, one thing I found unsettling was in the way university policy intervened in what should be a decision between the student and their therapist. This type of thinking, to me is a relic of an assembly-line mentality in managing mental health. Unfortunately many social service agencies are structured that way. Such a way of thinking can be very dehumanizing. We are not machines. We are all unique. Each of us is a product of our own experiences and it is unreasonable to think that everyone will respond in the same way to the same kind of treatment

Another disturbing outcome university oversight of student mental health surfaced in 2015 when the University of Oregon successfully accessed a student’s mental health records when she sued the university over mishandling her rape case. The University tried to label the student’s lawsuit “frivolous,” and demanded that she repay legal expenses the university incurred in the suit. Disturbingly, the student’s post-rape counseling records were going to be used as part of a counterclaim against the lawsuit–over the strong objections of her therapist and the senior staff therapist. Ultimately, the university withdrew their counterclaim, perhaps in response to the public outcry over the tactics they were planning to employ.

In a 2008 document, the US Department of Education upheld the right for the university to access those records because they are considered university records, not medical records. While medical records are considered to be protected by HIPAA (Heath Insurance Portability and Accountability Act) university records are protected by FERPA (Family Educational Rights and Privacy Act), a much older, much weaker set of regulations. The DoE explicitly stated that HIPAA does not apply to such records.

Students should keep these negative experiences in mind when seeking mental health assistance. Depending on the university and on the situation, the university may not be the best place to turn to when dealing with mental health issues. These two case studies illustrate what happens when a university uses your own statements against you, even in a setting that is supposedly confidential. Anyone considering seeking mental health services from a university should examine the university’s policies regarding confidentiality.

It’s worth noting that the U of O senior therapist who blew the whistle on the university’s actions engaged in an arguably heroic effort to assert the student’s best interests and that of the psychotherapy profession. Without a doubt, there are good therapists and not so good therapists at many mental health facilities, including universities. The quality of mental health support depends in part on the quality of the therapist and the quality of the administrators above the therapist.

But there is a certain point where student needs may play second fiddle to what the university considers to be its own best interests, and as such buyers should beware.

secondfromthesun0 / Pixabay

I have just started offering online therapy sessions. I started with one client and it went so well, I now want to offer the service to anyone else wanting to receive therapy sessions from me.

I have to admit that I was a bit reluctant to delve into this new technological aspect of therapy. I’m far from being phobic of new technology developments. But new technology developments can often bring both benefits and problems. It’s not always wise to hop on the latest trend, technological or otherwise. I think that it’s important to step back and observe the impacts of the technology and evaluate.

But I think the geography of Wisconsin has me thinking differently about online therapy than before. Wisconsin is a largely rural state, and here in Madison, people often commute from far away for jobs and other services. I had a job here where the person in the cubicle next to me commuted 45 miles each way daily from Dodgeville. Another person in the department commuted 45 miles each way from Beaver Dam. I even knew someone who commuted 71 miles each day from Platteville . This is the reality that many people in Wisconsin deal with every day. Plus, I have even had clients in Madison who have had a difficult time getting to my office on Madison’s west side due to lack of a car and a public transportation system that doesn’t serve all areas of the city well.

I recently took on a new client who travels about 1½ hours each way to see me. They were seeing me every other week. Recently, they asked if they could have sessions every week, with alternate sessions being over video chat. How could I say no?

Before our first session, I decided to do some research. I knew that Skype had some security issues,  and I didn’t want to put my client in a position where their privacy could be violated. Then I found the website Doxy.me and was impressed with what I read. Doxy.me is an online platform designed for all sorts of online health-related and medical consultation. They are HIPAA compliant and don’t keep copies of the sessions. I also like that no one has to download anything, unlike services such as Skype. Each practitioner is able to create a page on the Doxy.me site. Clients can register and the site will notify the practitioner that their client is waiting for them. I found the connection to be remarkably clear.

My first session with a client on Doxy.me went quite well. I think it helped that I’d had a number of in-person sessions with them prior to our online session and already had a well-established counseling relationship. Some people have argued that people might actually feel more comfortable opening up to their therapist online than when their therapist is in the room with them in person. I don’t know if that’s true or not—it may depend on the person, the relationship and the circumstances.

For now, I am going to recommend that any online sessions be accompanied by in-person sessions. I still believe in-person sessions, at the very least, offer something different from video sessions. I am going to continue to closely observe this technology and solicit feedback from my clients to see how well it goes.

But if traveling to my office creates great difficulty, let’s talk. I am open to all suggestions.

Source: 23/365: Eye Spy

I believe people receiving mental health care need to be fully informed about how their privacy might be protected or not protected. And one are which I believe every student needs to be aware of is that therapy records at public schools and universities don’t have the same privacy protections as those handled by private therapists and private clinics.  Under certain conditions, schools can legally release your counseling to parties that may not have your best interests in mind.  In the worst possible situation, they may even use these records against students.. Schools permitted to do this include, at the very minimum, public universities and public school systems.

This loophole came to light two years ago when a state university accessed a student’s personal therapy records to use in defense of a lawsuit the student herself filed against the university. They did so over the objections of the student’s therapist and the senior staff therapist.  The student’s lawsuit alleged that the university mishandled her rape case. The school even filed a counter-claim, seeking to have the student’s lawsuit dismissed as frivolous and recover legal fees from the student or her attorneys. Ultimately, the University withdrew the counter-claim.

The scary part is that current law allows universities to access student medical records under certain conditions, and one of them is when a student sues the university.   This is because HIPAA, which prohibits the unauthorized sharing of medical records, does not apply to student medical records at universities. Instead this area is covered by FERPA, a much older law related to education records, which has not been updated since the 1970s.

Often, mental health services at universities are the only affordable option for students. I can say that the quality of mental health services that I accessed through the two universities I attended was mixed–some of it was very good and some of it was shockingly substandard.  This, of course, is not necessarily different from the range of the quality of services to be found in the private sector.

I would strongly recommend that students do as much research as they can on university mental health programs and their alternatives. Many universities have reacted to the negative publicity generated by the University of Oregon case by clarifying their own internal policies and procedures regarding the privacy of student therapy.  Students should ask tough questions as to how records are protected and when they can be accessed.  Students should also try to find out as much about the counseling department within their university as possible.  Does there tend to be a long waiting list? Has there been high staff turnover in the department? What resources are available to a student in an emergency. Weakness in these areas could be warning signs that a student might not receive the best mental health care possible.

Many college towns will often have independent therapists wanting to work with students. Many are often willing to offer more affordable fees than what would normally be available to the general public.  Bulletin boards on and off campuses often have ads of counselors looking for new clients. Such therapists also should be subject to scrutiny as well–which is a topic I will cover in a subsequent post.