From the Frontlines: Pandemic Suicide Awareness

September 13, 2021

From the frontlines: Thoughts from a therapist on Suicide Prevention Awareness Month during a pandemic

by Dr. Rebecca Levy, LMFTA

September is National Suicide Prevention Awareness Month.  In the past year and a half, we have experienced a great deal of tragedy, especially when considering the impact of this pandemic on mental health. Prior to the pandemic, researchers reported that approximately 50% of people who attempted to kill themselves went to their primary care doctor a week before their suicide attempt. With the impact of this pandemic, there was about a 50% increase in the use of a suicide hotline. As demonstrated by recent studies, COVID-19 has had a profound impact on mental health due to our increased isolation, stress, and fear of illness.

As a mental health provider, I am left with many thoughts; but here is my take on some of the major considerations of dealing with mental health issues during an international health crisis.   

Telehealth

Helping people who struggle with suicidal ideation has been different this year for many reasons. As a mental health provider, I have had to provide therapy to patients over the phone or over video more than in person. Teletherapy can feel different, disconnected, or even scary, especially with a high-safety-concern patient. What if they are in a different city or even a different state? Before the pandemic, this geographic difference was almost unheard of. 

Managing my own stress in conjunction with the increase of patients presenting with suicidal ideation over telehealth has been challenging. This increase in mental health concerns, combined with the physical distance between patients and providers, has been a recipe for mental illness to rear its head. Yet, there are some positives to telehealth for patients struggling with suicidality. Having a virtual option for patients we might not have typically reached has allowed for more access to those populations in need.  There is also something to be said about having an emotionally charged conversation with your therapist in the comfort of your own home.

The Secondary Pandemic

As a society, mental health is something we have struggled to address. There is stigma attached to each diagnosis, as well as barriers to getting care. Historically, the importance of mental health has not been viewed as on par with physical health; however, suicidality is the pinnacle of illness because it can result in death. Dare I say that this pandemic has a brought a necessary focus to addressing poor mental health as the crisis it is?

This pandemic may have caused great distress and loss, but maybe it brought us where we need to be in recognizing the importance of taking care of our mental health. The biggest question is, what we do in times like this to help ourselves and our loved ones?

What To Do

 What has mattered to people in helping them through a tough time, such as struggling with suicidality?

Normalize. A lot of us do not talk about having thoughts about not wanting to be here, but they are more common than we think. Having that de-stigmatizing perspective, and reminding people that those thoughts and feelings are normal when we are feeling very low, is helpful when talking to people who are having thoughts of suicide.

Ask. As mental health providers, and as friends and family of loved ones, we are doing a disservice by not asking the hard question: Have you had thoughts of hurting yourself in some way? By asking this question, we are normalizing the fact that we can talk about suicide and allowing space for those who are in that place to talk about it.

Listen. During this tough time, it should be everyone’s responsibility to check in on each other and their loved ones. Go ahead and ask that tough question or the easy question, ”How are you?” But take the time to be patient and wait for a real answer, and then truly listen.

Acknowledge – This pandemic is life-changing. The COVID-19 pandemic is overwhelming. Our worlds have been turned upside down. I think one of the most invalidating things I have seen done to people who are struggling with suicidality is telling them that they “need to be grateful” in some form or another. It is more helpful to validate them in their pain (i.e., “It sounds like you are having some really scary thoughts”) or risk emotionally isolating them further.

Get help. There is help if you, or a loved one, is struggling with mental health. Therapy, it can do wonders! A lot of therapy offices have walk-in hours to help patients in crisis. There are also a lot of medication options (e.g., antidepressants) you can discuss with your primary care provider that can bring relief from symptoms of feeling down or hopeless. If you are worried about a loved one, there are options available to help them. Your area may have a Mobile Crisis group that will go to a person’s home and assess for safety, or work collaboratively with the police department to complete a welfare check (which can be requested anonymously if you are nervous to do so!). In addition, you can research your local behavioral health crisis centers to see what services are available. And finally, the Emergency Department of your local hospital is available in cases of severe crises.

It has been a difficult, but enlightening time, supporting patients, providers, and families with mental health and substance use needs throughout the pandemic. When it comes to awareness about suicide prevention, please remember that it is okay to directly ask the hard questions, and there is help available.

If you or someone you know needs help, call: 1-800-273-8255 or Text HOME to 741741

Please call 911 if you sense immediate danger.

Dr. Rebecca Levy is a Medical Family Therapist and the Director of Behavioral Medicine at Cone Family Medicine. She holds a bachelor’s degree in Psychology, a master’s degree in Couple and Family Therapy, a doctorate in Medical Family Therapy, and an associate license in Couple and Family Therapy (LMFTA). Her areas of expertise are suicide assessment, integrated behavioral health care, cultural humility, and family medicine resident wellness. She sees her role in clinical practice, research, and education to advocate for underserved populations and health equality.

Posted in Mental Health AwarenessTagged , ,

So, You’re Thinking of Trying Therapy…

May 12, 2021

Seven helpful tips from a therapist (who has been to therapy herself!) on navigating the decision to start the therapy journey.

by Sara Herrity, MS, LMFT

If the last 15 months have taught us anything, it is that:

  1. Social media is the best and worst thing ever (hello Tiktok dances, but also political debates)
  2. Banana bread has finally been recognized for the ultimate comfort food we never knew we needed, and
  3. Our mental and emotional health matters.

In the beginning of the pandemic, we all were there with feelings of hope and optimism. The thoughts that crossed our mind were along the lines of, “This will just be two weeks, four weeks tops.” These thoughts were soon invaded by feelings of confusion, frustration, isolation, anger, and so much fear of the unknown, and of the virus itself. Gratitude floated in and out depending on the moment. And, for many, survival mode kicked in – just put one foot in front of the other, do what you need to do this minute, and worry about tomorrow… well… tomorrow. And just as we were concerned with our physical health and contracting COVID-19, we were increasingly noticing the toll the pandemic was taking on our mental and emotional health. Added onto all of this was a highly contentious election cycle and an increased discourse surrounding the racial injustices present throughout our systems as a nation.

For myself, I was making every effort to be cautious to protect and care for my physical health while maintaining my mental health. Despite two years in graduate school to become a Marriage and Family Therapist, having worked in behavioral health for more than nine years, having many close friends who were also therapists, and having just wrapped up my own personal course of therapy two weeks before the pandemic hit, I found myself still struggling as this last year moved on.

A good friend told me recently that in tech engineering they say, “If you do not schedule system maintenance, the system will schedule it for you.” The same thing goes for our bodily systems – if we do not schedule time to take care of all parts of ourselves, it will force us to schedule it. This last year has served as a wake-up call for some, and a reminder for others, that our mental and emotional health matters as much as our physical health. We must take time to nurture and care for our bodies, minds, and relationships.

As vaccine distribution increases and restrictions slowly begin to lift, we are preparing to re-engage into our new normal. Despite the feelings of relief and joy this brings, many of us will find ourselves still struggling with feelings of depression, anxiety, fear, confusion, and so forth. If that is the case, and you’ve started to wonder what to do, might I suggest therapy? Here are some helpful tips that can hopefully make navigating the decision to engage in therapy a bit easier:

  1. THINGS DON’T HAVE TO GET “THAT BAD” – I cannot explain to you the number of times I have heard, “Well, I don’t think it’s bad enough that I have to go to therapy.” But that is the point. You can go to therapy when things are going well to process changes, build emotional or relational skills, or get support. Or, you can go to therapy when you feel utterly distressed. A good therapist will meet you wherever you are in your journey and help you get closer to truly living your best life, however you define that.
  1. FIND A FIT – Once you have made the decision to go to therapy, the next step is finding a therapist. Psychologytoday.com is a great resource to find therapists in your area (or online) while allowing you to filter searches and be as particular as you would like – many people prefer a therapist who is a certain gender or race, or of a certain faith background, or offers teletherapy appointments or in-person, only takes sliding fee scale, or perhaps will bill through insurance. Clinicians provide a picture, short bio, and information regarding their services on the site to ease in selecting a therapist that could be a good fit. If you have insurance, you can also contact your insurance company via phone or their website to find a list of credentialed providers. Finding a clinician who is a licensed provider helps ensure that you are seeing a professional who has been through appropriate training and supervision . Lastly, one thing to keep in mind is to ask about any additional training or certifications the therapist may have earned. For example, if you are seeking therapy to address your experience of childhood abuse, it is important to ask the therapist you are considering about any additional training and/or experience working with this issue. The same way you would not want to go to a cardiologist for an ankle sprain, you would not want to go to child psychologist for coping with your adult complex trauma concerns.
  1. I REPEAT, FIND A FIT – The number one predictor of success in therapy is the relationship the client has with the therapist. If you have a couple of sessions, or even just one, with a therapist and you feel like you will be unable to connect with the person, just let them know! I promise, the therapist will not be offended if you tell them it is not a good fit. Therapists know the importance of the relationship and fit and they are ethically obligated to provide you with referrals. Of course, you are welcome to find a new therapist on your own. My friend and colleague Lisa says, “You don’t stop ever getting your hair cut because the last hairstylist gave you a bad cut – you find someone you like better.”
  1. DON’T GET HUNG UP ON DIAGNOSES – In the first session, therapists often complete what is called a “comprehensive clinical assessment.” This generally is comprised of an overview of your mental health, substance use, family and medical history, understanding your strengths and supports, and beginning to understand what your goals are for therapy, and most likely providing a provisional diagnosis. While a diagnosis is typically required if therapy is being billed through your insurance company, it is also a category that helps provide a directive to the therapist for the most effective, evidence-based treatment and approaches for your care. Though not every reason to attend therapy results in a diagnosis such as depression or anxiety, receiving a diagnosis can be an extremely validating experience and your therapist can talk through your diagnosis with you.
  1. RELATIONAL WORK IS POWERFUL – If you are seeking individual therapy and find that it would be beneficial to include a partner, friend, or family member, let your therapist know.  Most therapists will encourage relational work if they recognize the need, but you can always ask for a support person to be involved in your treatment, whether for just one session or several. We are relational beings, not independent but interdependent, and thus having the skilled support of our loved ones who are learning some of the tools you are learning in therapy can make a world of a difference. For example, my fiancé knows to start deep breathing when he sees me in distress, often before I have realized I am even in distress. Because of his cue (thank you mirror neurons!), it is a reminder to myself to take a pause and focus on my breathing to calm my system before I proceed to problem-solve. He learned this through me teaching him and also from joining me in therapy.
  1. FIND COMFORT IN THE DISCOMFORT – More often than not,  therapy might not feel good at first. Change and growth and healing can be HARD, but it is the GOOD hard. Consider the beautiful butterfly and its humble beginnings of the caterpillar; we often forget the mucky, hard, process it takes for the caterpillar to turn into that butterfly. That hard work usually does not occur solely in the one-hour session you have once a week. To really see change sink in, that work happens mostly in the other 167 hours that occur in the week between sessions. Therapy is a space to slow down, reflect, process, gain insight, and learn skills, but the time in between sessions is where the practice of these skills are put to work and become part of ourselves. So give yourself and the process grace when it feels uncomfortable, angry, scary, or slow. Often times, it means the treatment is working.
  1. GET THE BEST OF BOTH WORLDS – Just because you choose to see a therapist does not mean you cannot also engage in other types of therapies. In fact, many therapists can incorporate art, yoga, music, biofeedback, and more into their approaches. If these seem like approaches you would benefit from, talk to your therapist about this or you can find a licensed art therapist, Trauma-Sensitive Yoga therapist, and more. Additionally, medication for your mental health condition(s) has been a game-changer for many.  We don’t bat an eye at providing insulin to people with diabetes when it is needed, so we must remove the stigma of asking for pharmacological help for mental health when it might be helpful. Please talk to your doctor and/or therapist if you are considering medication, and they can walk you through your concerns and needs to find the best medication for you.

The first time I decided to go to therapy, I was scared, but had the support to guide me through the process. I hope this information can provide some support and comfort to you, because taking this action step is worth it, as are you.

Posted in Mental Health AwarenessTagged ,

Essential Understanding: What is psychotherapy?

September 25, 2020

Friday, September 25th is recognized as “National Psychotherapy Day” in the United States. In healthcare, we have observed that some patients, clients, and providers seem to have an aversion to the idea of psychotherapy, probably due to the stigma associated with the term or related terms. As a team of therapists working to promote behavioral health integration and whole-person care, the Center of Excellence for Integrated Care staff wanted to use today as an opportunity to promote a better understanding of psychotherapy.

The term “psychotherapy” comes from the ancient Greek word roots of “Psyche” which means breath, spirit, or soul, and “Therapeia” which means healing or medical treatment. Those root meanings are a long way from the often stigmatized vernacular term of “psycho.” Additionally, the historically popularized image of therapy — during which clients lay on a couch while a therapist proclaims hypotheses about childhood experiences and current mental illness — have contributed to a misunderstanding about the expectations and outcomes regarding psychotherapy.

What is psychotherapy?

In the context of mental health treatment, psychotherapy is often used interchangeably with the terms “therapy” and “counseling.” Though some professionals in the mental health field have highlighted distinct differences between psychotherapy and counseling, psychotherapy remains the name of the service of providing talk therapy. At COE, we advocate that there should be a common understanding of the language used to describe any therapy services, outpatient or integrated. However, we think that whichever term feels most comfortable to clients/patients and their care team is appropriate. Most important is that the client is well aware of the service they are consenting to receive.

What happens in psychotherapy?

Therapy could be beneficial to most everyone; you do not have to have a serious and persistent mental illness to benefit from therapy. Many people participate in psychotherapy to work on challenging relationships, cope with stress, adjust to new life situations, and explore self-identity.

Once you identify a therapist with whom you feel comfortable working — see this page about identifying a behavioral health provider — you will work toward developing a safe and trusting working relationship with your therapist. The therapist’s role is to help you walk through your challenges, versus the commonly held assumption about offering direct advice or making decisions for you. You and your therapist will work collaboratively to set goals, and both you and your therapist will establish boundaries about the work you will do in therapy. Sometimes therapy will primarily involve talking. Other times your therapist may introduce various activities into therapy, such as creative expression or role-playing to help practice talking through relational issues.

The COE team hopes that this discussion has helped improve awareness and understanding about psychotherapy — and provided some normalization about the therapy process — in honor of National Psychotherapy Day.

If you would like to learn more about providing whole-person care involving psychotherapy, please reach out to us!

Other resources:

Psychology Today locate a therapist.

Therapist Locator.net

Emotion Focused Therapist Locator

Posted in Mental Health Awareness, ResourcesTagged , ,

Uncertainty in the time of COVID-19

May 13, 2020

Grace in Uncertain Times

by Lisa Tyndall, PhD, LMFT

In the midst of COVID-19, most mornings I wake up unsure of how the day will find me. I know what I am supposed to do, and how I am supposed to feel. The experts say I should slow down, take time to be grateful, some say to meditate during the day, and we have all heard the ever-present suggestion to get outside and exercise. Don’t get me wrong, I like all of these suggestions – it is just that ironically sometimes it feels impossible to do these tasks that are supposed to make life easier right now. How hard is it to just take a time out for 10 minutes to breathe?

Turns out that 10 minutes can actually be hard to find indeed. Everyone has different working situations right now, some are working more than ever on the front lines of the healthcare system, some are working remotely, some are dividing their time between the office and home, some have been furloughed, and some have lost their jobs entirely. Our work environments have changed dramatically. Clinics can be deserted, and some may be overrun. Co-workers can become second family if they were not so already, and those at home may be squeaking out a somewhat professional and quiet work-space that invariably will compete with the other life demands peeking from behind the cracked door. For me it is a new “work from home” environment, which includes children home from school but yet somehow still in school. While there have always been best practices as far as remote working is concerned, these days I come across even more “work from home” tips floating around various websites and depending on the day I am either fairly receptive or I want to tear them up into little pieces.

If you are at home, be sure to keep a schedule. Shower and get dressed every work day. Wherever you are, be sure to take a daily meditation break. Be present with your family, either in person or through a glass door. Slow down but meet your work expectations. For those of us with kids, don’t forget to add to that parenting, refereeing fights, fending off questions about hanging out with friends, teaching, and don’t forget to flagellate yourself for the increased screen time.

You get the picture – there are a million potential directions a day could take and often does take – during this time where we are supposed to be adjusting to the “new normal.”

When you read all of the advice columns – it seems like it should be simple. And yet, what we are often missing is the layer of uncertainty that drains the energy from each of us like an app open on your phone which can never close. It isn’t the same right now. We aren’t just working from home some, changing our clinical workflows, having lots of zoom calls and for some, working in pajama bottoms. Whatever your environment, a large percentage of our energy is going towards emotionally processing the uncertainty that looms over the entire world. What will it be like when the world re-opens? How long will it look like this?  Will we get back to celebrating life’s milestones? Or will we even get back to being able to be at someone’s bedside during their last moments? Surely the basic human needs for touch and connection won’t be forever gone from our reality…will they?

I do believe that this collective trauma will eventually be settled. What “settled” looks like I am not sure – but I know that developmentally and all through life when the hardest of times has come as people and as a country, there is a pendulum of reaction and response that swings but eventually finds the middle and settles. We all wish for the return of the freedoms we once took for granted, but are currently hazardous, to stop being afraid of seeing people in masks in the store, to wish to start seeing more people in masks, to learn how to work from home while missing live human interaction with others, we all want to feel productive and balanced again. As human beings, we always want to rush through the uncomfortable parts – and it is very uncomfortable right now to say the least. How in the world do we sit in the waiting for this pendulum to settle?

In those moments where I feel guilty for not being more productive, guilty for not parenting better, guilty for still having a job, yet afraid of the very clear temporary nature of jobs we never deemed temporary, there are so many conflicting emotions and states of being. In these moments, I do my best to choose grace. That also sounds simple – but it isn’t. It takes my village of people to remind me to choose grace for myself. It takes my spiritual practice to remind me to choose grace. It takes what I know as a therapist to choose moments of grounding and gratitude to eventually get lead back to grace. The irony here is that I also have to forgive myself for the moments I forget to choose grace, when my pendulum swings too far to one side or the other.

There are enough suggestions out there in the world for how to handle and cope with the current situation, both personally and professionally, a few even on our own website! And with May being mental health awareness month, we are particularly aware of the importance of taking care of not only our mental health, but our behavioral and relational health as well. My experience has been that those, as well as our physical health of course, are all connected. Keeping those connections in mind, how you choose to manage the swings of the pendulum is up to you. But overall I would say listen to your heart, give yourself and others large amounts of grace, and take it one day (even one minute if need be) at a time.

Stay tuned for more from the COE team during Mental Health Awareness Month 2020!

Posted in Mental Health AwarenessTagged ,