Online Counseling and Interstate treatment

Most people are surprised to learn that I transitioned to an online counseling platform long before a worldwide pandemic entered our lives.

Covid forced many therapists into the world of online counseling in order to continue to provide care and support for their current clients. A cross-country move prompted me to research the legalities, effectiveness and logistics of online counseling in order to offer continuity for my clients. 

During my training to receive my certification in TeleMental Health, I learned about how the online disinhibition effect can have a positive effect in building rapport quicker in an online setting versus an in-person setting.

Most people mistakenly believe they can continue counseling sessions while on extended trips or after an out-of-state move. However, that is not the case. The general rule across most states is that the therapist must be licensed in the state that the client is currently located. Notice the  distinction made between location and residence. It does not matter if the client has residency in the state the therapist is licensed in but where the client is physically located at the time of the session.

Unfortunately, most therapists used FaceTime or Zoom to continue counseling sessions. However neither of these platforms provide the appropriate ethical safeguards that ensure confidentiality.Not all online counseling platforms are the same.

While most people are accustomed and expect most therapists to offer online appointments in a post-pandemic world, it is important to make sure your therapist has taken the appropriate legal and ethical steps to safeguard your privacy and health information.


5 Ways to Sabotage Your Therapy

     By the time someone seeks out a therapist, a significant amount of struggle and pain has already occurred.  Most people have attempted to do something to make themselves feel better to no avail.  At some point, they realize that they could benefit from an outside person to help with their issue.  

     It is not always easy to pick up the phone and call for help. In fact, most people put it off as their symptoms worsen. They often hope things will just improve on their own without intervention or try and struggle to improve things on their own.

     It is no surprise that when people actually begin counseling that they inadvertently or even intentionally do things to sabotage their own success. After 20 + years experience in mental health counseling, I am covering 5 ways that clients sabotage their own counseling process.

1. No-Show your appointments.

     Yep, make sure not to give your therapist any notice.  Not only are you taking a slot away from someone who could have really used it had you given sufficient notice, but it completely disrupts the therapists schedule as well.

     Later when your therapist addresses it with you, avoid telling him or her the real reason such as therapy is becoming difficult, too vulnerable or hard work but that you had to feed your cat. (yes, I was actually told that once.)

 2. Withhold relevant information.

     Of course it takes time to build trust and rapport. I don’t think any therapist would expect their client to share their darkest and most painful stories on the very first session. However, sometimes clients can play games with their therapist in an effort to avoid doing the hard work by saying things like, “Well you never asked me that so I never told you.” 

     Counseling is a collaborative process between therapist and client. Both must work together.  Contrary to popular belief, therapists really are not mind readers. Counseling has a beginning, a middle and an end.  If you want to have a mutually satisfactory outcome then sharing all the relevant bits of your situation are essential.

3. Ghost your Therapist.

     Therapists are a compassionate bunch. We truly do care what happens to you and we wonder how you’re doing when you suddenly just disappear.  Please if counseling isn’t going as you hoped or if it’s just getting too difficult, please communicate with your therapist and let them know. They can pace the sessions so that you feel more comfortable and engaged in the process. It’s okay to even take a break from counseling for a while.

4. Blame therapist for lack of change.

     This one is a bit two sided. If your counseling experience is one in which you just vent about your week, you will not experience change, at least not lasting change. And you’re definitely not building new skills to solve the problems that you’re having and  symptoms will persist. You might feel better temporarily but you won’t experience results. So if you are not making any progress because of a dump session style of counseling then responsibility for the lack of change truly lies with the therapist.

     If indeed your therapist is giving homework, improving coping skills, and increasing insight and you are not experiencing change, consider if you have not been giving your therapist adequate feedback.  In addition, take full ownership of your contribution to the problems that had you seek out counseling in the first place.

     It is important to shift your mindset of counseling to a “working with” model versus a “doing to” model. I always tell my clients that nothing magical happens within a counseling session but it is the work that is done outside of the appointment, during all the other days of the week, in which true transformation occurs.

5. Don’t do your homework.

     This ties in with the above example.  No one I have worked with has gotten better without doing some type of homework. When the pain of staying the same outweighs the pain of changing, that is when you will be willing to do whatever it takes to get better and stay better.

     So do you recognize any of these behaviors in your own past counseling experience? If so that’s a good thing. Now you can be aware of them and understand the resistance to change that is behind them. Once you are aware then you have the power to make different choices. Transformation does not come without doing the hard work. I wish there was an easy button. I wish there was some kind of fast pass. 

     But we didn’t come about our problems or symptoms overnight so likewise change doesn’t happen overnight. Remain committed. Roll up your sleeves and do the hard work. You’ll look back on your counseling experience and be glad for it. 


Are you really ready for counseling?

People have all kinds of misconceptions about what happens in a counseling session and I’ve heard it all. But this ONE concept must be woven into counseling if you want to experience results and end treatment successfully.

I Can’t Handle This!

             Anxiety speaks in its own language. Or rather it screams, “I can’t handle this!” Whenever we feel anxious, the underlying belief is that we are not fully equipped to handle the situation.  The common theme of anxiety-provoking thoughts are, “I can’t handle this!”  The resulting feeling is usually overwhelm.  I’ll address this shortly. When we are flooded by thoughts that we cannot handle our present or future imagined circumstances, anxiety is usually the resulting emotion. 

            Of course there is another way to react to anxiety’s unique language.  But first let’s look at this unique language.  Anxiety speaks in a language that isn’t always conscious to us at first.  From a Cognitive-Behavioral perspective we call these automatic thoughts.  Automatic thoughts are those first thoughts that occur after a trigger, usually a situation or event.  These thoughts fly under the radar. We are not consciously aware of them but we react to them almost instantly.  However, we are aware of the subsequent feelings of anxiety, overwhelm, and panic.  Our reactions are then fueled by these feelings. They trigger our alarm system (read more about that in the post here) and throw us into fight, flight or freeze.  From there physiological symptoms develop like increased heart rate, sweating, shaking, and agitation. 

            Anxiety wants to avoid the situation at all costs.  We want to run and get away as quickly as possible.  That is our natural inclination.  We don’t live in an age where we are in fear of being attacked by a saber-tooth tiger.  Often it is modern-day stress that triggers this response. Instead of fight, flight, or freeze, I would propose we focus; to immerse ourselves in the situation through acceptance of what is. That doesn’t mean we have to like it.  If we get a flat tire in the pouring rain at 2 a.m. that doesn’t mean we are to enjoy the situation but to simply accept it and be mindful of the task of replacing the flat tire or calling roadside assistance in my case .

             Overwhelm is when we believe too much is expected of us or there is too much to do and not enough time or resources to accomplish what needs to be done. A more specific definition of overwhelm is to be completely surrounded in or buried by. We just exist in our surroundings. For example, a fish is completely surrounded by water. It simply exists in its surroundings. The fish doesn’t wish for something different. Whether the water is smooth or rough the fish must exist within it.  So it is with us, our current situation is the water that we swim in.


             On the other hand, frustration is the belief that things are not the way they should be. So let’s flip this on its head for a minute and consider that things are always exactly as they should be. Because whatever you are experiencing is your current reality so therefore things are exactly as they should be because it is what it is. It isn’t any different no matter how much you want it like it to be.


             Most of our problems or struggles are a result of errors in thinking. And when we start to differentiate our thoughts from the truth we begin to accept our current reality, no matter how unpleasant it might be. A new way of thinking will naturally be met with resistance but over time our brain will generate a new dialogue with ourselves. We experience a release of the resistance to our situation. Our language then begins to change to, “I’m exactly where I should be right now.” “I’m right on schedule”. Telling yourself, “I’m late” only increases anxiety and doesn’t get you to your location any quicker.


             When resistance to our current situation decreases and we come into alignment with our current reality we experience more ease with the bumps and bruises of our day. We aren’t so easily rattled and thrown off. We simply accept what is. We remain grounded despite our circumstances. That doesn’t mean we like it but we are in alignment with our current reality.


             The next level after that is to then consider what this current situation is there to teach us. One one of the biggest shifts in thinking can be to change a simple preposition. Instead of thinking something is happening TO you consider that something is happening FOR you. What is this situation growing in you? Is it patience? Is it increasing frustration tolerance? Self-control? or confidence in yourself that you can handle difficult situations.


How anxiety is like a security system


What exactly happens in our minds and bodies when we experience anxiety and how can that knowledge help us through the anxiety process to arrive at a state of peace?

This post is going to focus on different aspects of anxiety and how they all work together.


When we talk about anxiety we tend to focus on the painful side of anxiety and all the suffering it causes in the forms of panic attacks, social avoidance, and excessive, debilitating worry. Let’s dive in to the side of anxiety we tend NOT to focus on, the upside of anxiety. Yes, there is a positive aspect of anxiety.

A little bit of anxiety helps us to avoid danger, make moral choices, motivate us to take effective action, and perform at our peak. Being in a state of complete relaxation is not very useful when we are taking a test, giving a presentation, contemplating whether or not to tell our friend that their spouse was acting inappropriately, or yanking our child out of the street as a car zooms by. In these situations anxiety does its job and then we resume our usual state of regulation.

Anxiety becomes unhealthy when our distress is disproportionate to the trigger or stimulus. Excessive avoidance of the anxious situation becomes extreme when it gets in the way of our everyday life. For example, avoiding going to stores, social gatherings, or school classes (pre-COVID) because the fear of scrutiny is so intense exemplifies how anxiety can impact our ability to function in everyday life.

If a lion is chasing us then we should feel extreme anxiety which would instinctively make us run. Feeling anxious seeing a lion at the zoo is excessive. Feeling anxious reading a story about a lion is really excessive.

Not all anxiety is bad and as you can see, some of it can be quite useful. The problem comes when we can’t regulate ourselves to a normal state once the stressor or stimulus is gone.


In this article I will dive deeper into the 4 phases of anxiety and how it is similar to a security system.


There are 4 phases to the anxiety process that help us to keep ourselves safe from a real or perceived threat.  It is like our internal security system. We all have an alarm system whether or not we have “diagnosable” anxiety or not.  If fact, this process is necessary for survival.

This post will address the first phase of our security system: Alert.

The alert system senses danger.  It detects any threats to safety instantaneously.  An alert system works properly when we see a car swerve into our lane and we react by honking our horn or swerving to avoid the collision.

People suffering from anxiety have a very sensitive alert system and do not always interpret events accurately. Or in turn, they look for things to be anxious about triggering their alarm system.

Similar to a motion light sensor, our alert system can be set too high.  It misfires, thinking there is a threat when actually there is none, hence a panic attack.  You don’t want your motion sensor to go off every time a moth flies by.  Conversely, people who are anxious have difficulty turning down the sensor so that it is not triggered by every little thing.


The second response in our internal alarm system is alarm.

When we detect a threat our alarm response is activated.  We enter into an anxious state with all the accompanying emotional and physical manifestations.  We experience increased heart rate, sweating, rapid breathing along with fear, racing thoughts, anxiety.  These 2 processes allow us to keep ourselves safe.  It helps us to fight, make a plan, run for help or flee to safety.


In a properly working alarm system, no danger=no alarm.  But when the security system malfunctions or is set too high no danger can still =alarm.  When our parasympathetic nervous system (which helps to stabilize our body to a calmer state) misfires a panic attack can result.  This can be terrifying because it can seem to come out of nowhere.

Remember when we discussed that lion? An overactive alarm system cannot distinguish between being chased by a lion or simply seeing a picture of a lion.  Consequently, a wide range of anxiety symptoms are experienced and can cause personal distress.

It also creates conflicts in relationships because someone with an alarm that is only triggered in the face of real danger vs. perceived danger usually has trouble understanding why a person is so reactive to nothing at all (like a picture of a lion).  This in turn, increases the anxious person’s sense of shame and isolation. They are fully aware their anxiety is irrational and extreme.


The third step in our internal security system is assessment.

This happens in the thinking part of our brain versus the emotional part of our brain, where alerts and alarms take place.  Assessment helps us to decide if there really is a threat.  It is the thoughtful evaluation of danger and safety. If we decide there is a present danger then we can make a good plan about how to proceed.

Using our lion analogy we can decide that it is only a picture of a lion, it is not real.  However, someone with an alarm set too high has difficulty making an accurate assessment.  They have a tendency to see danger everywhere. Thus, it can severely limit the activities of everyday life.  It just feels safer to stay home as is the case in social anxiety disorders.

Alerts, alarms, and assessments are designed to work together.  The team work doesn’t happen in an overly anxious brain. It can take a long time to confirm danger or decide all is well.

The 4th and final phase of our internal security system is: All clear.

This signals the alarm system to turn off.  It says, “All is well. I’m ok. I’m safe”  As you can guess by now, if a person struggling with anxiety has an alert set too high, then their all clear signal is set too low.

The anxious brain distrusts any reassurance from outside sources.  Reassurance can be useful to those who experience mild anxiety. Rationalization tends to backfire with someone with moderate to severe anxiety. Anxiety can rarely be overcome with logic because it flows from the beliefs we hold, not reality.  And an overly emotional anxious response overrides logic everytime.  Remember flight or fight?  We need those emotions for safety.

We’ve all had the experience of ALMOST getting into a car accident. Very quickly we go through the 4 phases of alert, alarm, and assessment, and all clear.  While it might take a few moments for our heart rate and breathing to return to normal, we know that we are safe.  An overly anxious brain will focus on what could have happened if the accident did indeed occur.  “We could have been killed!”  The all clear signal doesn’t get activated because the brain is still in the alarm phase.


If this sounds like you or someone you know please reach out to me.  It is possible to weaken the overly active alerts and alarms while strengthening the underactive assessments and all clear signals.


Just because you have been stuck in a pattern for a long time doesn’t mean it will take a long time to make improvements quickly.  What do you really have to loose?

3 Steps for Self Care during COVID-19 Isolation

We have at least 1 more month with continued social distancing, possibly even longer. Today’s article addressing 3 simple things we can do to take care of ourselves during this time.

But before I do that I’d like to mention that I have heard from more than 1 introvert that they are really enjoying this time of contraction, this time of turning inward. However, the extroverts are crawling out of their skin and trying to find ways to engage with others in new and interesting ways.

It would seem our personalities or natural inclinations for interacting with the world and others influence how social distancing impacts us.

On to 3 simple (not always easy) steps you can implement…

  • Stay Connected

Technology does make it easier than ever to continue to talk with loved one and friends.  It isn’t exactly the same and it isn’t a perfect solution but it is the best temporary solution we have available to us right now.  Imagine going through a pandemic in the  1990s?

On a grim note, suicide rates are increasing as isolation and other stressors such as unemployment and subsequent financial strain is a big predictor of suicide. Check out this link to read more.

As I mentioned above, it is very easy for natural introverts to go inward during this time.  Someone experiencing depression must be aware of how social distancing impacts their tendency to withdraw.  If you know someone who is vulnerable to suicide read this.

  • Self-Care-

No one is immune to the effects of living through a worldwide pandemic; not Mental Health Counselors or HealthCare providers.  It impacts us all. Engaging in daily self- care routines   help us all to cope with the unique stress that we are all experiencing.  Some people have been thrown into crisis-schooling while transitioning to working from home, some have lost their job and source of income completely.  We all have been cut off from our routines of gym classes, Starbucks runs, and gatherings with family.

We have all had to adjust to a new normal.  And while we may be enjoying a slower pace and not having to run our kids to dance classes or sports we need to replace what use to fill our proverbial bucket with other practices.

Creating a daily schedule to keep oneself accountable is crucial, otherwise the days tend to blur into each other.  Which days are you going to exercise, meditate, meal plan, have a group chat, clean, engage in a hobby?  It doesn’t have to be rigid or set in stone but having an idea of what you will do each day contributes to a sense of purpose.

  • Nature

Getting outside on most days, if not every day, and connecting with nature and breathing fresh air also feeds our soul.  It clears our head, it helps us to be grateful, it soothes our senses. When we are outside everything looks the same and familiar in a world that has changed so much.

The virus has taken so much from us that we can feel empowered to claim what is ours in nature. The trees, and flowers, and little critters all have no idea how the world has changed around them. Seeing nature unchanged brings a little piece of normalcy in our lives.


“Just being surrounded by bountiful nature, rejuvenates and inspires us.” E.O. Wilson.