Thoughts From A Psychotherapist

This is a collection of all of my Blog Posts.

May 2024

An Introduction to Dissociation and How To Work with it as a Therapist

2024-05-16T00:23:52+00:00May 16th, 2024|Thoughts From A Psychotherapist, trauma|

Dissociation is a word that scares many. As a trauma therapist, I have learned to normalize dissociation. Everyone dissociates. Binging Netflix, highway hypnosis, and mindless eating are all ways people do this.

There are many different ways to define dissociation. It is a protective mechanism that removes a person from a painful experience. 

For therapists, there can be many signals that can indicate dissociation. 

Stories that do not quite track. A lack of connection with any affect when discussing traumatic experiences or a loss of time can also be indicators. A long history of unsuccessful therapy may also indicate this. 

There are a few resources to assess for dissociation. The Adverse Childhood Experience (ACE) can tell you the level of trauma a client faced in their younger years. If they score high, they may have used dissociation to cope. The Dissociative Experiences Scale (DES) and The Multidimensional Inventory Of Dissociation (MID) can give more precise indicators of dissociation. The MID is more thorough; if you access the link in the resources, you can get more information on how the dissociation manifests. 

Best practices for trauma treatment involve using a Phase-Based approach. You start with stabilization, which means getting the client to a place where they can maintain a window of tolerance for trauma processing. Remaining in your window of tolerance means you can think and feel at the same time. There are many ways of doing this, including teaching grounding techniques, psychoeducation, and doing parts work. 


I help clients stabilize by utilizing parts work with EMDR resourcing techniques sprinkled in. I work from the Internal Family Systems model, which believes we all have parts. These parts consist of protector parts that try to help our system avoid pain and exile parts that hold our burdens. Dissociative parts are protectors trying to keep the system from feeling emotional pain. 

When I work with clients, we address their dissociative parts from a place of curiosity. We ask those parts what they are trying to avoid happening. What are their fears? A standard intervention is time orientation, which involves working with the part to help it understand that it is not in the time of the trauma but the present time. Time Orientation is an essential aspect of trauma treatment and working with dissociation. I have included a diagram explaining a few different ways to do this. 

In this blog post, I demonstrate the Back of the Head method from Jim Knipe. This method helps clients show their dissociation level and is used in his Constant Installation of Present Orientation and Safety (CIPOS) protocol.

In this blog post, I demonstrate the Back of the Head method from Jim Knipe. This method helps clients show their dissociation level and is used in his Constant Installation of Present Orientation and Safety (CIPOS) protocol.



DES with color-coded tabs

This shows what areas of dissociation the client is scoring higher on.

MID-60 instructions to clients

This is an instruction sheet to use when using the MID 60

Version for the client to complete – MID-60

This is a spreadsheet version that the client can fill out

MID-60 pdf form client

This is a PDF version of the MID-60

Clinician scoring template spreadsheet – MID-60

Dr Mary-Ann Kate’s video for the MID-60.

Dr. Kate is responsible for many of the resources above and more. She shares it all on her Google Drive.

EMDR Chicago resources on dissociation

Jim Knipes Constant Installation of Present Orientation and Safety (CIPOS)


The book resources are affiliate links to Amazon, and I receive a small stipend if you click and buy. These are all books I use a lot!

Healing the Fragmented Selves of Trauma Survivors by Janina Fisher

This book focuses on structural dissociation and must be in the trauma library. It has great appendices with great client resources, though the book can be overwhelming.

Dissociation Made Simple: A Stigma-Free Guide to Embracing Your Dissociative Mind and Navigating Daily Life Jamie Marich PhD 

This book is on dissociation by a therapist with lived experience

How to Use Fraser’s Dissociative Table Technique to Access and Work With Emotional Parts of the Personality

Martin, Kathleen M. Journal of EMDR Practice and Research Vol 6 Issue 4, DOI: 10.1891/1933-3196.6.4.179

EMDR and Dissociation: The Progressive Approach Paperback by Anabel Gonzalez (Author), Dolores Mosquera (Author)

All of these authors also have training available, and I have attended some by all of them, and they have been very helpful.

April 2024

Navigating Trauma: A Guide to Short-Term EMDR Therapy

2024-04-17T23:11:57+00:00April 17th, 2024|emdr, Thoughts From A Psychotherapist|

In this era of telehealth, finding the right therapeutic approach that resonates with clients can be a journey in itself. As a therapist, I’ve navigated this and decided on a specialized path that can help many: short-term Eye Movement Desensitization and Reprocessing (EMDR) therapy.

Transitioning to an EMDR-focused model, I’ve woven in techniques like Internal Family Systems work, creating a toolbox of modalities tailored for trauma processing. 

Many individuals find themselves grappling with persistent feelings of being stuck, yearning to break free from the binds of their past traumas. Whether they’re already engaged in talk therapy or not, the desire to move forward swiftly remains palpable. Enter adjunctive or short-term EMDR therapy – a modality that offers hope for those seeking rapid yet effective intervention.

But what does this entail exactly? Simply put, adjunctive EMDR therapy offers a targeted approach for individuals who may already be working with another therapist but seek additional support in addressing specific unresolved issues. Conversely, short-term EMDR therapy caters to those who desire focused trauma resolution but do not currently have a therapist.

My approach may sound stringent at first glance. Contracting with clients for a defined timeframe for trauma work and not extending beyond that might seem abrupt. However, it is instead a highly concentrated intervention aimed at achieving specific goals. In traditional therapy, sessions often revolve around discussing current events and situations – important, yes, but not always conducive to resolving deep-seated trauma.

In my practice, we dive headfirst into trauma processing by the second session. For this to work clients must possess a robust support system and have self-calming techniques to navigate any potential overwhelm during trauma processing.

To ensure readiness, I offer a complimentary 30-minute phone or Zoom meeting to assess whether short-term EMDR therapy is a suitable intervention. From there, we embark on a 90-minute initial session, where I conduct a thorough assessment and begin equipping clients with the tools to soothe themselves when they feel emotional dysregulation. We establish a treatment plan with specific goals and a tentative time-frame.  

Subsequent sessions, lasting either 60 or 90 minutes, are dedicated to journeying through the trauma until it’s processed. It’s an intensive yet focused approach, one that prioritizes swift resolution without sacrificing depth or efficacy.

In a world where time is of the essence and healing can’t wait, short-term EMDR therapy offers a pathway to healing from  trauma, one session at a time.


Resources About EMDR


EMDR Institute-information about what EMDR is and cites the research that supports its utilization.


March 2024

Raising the Alarm on Gender Identity Change Efforts Disguised as Talk Therapy

2024-03-12T21:34:50+00:00March 12th, 2024|Advocacy, Gender identity, LGBT, Thoughts From A Psychotherapist|

Below is a petition that some concerned California clinicians wrote to both educate providers and consumers and to use to send to mental health professional organizations to urge them to speak out against these practices.

I want to recognize that the American Psychological Association(APA) issued a very thorough statement February 2024 called APA Policy Statement on Affirming Evidence-Based Inclusive Care for Transgender, Gender Diverse, and Nonbinary Individuals, Addressing Misinformation, and the Role of Psychological Practice and Science. It was a great statement and occurred while this petition was being devleoped. You can find the entire statement here. I will quote below two statements that are especially relevant to the petition ask.

WHEREAS such misinformation is widely disseminated through formal and informal networks, yet credible scientific evidence has not been widely disseminated and is not readily accessible to the public, having the potential to further stigmatize and marginalize all transgender, gender-diverse, and nonbinary individuals, hindering their access to indicated and necessary healthcare, worsening existing geographic disparities in healthcare access, and fostering an environment that may lead to discrimination (DuBois et al., 2023; Goldenberg et al., 2020; Weixel & Wildman, 2022);

THEREFORE, BE IT RESOLVED that the APA supports efforts to address and rectify the dissemination of false information to ensure the well-being and dignity of transgender, gender-diverse, and nonbinary individuals

The below petition can be viewed and signed here. I am encouraging everyone to both sign it and share it. It is important to the well being of the trans community that we get information such as this out there to counter all of the false information that exists. It is also important the reputable organizations like make strong statements like that of the one from the APA to fight the narrative that supporters of gender affirming care are extremists when the reality is that there is wide support of such care.

Thank you to all the therapists that took the time to engage in this work which is critically important right now.



We are a group of concerned therapists, psychologists, and psychiatrists writing to ask your associations to put out a statement regarding the rise in Gender Identity Change Efforts (GICE) disguised as psychoanalytic or talk therapy. The effort to delegitimize and provide an “alternative” to gender-affirming therapy and the World Professional Association for Transgender Health (WPATH) Standards of Care (Coleman et al., 2022) is being led by a small group of clinicians who start many organizations that attempt to wield power through promoting debunked research. The main organizations involved in this effort are Wider Lens Consulting, Therapy First (formally the Gender Exploratory Therapy Association), Thoughtful Therapists, Genspect and SEGM. We are asking your association to put out statements warning against these organizations for their dishonest and fraudulent advertising, as well as naming them as organizations promoting GICE.

1. Dishonesty, Fraud, and Deception:

All of these organizations are careful to sound like they promote reasonable, well-informed, evidence-based treatment for those with gender dysphoria – “a neutral ground between the ‘radical’ gender-affirmative model and ‘unethical’ conversion practices” (Ashley, 2022). The byline for Therapy First reads: “Therapy First exists because we see a great need arising from the current oversimplification and politicization of gender dysphoria in the field of mental health.” Therapy First represents itself as apolitical. However, multiple clinicians on the advisory board and clinical team have participated in political activity aimed at anti-trans legislation and related to many of the trans health bans that we are seeing today. Stephen Levine, one of the clinicians who authored the Therapy First clinical guidelines, was the sole “expert” witness for the state of Arkansas’s ban on gender-affirming care for minors. It was struck down in June of 2023 (Levine, 2020). SEGM has been the central subject of subpoenas by the state of Alabama to the American Academy of Pediatrics, WPATH and the Endocrine Society in the trans youth care ban case Boe v. Marshall (Lannin declaration).

The clinicians involved in founding these organizations are part of a large web of anti-trans organizations aimed at attacking trans rights (Anti-Trans Conversion Therapy Map of Influence), including the American College of Pediatricians, which has been labeled an anti-LGBTQ hate group by the Southern Poverty Law Center (American College of Pediatricians | Southern Poverty Law Center).

Stella O’Malley, who founded SEGM and Wider Lens Consulting, has stated that her mission is to make sure that children are stopped from medical transition (Leveille, 2022). In emails leaked in March of 2023, Lisa Marchiano, LCSW, another board member of Therapy First, SEGM, and Wider Lens Consulting, was caught trying to obtain private information about a transgender journalist with the intent of leaking information to Fox News. When the private information was leaked, it resulted in online harassment of the journalist (Doyle, 2023).

The claim that Therapy First, Thoughtful Therapists, Wider Lens Consulting, SEGM, and all affiliated organizations have no political agenda is completely dishonest and deceptive. We need reputable clinical organizations to make this known to both consumers and therapists.

2. Gender Identity Change Efforts (GICE) by these organizations:

Even though Therapy First claims to not promote so-called “conversion therapy,” further investigation into the organization and client experiences points to GICE. The Therapy First clinical guidelines promote a “psychotherapeutic approach” to gender dysphoria, stating:

“Psychotherapeutic inquiry does not simply accept that a person has the wrong body or gender, it explores why and how a young person came to have negative feelings about their sexed body or that their body or gender is “wrong.” This involves exploring relational and developmental history, the quality of relationships with parents, any traumas or losses that have affected the family, the presence of marital dysfunction, domestic violence, sexual abuse or other detrimental interpersonal dynamics. It also involves exploring social relationships with friends and peers (Ayad et al., 2022, p. 41).”

In practice, what this often looks like is searching for any possible reason for a youth or young adult being transgender, rather than simply being transgender (Santoro, 2023). Marchiano spoke out against the executive order against conversion therapy signed by Joe Biden in June of 2022, telling The Economist that it would have a “chilling effect” on the practices promoted by these organizations. She acknowledges the goal of gender exploratory therapy, which is for trans children and teens to resolve their dysphoria through finding the root psychological cause of their dysphoria (“The Biden administration’s confused embrace of trans rights,” 2022). Furthermore, the Therapy First Clinical Guidelines contain detailed assessment questions including intrusive inquiries about the client’s masturbation habits and sexual fantasies (Ayad et al., 2022, p.26). This type of pathologizing, gaslighting, and delaying any gender-affirming care until a talk therapist rules out every possible cause for the gender dysphoria, besides being transgender, is highly problematic and psychologically damaging (Matouk & Wald, 2022; Boerner, 2022; Bhatt et al., 2022; Tordoff et al., 2022).

Everything put forth by members of these organizations points to their belief that being transgender is undesirable and therapy should seek to explain and resolve the transgender identity so that the patient “accepts themself” as the gender they were assigned at birth. The case studies presented in the Therapy First’s clinical guidelines highlight these beliefs and intentions (see Therapy First clinical guidelines pages 57-102 for case studies) (Ayad et al, 2022).

These organizations have been able to wield extensive power in a short amount of time and are attempting to replace the WPATH Standards of Care. Gender Exploratory Therapy/Therapy First has been recommended as the treatment in many of the trans health care bans gaining traction across the country (Reed, 2023b). It has also gained notoriety in prominent problematic articles in The New York Times (Paul, 2024), which greatly inflate the statistics regarding “detransitioning” and conversion therapy (Reed, 2024; Urquhart, 2024; Urquhart, 2023).

Research continues to confirm that gender-affirming care is not only evidence-based but life-saving (American Psychological Association, 2024). The results from the national trans survey have found that 94% of people who pursued a form of medical transition report greater life satisfaction (U.S. Trans Survey, 2024).

The NASW, AAMFT, and the two APAs are signatory associations of the United States Joint Statement Against Conversion Efforts (United States Joint Statement, 2023), a statement by 28 professional associations clearly asserting that so-called “conversion therapy” is unethical and potentially harmful.

We ask that the NASW, AAMFT, and the two APAs (both psychological and psychiatric) also make a clear statement about Therapy First, Genspect, SEGM, Wider Lens Consulting, and other affiliated organizations, warning potential clients about their false and deceptive advertising.

We also want it made clear that social workers associated with these organizations are violating the NASW code of ethics, and potentially their local state laws, as they pertain to Gender Identity Change Efforts and conversion therapy.


American College of Pediatricians. Southern Poverty Law Center. (n.d.).

American Psychological Association. (2024, February 17). APA policy statement on affirming evidence-based inclusive care for transgender, gender diverse, and nonbinary individuals, addressing misinformation, and the role of psychological practice and science.

Anti-Trans Conversion Therapy Map of Influence.

Ashley, F. (2022, September 6). Interrogating gender-exploratory therapy. Sage Journals.

Ayad, S., D’Angelo, R., Kenney, D., Levine, S., Marchiano, L., & O’Malley, S. (2022). A clinical guide for therapists working with gender-questioning youth, Version 1. Clinical Advisory Network on Sex and Gender.

Bhatt, N., Cannella, J., & Gentile, J. P. (2022, Apr-Jun). Gender-affirming care for transgender patients. Innovations in Clinical Neuroscience.

The Biden administration’s confused embrace of trans rights. The Economist (2022, June 23).

Boerner, H. (2023, March 30). What the science on gender-affirming care for transgender kids really shows. Scientific American.

Coleman, E., Radix, A. E., Bouman, W. P., Brown, G. R., de Vries, A. L. C., Deutsch, M. B., Ettner, R., Fraser, L., Goodman, M., Green, J., Hancock, A. B., Johnson, T. W., Karasic, D. H., Knudson, G. A., Leibowitz, S. F., Meyer-Bahlburg, H. F. L., Monstrey, S. J., Motmans, J., Nahata, L., Nieder, T. O., … Arcelus, J. (2022). Standards of care for the health of transgender and gender diverse people, Version 8. International Journal of Transgender Health, 23(Suppl 1), S1–S259.

Doyle, J. E. S. (2023, March 23). Inside the Terf Harassment Machine. Medium.

Gender Exploratory Therapy Association.

James, S.E.,Herman, J. L, Durso, L. E. and Heng-Lehtinen, R. (2024, February 8). Early Insights: A Report of the 2022 U.S. Transgender Survey.

Leveille, L. (2022, April 3). Leaked audio confirms Genspect director as anti-trans conversion therapist targeting youth. Health Liberation Now!

Levine, S. B. (2020, March 12). Expert Submission of Dr. Stephen B. Levine, MD – PA General Assembly.

Matouk, K. M., & Wald, M. (2022, December 8). Gender-affirming care saves lives. Columbia University Department of Psychiatry.

Paul, P. (2024, Feb. 2). As kids, they thought they were trans. They no longer do. The New York Times.

Reed, E. (2023a, January 13). Unpacking ‘gender exploratory therapy,’ a new form of conversion therapy. Xtra Magazine.

Reed, E. (2023b, May 29). Ohio rep. pushes conversion therapy; Bill mandates it for trans kids. Los Angeles Blade.

Reed, E. (2024, February 2). Debunked: Misleading NYT Anti-Trans article by Pamela Paul relies on pseudoscience.

Santoro, H. (2023, May 2). How therapists are trying to convince children that they’re not actually trans. Slate Magazine.

Tordoff, D. M., Wanta, J. W., & Collin, A. (2022, February 25). Mental health outcomes in transgender and nonbinary youths receiving gender-affirming care. JAMA Network Open.

United States Joint Statement (2023, October 11).

Urquhart, E. (2024, February 6). Pamela Paul shows NYT Opinion’s lack of accountability to the truth. Assigned Media.

Urquhart, E. (2023, December 1). What it actually means to listen to detransitioners. Slate Magazine.

February 2024

Emergent Neurodivergent: Neurodiversity-Affirming Therapeutic Education

2024-02-09T20:13:29+00:00February 5th, 2024|Thoughts From A Psychotherapist|

Last summer I wrote a blog post about how to spot trainings that were not Neurodiversity affirming. 

That did not feel like enough for me so I decided to take it a few steps further and joined by my colleagues Dr. Tiff Lanza LCSW, M.Ed. (They/Them/Theirs) and Christine MacInnis, MSed, MS, LMFT (She/Her/Hers) I co-authored an article published in the California Marriage and Family Therapist Organization’s magazine called The Therapist. We were all super excited both that our article got published and it that it happened so quickly. It was even more exciting to have it in an edition with a Neurodiversity cover.

I have gotten numerous emails thanking me for the article and/or asking me to send a copy of the article. In particular, our review of the current language used was helpful for people. As we know language evolves quickly and we anticipate that even our article will have outdated language at some point in the future. Most therapists and people want to use correct language but do not have the information to do so.

Our article delves into the burgeoning field of Neurodiversity (ND) therapy, critically examining its evolution, challenges, and potential for affirming and empowering individuals with neurodivergent experiences. The authors, themselves neurodiverse, analyze the historical context of ND therapy, highlighting the shift away from deficit-based medical models. The article scrutinizes the controversial Applied Behavior Analysis (ABA) intervention and emphasizes the need for client-centered, neurodivergent-affirming practices. The authors also explore the importance of language in promoting inclusivity and provide a comprehensive glossary of relevant terms. Finally, the article underscores the significance of involving neurodivergent individuals in therapy training and explores the intersectionality of the ND community.

Many of us in the ND community are passionate about sharing our experiences with other therapists and the world at large. I know many of us have learned to embrace our own ND experiences during the course of our own education about Neurodiversity. I have been super frustrated seeing people teaching about Neurodiversity who do not have any lived experience and are using outdated and ableist language. We want the therapist world to do better. I encourage all therapists to take some classes about Neurodiversity. You don’t know what you don’t know. I know I have learned much and still have so much more to learn.

You can read the article through the magazine link here. 

Feel free to email me if you have any challenges accessing it and I will happily email you a copy. 


Gender Exploratory Therapy has a new name and it is still dangerous

2024-02-09T20:12:14+00:00February 5th, 2024|Gender identity, Thoughts From A Psychotherapist|

A few months ago I wrote about the dangers of Gender Exploratory Therapy. The organization promoting this therapy, previously known as The Gender Exploration Therapy Association (GETA) has undergone a name change to Therapy First. Upon examining their revised website, one might find the content appealing, especially in the context of allowing children time and support to explore their gender identity through therapy, which on the surface appears commendable. Notably, a guidebook designed for therapists working with gender-diverse youth has garnered attention for its articulate and seemingly rational content. However, a closer examination of the authors reveals Lisa Marciano’s involvement, who has been advocating for the concept of Rapid Onset Gender Dysphoria since 2017, a purported condition often invoked by conversion therapists to justify their practices.

Upon, reviewing the case studies featured in the aforementioned guidebook, several concerning observations emerged. The first case study involving a teenager named Alina showcased the therapist’s pursuit of various explanations for the teen’s gender identity, none of which acknowledge the possibility of Alina being transgender. The study lacks any clear outcomes apart from a reduction in family conflict and a diagnosis of ADHD for the client. The language employed within Alina’s case study exhibits transphobic undertones, with Alina’s efforts to express their identity dismissed as “antics.” Moreover, the report mentions instances where Alina’s parents intervened by isolating them from perceived negative influences and confiscating their binders, leading Alina to resort to potentially harmful alternatives such as using multiple sports bras, exacerbating their asthma. Rather than recognizing potential signs of transgender identity, the therapist attributes Alina’s behavior to a “hatred of the sexed body and fear of adulthood.” 

I would argue that there was no harm in letting Alina use another name and wear a binder. If they later decide that the name or binders do not work for them they can change their name and stop using their binder. These are social transition steps that are fully reversible. Allowing the client to be where they are at and accepting that is the supportive intervention. Telling an adolescent that they do not know themselves never has a good result. It only invalidates them and makes them feel unheard and unaccepted, which certainly can lead to depression. 

It is imperative to clarify that therapists engaging in gender-affirming therapy do not presuppose that all clients are necessarily transgender or non-binary. Instead, the aim is to facilitate clients in exploring and establishing their identities, acknowledging that identities may evolve. Medical interventions, particularly in youth, are typically limited to reversible measures such as puberty blockers, which afford individuals the opportunity to explore their gender identity without undergoing irreversible physical changes. Social transition steps, such as adopting a different name or using binders, are reversible and serve as avenues for self-expression and exploration. Respect for the client’s journey and acceptance of their current state are central tenets of supportive intervention. Conversely, dismissing or invalidating an adolescent’s self-perceived identity risks exacerbating feelings of alienation and may contribute to mental health challenges such as depression.

Regrettably, prominent news outlets like the New York Times have perpetuated misinformation by featuring articles that promote conversion therapies, citing discredited studies to bolster their arguments. Erin Reed’s comprehensive rebuttal of a recent New York Times article on detransitioning offers a valuable counterpoint to such narratives. A link to the article is provided below. 

As therapists, it is incumbent upon us to speak out against practices that may cause harm to individuals under our care. The alarmingly high suicide rate among transgender youth underscores the urgent need for approaches that affirm and support their identities. A therapist’s role is to provide a nonjudgmental space for clients to navigate their identity journey, recognizing that it is a dynamic and evolving process.

Contrary to these principles, Therapy First adopts an adversarial stance, refusing to acknowledge the possibility that a client may be transgender. Instead, they attribute clients’ identities to external factors such as autism, trauma, or social influences. An affirming therapist approaches trauma with sensitivity and does not discount the self-awareness of neurodivergent clients. The notion of social contagion, proposed by Therapy First, is unfounded and has been debunked by reputable sources.

I would encourage all therapists to stay educated and make sure if any of your clients need information that you direct them to reputable resources.

Please note that I have intentionally not linked to any of the resources provided by Therapy First in this article as I do not want to do anything to validate their website.

Recommended further reading

Why Ethical Therapists Everywhere, Should Be Alarmed by Gender Exploratory Therapy, now dubbed “Therapy First” by Addie Kogan 

Debunked: Misleading NYT Anti-Trans Article By Pamela Paul Relies On Pseudoscience by Erin Reed

December 2023

Boundaries-What Fun!

2023-12-12T22:44:01+00:00December 12th, 2023|Thoughts From A Psychotherapist|

The Joy of Setting Boundaries Not really-why you need to set them even if it hurts

Upon deciding to explore the topic of setting boundaries, it became evident that a mere discussion of the mechanics of boundary establishment would prove insufficient. While many of us understand the procedural aspects of setting boundaries, encapsulated in the simple act of uttering the word ‘No,’ the true challenge often lies in the apprehension that such an assertion may elicit displeasure, particularly when the individual in question holds significance in our lives or exerts influence over us. Consequently, finding the resolve to utter ‘no’ becomes a formidable task, even when such refusal is imperative.

The challenge extends beyond the procedural aspects of boundary setting; it resides in the careful deliberation of whether these boundaries are necessary and how to navigate potential repercussions in the face of backlash. Among those socialized as female, this struggle is perpetuated by historical conditioning that emphasizes the paramount importance of preserving others’ happiness—an expectation ingrained in the female psyche. Many internalize the notion that their self-worth is contingent upon their ability to ensure the contentment of those around them.

This begs the question: How does one successfully establish boundaries amid the concern for potential consequences? For many individuals entering their 50s, a newfound liberation emerges, liberating them from the burden of worrying about others’ opinions. This liberation may stem from a culmination of factors, including fatigue resulting from years of shouldering substantial burdens or the transformative phase of menopause, which seems to grant freedom from societal expectations.

Despite this newfound freedom, the most challenging boundaries to set are often within the realm of familial and relational dynamics. Instances of this complexity manifest prominently in sibling relationships, where established dynamics, seemingly ingrained since childhood, appear resistant to change. Effecting transformation in these dynamics proves to be a formidable undertaking, particularly when only one party desires such change.

Initiating change requires the persistent reaffirmation of boundaries, often necessitating repetition until the recipient can assimilate and accept them. Maintaining a neutral stance during this process is paramount, as impatience may undermine the effectiveness of the boundary-setting endeavor. For many, this journey is an ongoing process, one that demands a steadfast commitment to self.

Learning to set boundaries and uphold them constitutes an ongoing learning curve. If we can reach a point where we confidently establish and maintain boundaries, it enables us to take better care of ourselves, fostering the potential for a happier life.

August 2023

Red Flags that a Training May not be Neurodiversity Affirming

2023-08-29T00:42:09+00:00August 25th, 2023|neurodiversity, Thoughts From A Psychotherapist|

potential indicators that a training may not be Neurodiversity affirming.

It feels like everyone and their dogs are now offering neurodiversity training. However, many of these trainings endorse ableist language, such as high functioning or behavioral approaches that encourage a person to act in a manner that is more acceptable to society rather than accepting the client and supporting them living an authentic life. I have developed an infographic that reviews some red flags. However, I am sure I have missed some along the way, so feel free to comment and I can do a round two of this information.

The big things to look for

  1. Does the instructor have lived experience as a Neurodiverse (ND) person? The community has a saying “Nothing about us without us.” We must listen to people with lived experience and integrate their needs into trainings for any therapeutic topic. There are many aspects of Neurodiversity with some definitions including only ADHD and Autism, while others include a spectrum of other conditions. I identify as ND, but I do not have ADHD or Autism. I feel like it is important to be open about that. I can advocate but I will not teach an ND class because that space should could be filled by the many ND therapists out there.
  2. Does the instructor endorse Applied Behavioral Analysis (ABA)? If an instructor is currently advertising that they are trained in ABA then any training from them should be a hard no.
  3. Does the advertisement use ableist or otherwise unacceptable language? This includes language such as high-functioning, Aspie or Aspbergers, treatment, or special needs. This is not an inclusive list but has some common terms I see when people advertise their training. In addition, we should be using identity-first language such as Autistic person rather than person with Autism.
  4. Does the training focus on behavioral interventions? In the past Autism and ADHD have been focused on as an condition that needed to be cured. People were treated with ABA and taught to behave in a manner that was considered socially acceptable. Examples include being forced to make eye contact or to not stim. Forcing ND people to behave in a certain manner is abusive and causes them to have to mask and pretend to be someone that they are not. That is traumatic and exhausting for them. Instead of treatment, we need to look at a model of support. Living in a neuro-typical or neuro-normative world is exhausting for many ND clients. We should work with them on how they can navigate that world while also being able to be authentic to who they are. There is not a cure for Autism or ADHD nor should there be.
  5. Does the training advertise a specific protocol to follow? If you meet one Autistic person you have met one Autistic person. No protocol can allow for the complexities of the Neurodiverse community. Creativity is key. Asking clients what they need and listening to it is essential. There is no one-size-fits-all protocol for Neurodiverse people.

Here is a video of me discussing some of these issues.

Please feel free to comment and add more red flags so I can continue to grow this list.

Here is a video of me discussing some of these issues.

June 2023

Assessing For Dissociation Is Essential

2023-06-19T22:13:06+00:00June 14th, 2023|emdr, Thoughts From A Psychotherapist|

Eye Movement Desensitization and Reprocessing (EMDR) therapy is an amazing treatment for trauma. However, it is crucial to assess for dissociation before using EMDR. Dissociation is defined as a psychological defense mechanism that involves a detachment from one’s thoughts, emotions, or sense of identity. Understanding and evaluating the presence of dissociation is vital for ensuring the safety and effectiveness of EMDR therapy.

Below I have some tools on how to assess for dissociation. For a first-level screening, the DES II is recommended. If the score is high or you otherwise still suspect dissociation that did not show up you can then use the MID-60. Both of these tools are accessible via the links below.

I recommend everyone get some training in working with dissociation and integrating parts or ego states work. My experience as an EMDRIA-approved consultant is that most stuck EMDR sessions can be resolved using parts interventions. This is also true for clients without dissociative disorders. We all have some protective parts and many times those parts need some time to prepare for processing. They may be fearful of what happens if trauma is processed.
The assessment process allows us to establish an effective treatment plan for each client. A client that has dissociative tendencies may need additional stabilization work before EMDR processing.

I have an online course on working with complex cases which, includes parts interventions to help with these stuck cases.

Resources for Assessing Dissociation

DES with color coded tabs

This shows what areas of dissociation the client is scoring higher on.

MID-60 instructions to clients

This is an instruction sheet to use when using the MID 60

Version for client to complete – MID-60

This is a spreadsheet version that the client can fill out

MID-60 pdf form client

This is a pdf version of the MID-60

Clinician scoring template spreadsheet – MID-60

Dr Mary-Ann Kate’s video for the MID-60.

Dr. Kate is responsible for many of the resources above and more. She shares it all on her Google Drive.

May 2023

Why Gender Exploratory Therapy is a BAD thing

2023-05-05T15:53:48+00:00May 3rd, 2023|Gender identity, Thoughts From A Psychotherapist|

Recently the California Association of Marriage and Family Therapists printed a letter to the Editor promoting Gender Exploratory Therapy. For those of us in the community we saw the language and knew this was a bad thing. But if you go to their website they state things in a gentle way that does not show their true agenda. Their agenda is clearly to not allow children to transition at all. That is conversion therapy which is illegal in CA. Many of us let CAMFT know what we thought about them publishing such a horrific letter. I am grateful to be a social worker our professional organizations would never publish something like that.

However, for a parent seeking out therapy for their gender-curious kid, this therapy might look like a good thing. It plays up all the reasons that a parent might be thinking about. A parent might worry it is a trend or their kid was influenced by others (there is no scientific evidence to back this claim). A parent will of course want there to be a thoughtful process with their child and they want to make sure that their child is not influenced. And although that is what good gender therapists do the right-wing extremists claim otherwise. A parent worries about what transition would be like for their child and fears that they will change their minds (again the rate of de-transitioning is very low and has not been studied alongside family support). So a parent can easily be sold on this group of therapists. 

Questions a parent might ask a gender therapist for their child

  1. How many clients have you supported through transition?
  2. What are the main obstacles you see for a child struggling with gender?
  3. How do you feel about puberty blockers?
  4. What is your training in working with gender-diverse children?
  5. How do you collaborate with parents, medical providers, and the schools?

A good therapist will collaborate with other providers. A good therapist will be open to puberty blockers at the right time. A good therapist will cite that family support is the main protective factor for transgender children. A good therapist will work with the child and family where they are at and let the child show the way on their journey. They will let your kid be your kid in ways that are authentic for them. A good therapist never has an agenda for the outcome of therapy. 

Gender Exploratory Therapy is a repacking of therapy known as conversion therapy. This therapy started with therapists trying to treat the gay out of clients and now expanded to doing the same to gender-diverse clients. This therapy is dangerous. Suicide rates for people that have experienced this therapy are high. It is important to get the word out to laypeople so that they understand how to best support their loved ones that are struggling with their gender identity. 

Here is a great handout from the American Psychological Association with a more comprehensive list of questions

Below is a simple infographic I created about why Gender Exploratory Therapy is bad. Feel free to download the pdf and share yourself.

Why Gender Exploratory Therapy is BAD

Want to download the pdf to share? Do so below!

Why Gender Exploratory Therapy is BAD PDF LINK

This is a video I made describing why Gender Exploratory Therapy is Bad.

This is a video I made explaining why the letter to CAMFT was Bad

April 2023

Why you cannot get a therapist that takes your insurance

2023-04-13T22:03:28+00:00April 13th, 2023|Thoughts From A Psychotherapist|

I often hear potential clients tell me how hard it is to get a therapist that accepts their insurance plan. I get it. I accepted insurance for over 20 years and when I moved to PA I was not allowed to stay on CA insurance plans so I decided I did not want to make the huge effort to get on PA panels. The trade-off was no longer worth it.

I suspect the general public does not understand this concept. Or they blame therapists for being greedy. I mean many of us have price points well above $100 a session and often above $200 in urban areas. They wonder why we need or deserve that much money a session. It is a fair question to some extent. And unfair in others. To become a Master Level therapist (which is the “lowest” level of education needed) you must go to graduate school. Then to get licensed you must do many hours (I had to do 3500) of supervised practice. In places like California, many people do those hours at little to no pay. After graduating with student debt, therapists have to work an additional two years with no real income. Then you have to choose between working for a non-profit, government program, group practice, or going out on your own. Non-profits do not pay well. Most people choose to do private practice. If you do that you are starting your own business with all the financial and emotional commitment that takes. Of course, they do not teach any of those aspects in graduate school. Many therapists are good a providing therapy but not so great at running a business and marketing.
I now spend several hours a week marketing my business through blog posting and social media interactions. When I started my practice in 2001 this was not at all how I expected my time to be spent. If you accept insurance there are additional hours spent on record keeping. If you have your own office you are often your own cleaning person too. I was. Then you need to spend time and money on consultation and additional training. Like the rest of the world the therapy world grows and changes and you need to stay relevant.

The biggest issue right now is it is a very hard job. For some of us, that level of hardship happened after the 2016 election. For others, it happened when COVID changed the world and our practice. Something we had to adapt to immediately. I moved to a telehealth practice over the weekend. That meant figuring out the rules, changing paperwork, and finding a secure platform to work on.
Then week after week I was mired in the same crisis as many of my clients. My capacity to see clients was diminished. I stopped taking new clients in March 2020 and have only taken a very few new clients since then. I do not know a therapist who is not looking at other ways to make money right now. Many of us have moved into consulting work also.

The VC world has also now taken an interest in what they believe is a money maker for them. We have seen platforms like Better Help pop up. Where the goal is not to help people but to instead make money by selling data. (This is not a dig at any therapist working there, like everywhere some are good and some are not). Better Help also encourages therapists to forget about things like you need to be licensed to work in any state their client lives in. Next, there are companies like Alma and Headway who are recruiting therapists to work through them. They get higher reimbursements from insurance companies and pass that money on. So how are they making money? Why can’t insurance companies just pay a living wage directly to therapists without a middle person?
I saw a post today that likened therapists at these companies to early Uber drivers who were promised the sky as far as earnings potential. We all know how well that is going.

For many of us then the choice is to stay out on our own and off of insurance companies that want to pay us nothing and tell us how to do our work.

This is why you cannot find a provider that takes your insurance. The ones who do have most likely been full since 2020. The rest of us have moved on.

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