Thoughts From A Psychotherapist Blog2022-08-29T08:53:27-04:00

Emergent Neurodivergent: Neurodiversity-Affirming Therapeutic Education

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 As we know language evolves quickly and we anticipate that even our article will have outdated language at some point in the future.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 [...]

By |February 5th, 2024|Categories: Thoughts From A Psychotherapist|0 Comments

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

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 [...]

By |February 5th, 2024|Categories: Gender identity, Thoughts From A Psychotherapist|0 Comments

Boundaries-What Fun!

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 [...]

By |December 12th, 2023|Categories: Thoughts From A Psychotherapist|0 Comments

Red Flags 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 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. 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. 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. 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. [...]

By |August 25th, 2023|Categories: neurodiversity, Thoughts From A Psychotherapist|0 Comments

Measuring Dissociation Level with Clients

I have been taking Dolores Mosquera's excellent training on Treating Dissociative Disorders with EMDR: The Progressive Approach at EMDR Advanced Training and Distance Learning. This training offers two additional bundled days Day 2- EMDR Therapy for Suicidal clients and Self-harming behaviors and Day 3- Working with hostile voices and parts of the personality in complex trauma and dissociative disorders. I will be taking the Day three training next. I have learned a lot in this first day and hope to post more videos. This video today is of the Back of the Head Technique developed by Jim Knipe which Dolores brought up in her training. This technique is used to help clients show how dissociated they feel in a particular moment. Obviously different clients have different levels of ability to know when they are dissociated. If they have some ability to gauge this Back of the Head technique is a great tool to use. I hope to write up some more protocols to add to the list on my website. These are my explanations of other people's protocols written in a simple manner to help therapists better understand them. I myself, often struggle with long very detailed protocols as I work to implement them with my clients. Let me know if you have any topics/protocols you want me to cover.

By |June 26th, 2023|Categories: emdr|0 Comments

Assessing For Dissociation Is Essential

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 [...]

By |June 14th, 2023|Categories: emdr, Thoughts From A Psychotherapist|0 Comments
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