Moral injury has been defined as, “In traumatic or unusually stressful circumstances, people may perpetrate, fail to prevent, or witness events that contradict deeply held moral beliefs and expectations” (United States Department of Veteran Affairs). 

Essentially, moral injury can occur when someone either engages in or witnesses an event and/or action that goes against their own personal values, ethics, and beliefs. There are two types of acts that can lead to moral injury; acts of commission and acts of omission. Acts of commission refer to actions people take that go against their own morals and/or belief systems. While acts of omission highlight when someone intentionally does not take action on something that leads to an adverse event that goes against their own morals and ethics. 

To clarify, an example of an act of commission may be that a military member kills civilians in the midst of performing combat related duties. An act of omission might be a physician not taking someone off of life support despite patient suffering due to the patient's family making the decision to keep the patient on life support. 

So why are we talking about this?

Well, oftentimes we tend to associate the term “moral injury” with military personnel and military related tasks/traumas. However, moral injury extends to multiple life experiences in addition to the military experience. For example, those who are in the healthcare and/or mental health care field, first responders, survivors of crime, and survivors of intimate partner violence may also deal with the negative thoughts, feelings, and even potential decrease in functioning related to traumas associated with moral injury.  

What types of situations can lead to moral injury?

While we can take an educated guess that engaging in and/or bearing witness to a violent war event is traumatic and will create moral injury in most of us, there are other scenarios in the civilian world that can also inflict moral injury.

For example, during the height of the COVID-19 pandemic, healthcare workers across the world were stretched incredibly thin; working longer hours, having to isolate from their families for extended periods, seeing a high volume of patients, and not always being able to help dying patients see their loved ones one last time before they left this world. The unimaginable stress of working in healthcare at the height of the pandemic led to unavoidable moral injury on various fronts, given there was so much out of our control and so many difficult decisions had to be made. There are even people who blame themselves for others' deaths after unintentionally and/or unknowingly exposing people to the disease, healthcare workers or not.

Then, there are those who are survivors of violent and/or sexual crimes that often suffer with depression, anxiety, social isolation, grief, and resentment towards themselves, others, and the world based on their own traumatic experiences and moral injuries sustained. They might blame themselves for what happened to them, whether that be rape, sex trafficking, or assault. They may know their assailant and still have love and/or affection for them, which creates an internal storm of emotions and confusion.

People who suffer with moral injury often deal with bouts of depression, shame, anger, disgust, distrust, and self loathing. Such feelings can compound with clinical depression, anxiety, or even post traumatic stress disorder that makes moving forward in our lives that much harder. Maybe we notice ourselves to “shut ourselves off” to others, the world, and ourselves…we just can’t trust anything or anyone anymore which creates negative bias that impacts how we live our lives. We feel more isolated because we feel shameful or disgusted by what happened, so we disengage which ultimately fuels the anxiety, anger, sadness, poor sleep, helplessness, and hopelessness that may come with moral injury. 

So, what do we do to heal?

Much like any emotional wound, it is important to be able to have the felt safety to talk about our moral injury without being judged. Simple, right? No! Dealing with the dissonance that comes with moral injury is hard enough for the sufferer, but it is discouraging when we think about telling a trusted loved one with fear of being met with “well, why didn’t you just do this?” or “Oh, I would have handled that way differently” or “You could’ve just said no”. Sometimes we may be met with such responses; or, sometimes we may have unconditional love and nonjudgmental support. But we can’t know until we put ourselves out there as a first step in healing. Again, I acknowledge that this is far from easy.

Research also points to forgiveness and self compassion as means of coping and healing from moral injury. How is that done? Well, therapists can help you talk about the event(s) leading to your moral injury followed by discussion of negative beliefs you hold about yourself, others, and/or the world as a result. From there, your therapist can help you find ways to accept the reality of the occurrence and forgive yourself to release the hold of self hatred and condemnation. Your therapist can teach skills to reinforce self compassion, such as learning self empathy and acceptance to lift the burden as well. This work is nowhere near easy, but with time and dedication, the wounds of moral injury can be healed so that you can live your life again.

- Jackie Martinez, LMSW (NY), LCSW (NC)

Ah, the new year. We all think it – “new year, new me!”. We can be so eager to identify one or more resolutions. We always say, “this year is going to be different,” and we start off with a strong motivation until that dreaded crash about three weeks into January.

Some of the most popular resolutions include: exercising more, losing weight, getting organized, living life to the fullest or feeling happy, mastering a new hobby, budgeting, quitting smoking, traveling more, and spending more time with friends and family. While these are all admirable goals in and of themselves, the problem is that they are broad, vague, and unrealistic. For instance, exactly how does one plan to lose weight? Is it realistic to commit to going to the gym every day while having a strict low-carb diet? No. How does someone plan to budget? Does this mean paying for only necessities, and if so, what defines a necessity? Is it fair to say no to a night out with friends because that could break the goal?

The most important factor in making and keeping a resolution is to be realistic, balanced, and fair. No, someone will not lose three dress sizes in one month. No, they will not go to the gym every day. Yes, they will give in to temptation -- they will eat that Boston cream donut in the break room at work. Yes, they will end up buying something “on impulse” simply because they want it.

Now let’s change the “they” in the above paragraphs to “I.” Go back and read the paragraphs again. Reflect on what these sentences mean to you, if anything, when in the first-person.

Do they sound realistic, balanced, and fair? No.

In other words… Be nice to yourself. You are not a failure for a slip-up. You’re human, with your ups and downs, just like everyone else. Imperfection is okay. No one – absolutely no one – is motivated 100% of the time. Even Olympians struggle to maintain motivation. If you'd like additional resources of New Years Resolutions, click here.

Motivation Operates in Cycles

It is normal to experience the highs and lows of motivation. Instead of thinking, “why can’t I be motivated all of the time?” consider that some motivation is far better than none. That episode of motivation, no matter how fleeting it may seem, can still help you achieve your goals. Embrace it.

I used to struggle with not being able to uphold my motivation for long periods. I became frustrated at myself when I was doing something unproductive. Then I realized that the “something unproductive” was the very thing I needed to do to help recharge my emotional battery – to get me to feel inspired to get back on track with my goal.

Motivation operates in cycles, designed with peaks and troughs. It is not linear. Once you can begin to picture those highs and lows of motivation, moving away from the mentality that it is a straight-line to success, you work toward achievement of your goal (or you can at least readjust the goal to be a realistic one!).

The Phases of Motivation

The New Year before my wedding in October, much like so many other brides, I made it one of my resolutions to look a certain way for my wedding. I was determined to lose some of that weight I gained from too many snacks during all-nighters writing papers in graduate school.

I wanted to be reasonable with myself. I knew there was no way I was going to fit into a certain dress size, but I did know I could at least buy a dress in my real size and get it brought in if I lost weight. So, I did that.

I also downloaded Noom, a weight loss app with skills from cognitive behavior therapy (CBT). Daily, Noom drops short tips and suggestions to aid someone as they work toward weight loss. Early in the program, they introduced me to the Motivation Model, which changed my mindset. I began to be much more patient, loving, and kindhearted toward myself, addressing those nagging negative beliefs that were chewing away at me.

Let us use an example. Say you want to save 10% of your paycheck going forward. This is an illustration of what your motivation will look like throughout the journey:

No photo description available.
Photo credit: Noom’s Facebook page.

As you can see, the Motivation Model has peaks and troughs; it is not straight nor linear.

The following names of each phase come from the model by Noom. However, keep in mind it applies to all reasons for motivation, not only weight loss. It is a universal model, and I am certain there are other products that have the same model but simply with different names.

Phase 1: The Hype

This is the most exciting phase. This is the phase where you think, “I got this! I am going to achieve these resolutions!” and jump in with a complete, undeniable motivation. This is where you can feel caught in the momentum, determined that their first time saving 10% of your paycheck will be the norm going forward.

This is where you will experience the honeymoon – when motivation is at its most extreme. This is when we have that unstoppable, almost grandiose sense of motivation. We are in a blissful ignorance. We think we need to feel that motivated all the time.

Phase 2: The Plummet

This is the painful, dreaded crash that happens after the honeymoon. This is the part of the cycle where people have a bump in the road, thinking they are a failure, and may fall into an old habit. This is the part where we feel extremely judgmental toward ourselves, thinking we will never be able to get back on track with our resolutions.

This is the part where you did not save 10% of your paycheck. You had a draining day. The boss was hard on you, you got in an argument with your spouse, your child had a temper tantrum. To cope, you went online-shopping and bought some things you wanted but did not need.

You may think the following:
“This sucks. This is way harder than I thought it’d be.”
“Maybe I can’t do this.”

This is all normal! This is okay! It is all part of the journey. Simply acknowledge you had a slip up and continue along.

Trough 1: The Lapse

This is the most difficult part. This is where you will feel at your lowest in your progress with your resolutions. This is where you are most likely to give up, state you will never get better, give in to those negative core beliefs, and just go back to how you used to be.

“This is way harder than I thought it’d be” degenerates into “this is impossible.”
“Maybe I can’t do this” becomes “I won’t do this. I give up.”

This is the time when clients tell their therapists they have given up on their resolutions and goals. They are convinced things cannot get better.

But this phase can and will pass. Just believe in yourself!

To get through this phase, do something. Do something that will help you feel one step closer to your resolutions and goals, even if it is very minimal. If this feels like too much, use a visualization meditation to imagine you have achieved your goal. Visualization can be a powerful psychological trick to boost confidence.

Also, have some gratitude for The Lapse. Sure, it does not feel good being there, but it is not a crisis. It is an opportunity to be introspective, to dive into yourself to figure out what is effective for you when you are not doing well, so you can prepare to do better in the future. It is the time for wisdom.

It gets better.

Phase 3: The Slips and Surges

Phase 3 is the steadier phase, where going at a rabbit’s pace slows down to that of a turtle. You know the saying, “slow and steady wins the race.” In this phase, the highs and lows are easier to tackle. The highs are no longer mountainous like the honeymoon, and the lows are no longer like a great ravine. You will still feel those highs and lows, and yes, they are permanent. But that is exactly to be expected. It is normal.

You will have some days that are better than others. Perhaps one day, your boss says you did an amazing job leading the team project. Maybe that ongoing argument with your spouse is turning more so into manageable disagreements. Maybe your child is learning to use coping skills rather than have meltdowns.

There will be the bad days too, of course. You’re late for work because you got a flat tire – and it is the same day as an important business meeting. Maybe you get a phone call from your child’s teacher because he is having problems in math. Perhaps after weeks of you and your spouse working hard on effective communication, an argument happens again.

This is how motivation operates. It reflects the highs and lows of life – all the good and the bad, the celebrations and the tribulations, the gains and losses.

Once you accept that the slips and surges will happen, you can be mindful. You can think to yourself:

“Today I really will only spend my money on what I need.”
“Honestly, today really was a hard day. It’s okay if I indulge a little bit. But tomorrow I will be back on track.”

And it will also allow you to be more freeing and forgiving toward yourself… “You know, it really is okay if I go out with my friends on Fridays. It’s not going to ruin my goal if I let myself have some fun. If anything, it will probably motivate me to continue my journey.”

Summary

1. Our motivation operates in cycles. We will have highs and lows.
2. Be fair to yourself. Be mindful; reflect on what you can learn during the highs and lows. Know they will all pass.
3. When in a low, do one small thing rather than nothing at all.

- Valerie Smith, LMSW, CFTG

So…taking the first step to engage in mental health therapy can be jarring enough, especially when experiencing suicidal thoughts. If you have already taken this step, you should be so proud of yourself because this is a difficult step to take! 

Sometimes when we are seeking therapy, we have more on our minds than the day to day stressors and/or desire to vent to a neutral source. Sometimes, we are dealing with suicidal thinking, whether we realize it or not. And this can be quite frightening for some, while it feels fairly normal for others. So as a therapist, when I hear someone say something that may indicate suicidality, it is essential for me to take a closer look at what’s happening. 

Also, side note…if anyone in your life makes what you feel may be a suicidal statement, please make sure that you are asking questions, supporting them, and/or getting them connected to the appropriate professionals. Whether it is yourself suffering with suicidal thinking or a loved one, it is best to call the suicide hotline at 988 (press 1 for veterans) and/or call 911 or get to your nearest emergency room in the event that you or a loved one feels unsafe regarding suicidal thinking. Click here for additional resources.

Different Types of Suicidal Thoughts

I want to clarify the different types of suicidal thoughts that can happen for people so we all have a better understanding of varied experiences with suicidal thinking. 

Passive Suicidality

First, there is passive suicidal thinking. This type of thought is passive in nature, hence the name. When people have thoughts like this, such statements and/or questions may run across their mind like, “Maybe it would be better for everyone if I weren’t here”; “I wish I were dead”, “I want to die”, “why am I here?” or “I wish I could go to sleep and not wake up”. When people are dealing with passive suicidal thoughts, this tends to mean that there is no plan or intent to harm or kill themselves in place. In therapy, if we as clinicians have determined that you are safe at the time that passive suicidality is discussed, then we discuss creating a safety plan together and talk about safety contacts (trusted people and/or emergency contact) in case one no longer feel safe and they feel they cannot safely utilize their safety plan.  

What’s a safety plan? 

A safety plan is a tool that is created in a therapy session with one’s therapist for the purpose of having it at their disposal when suicidal thoughts creep back up. A safety plan will prompt one to list out triggers that contribute to suicidal thinking, plan, and/or intent; ways one can remain safe independently (go on a walk, read a book, spend time with a pet); who the trusted people in their lives are and who can be called by client for distraction (not discussing the problem) or for help (discussing the problem); listing out places that bring one a sense of peace and/or distraction, where they can go when feeling upset and/or overwhelmed; listing out emergency contact in safety plan (who can a therapist call in the event thatthere are concerns for safety and client is not reachable); listing out Suicide Crisis Line Phone Number- 988 (press 1 for veterans); list out 911 on safety plan; and list out nearest emergency room closest to client’s home where they may go in the event of a suicidal crisis/emergency.

Active Suicidality

Another kind of suicidal thinking is referred to as active suicidal thinking. With this comes thoughts of not only wanting to die and/or “not be here” anymore, but this has escalated to the point of the sufferer wishing to take their own lives, having formulated a plan and/or has intent to harm or kill themselves. For example, someone may tell you that they are feeling depressed, worthless, and life is no longer worth living. They then go on to say that they are ready to exit this world and plan to jump off of a bridge that very night. When something like this is said, immediate action should be taken. By immediate action, I mean calling the Suicuide Crisis Line and/or 911 or bringing your loved one to the emergency room. There is no tip toeing around this. If someone with active suicidal thinking has a plan and/or intent to harm or kill themselves, they need immediate safety and stabilization. No ifs, ands, or buts about it. They may be upset with you for calling the crisis line, the police, and/or taking them to the emergency room, but this is for their own safety and well being. 

Why take action?

Often times, those who survive suicide attempts are grateful they did and are more motivated to start a new chapter in their lives. Suicide is a permanent solution to a temporary problem. Suicidal thoughts are treatable! Therapy can help those who suffer with suicidal thinking to learn healthy coping skills,learn to reframe negative thinking and find news ways to navigate their lives in a way that feels worth while and meaningful.  

The Bottom Line

If you tell your therapist that you are suicidal, much more questioning needs to occur first before anything else. So you may get a slew of questions that seem redundant, but they are necessary to have the best grasp on what your clinical and safety needs are at that time. Oftentimes, we as therapists are able to formulate safety plans together and check in on this together regularly. However, there are some times when we need to call 911 and/or get you to an emergency room. Sometimes, this may result in a psychiatric inpatient hospitalization in order to keep you safe and have another treatment team in the hospital evaluate your safety and needs. This is all done in the name of safety and genuine care for our clients. We’d rather you be upset with us and get help than not be here tomorrow. 

The concept of psychiatric hospitalizations seems scary to some people, especially if you have never been hospitalized this way before. As someone who used to work in inpatient psychiatric hospitals, I can confidently confirm that the first goal at intake is discharge. Inpatient treatment teams seek to quickly stabilize and get patients out of the hospital safely with plans in place in the community to prevent future hospitalizations. 

We as therapists are here to support you no matter what. We just ask because it can save a life. Please see our emergency resources page if you are struggling with suicidal thinking.

- Jackie Martinez, LMSW

I’m a therapist who is transparent about seeking therapy for myself, and who believes both teletherapy and therapy is helpful for almost all people, regardless of the circumstances. Throughout my years, I have undergone my own therapy for different reasons, from wanting support for the trauma I experienced, to learning how to gain the self-esteem needed for me to break free from domestic violence, for simple advice about navigating through transitions, as well as for a means to cope as a caregiver for two parents who both were terminal. Sometimes, too, it felt cathartic just to be able to “vent” to a nonjudgmental, compassionate individual.

Unfortunately, as I’m sure you’ve noticed, it isn’t easy to get a therapist! I’ve had to leave voicemails, emails, and private messages for many local therapists – quite a few who never got back to me, and most who said, “sorry, I’d love to help you but I’m full” without any advice about who I could go to instead. Alternatively, for the therapists who did respond, there were issues with the commute (I require public transportation due to a neurodevelopmental disability) or with timing. For part of my treatment saga, I was also in graduate school and working a full-time job on top of balancing a mandatory field placement, which made it seemingly impossible to fit in self-care for myself.

Talk about irony! I remember it so vividly. I was a social work student learning how to be a therapist, employed at a community mental health agency while also interning at a private practice. I made the time to be there for my clients at the expense of ignoring my own needs. I desperately wanted a therapist of my own, but with the transportation issue, an unforgiving schedule, and the lack of available therapists in the area, how could I?

Then the pandemic happened. The world shut down. Overnight, I had to change meeting with clients face-to-face to going online. I will admit I came with a bias. Years before, during orientation for my social work undergraduate program, a rather old-fashioned professor rambled about why online therapy is a “threat” to the field. Mainly it was that she assumed HIPAA could not be honored or that the relationship was not as “real and organic.” However, now after being exclusively a remote-based therapist since the pandemic to the present, I must admit I respectfully disagree with her. Some of my most intimate, heart-to-heart conversations have been over a video screen. I have shared in my client’s sorrows, hopes, fears, joys, celebrations, and hardships. And I have seen glimpses into the very environment where they spend most of their time – their homes. There is something so powerful, insightful, and raw about seeing one’s home which cannot be captured through the spoken word while in a therapy office. It is truly a privilege to be trusted with seeing the private spaces of my clients, and in turn they get to see mine. Furthermore, teletherapy allows for me to work with anyone if their primary residence is New York State, going far beyond the borders of Suffolk County. This means the people who choose me as their therapist do so because they want to work with me, not because of just location. This arrangement has allowed me to blossom as a specialist in turn, having clients who all fit into my niches (grief/bereavement, complex trauma or C-PTSD, caregiving stress, and/or people with debilitating disease).

Thanks to teletherapy, I too got to have my own weekly therapy. After a somber event happened, I needed a therapist to process my emotions. One therapist who replied to me in a timely fashion offered teletherapy to anyone in the state. She offered everything I needed – experience, knowledge, efficiency, she even liked the challenge of having other therapists as her clients! Perfect! Yet best of all, the flexibility of being online allowed me the flexibility I required to remain efficient in my own role as a therapist to the people I serve. It was simple: I only needed to log in to the teleconference platform right before the session start time. This allowed me to never miss a scheduled session, be proactive about my recovery, and let my “therapy time” truly be 45 minutes (rather than adding in commuting time, which of course could be delayed due to an accident or inclement weather!). Plus, this also meant I got to have more time for other commitments in my life.

Still feeling unsure about teletherapy? Here’s some perks.

There are numerous reasons why teletherapy is beneficial. Here are a few in summary.

Privacy (the BIG one!)

Have you ever ran into someone you know while in the waiting room? Worse, was it someone you have difficulty with because you two do not get along? Yep, talk about awkward. Back in high school, I remember being in the waiting room at a therapist’s office when suddenly a girl I knew came in to pick up her younger sibling. She was best friends with a bully who absolutely loved to torment me. Yep… awkward.

Want to hear another unsettling story? That practice was so disorganized with communication that there was always competition for rooms. One time while I was there, one of the therapists came into the waiting room to ask if any of us would be willing to have our session in the kitchen – the public kitchen, where staff and clients alike could come and go to get coffee. Yeah, I’m not kidding. Talk about a HIPAA violation!

Or maybe you have been spared such severe examples, but most of us can relate to at least this experience: Have you ever overheard the entire conversation between the patient and the clinician while at a doctor or therapist’s office? Or have attempts to soundproof the rooms still proven impossible? I’ve been there, too.

Fortunately, with teletherapy you do not need to be concerned about coming across someone you know in the waiting room, parking lot, or restroom. You can schedule your session for a time where you will have optimal privacy and confidentiality, whether that be in your home, your car, or even in your backyard. 

Flexibility

Going to a session is easy when you do not have to drive to and from the therapy office! Clients can schedule their session during lunch break, before work or class, during their baby’s naptime or when the toddler is watching Sesame Street, or any other gap. In turn, it allows me to offer a wider schedule to also suit my clients’ needs.

Flexibility is especially important for clients who otherwise would not be able to fit therapy into their schedules at all. For example, for my clients who are caregivers, it would be impossible for them to commit to in-person therapy because they would need to arrange for care for both the session and the commute. However, with teletherapy, they are only “away” from their loved one for 45 minutes, and they also have the option to step away from the computer to care for them, if needed. Or as another example, say the client has a serious medical issue. They can prioritize their doctors’ appointments without having to suffer from a late cancelation fee because chances are, I can fit them into another time slot for that week. This is not always the case for in-person therapists because they tend to have stricter “on the clock” hours.

Accessibility for People with Illness or Disability

Sadly, although therapists tend to think they are sensitive to those with medical issues, this is often not the case. Their hearts may be in the right place, but they simply do not understand why going to an appointment in-person can be a great challenge. It is one thing for an office to be “ADA-friendly” by having an elevator. But what if the elevator fails? What if the parking lot is full of potholes? What if there is no ramp at the entrance or no automatic door? What if the restroom door is very heavy? What if the person needs their caregiver to help ambulate them but the only appointment times available do not work for the caregiver?

What if the person has IBS or Crohn’s disease? Or maybe they are pregnant? The fear of waiting in line for the restroom is a legitimate concern for such people, in addition to the embarrassment that comes with nosy strangers.

If you have limitations due to an illness, disability, or medical procedure, you may be unable to make it into the office, which will hinder treatment during when it is most needed. Teletherapy removes these barriers by allowing you to “log in” from the comfort of your bed.

Continuity of Treatment for College Students

For some youth, their connection with their therapist is one of the healthiest, strongest relationships they have with an adult. They make great progress, tackling the core beliefs or issues or whatever it is that is hurting them… until they must discontinue therapy because they are moving away for college. In the best-case scenario, the therapist may just happen to know another therapist who is in that area and can take on the referral – but that is almost never the reality. Usually, the treatment is terminated, and the client is left floating, just waiting to hopefully get some help through the counseling center at their college. These colleges may not have enough counselors available to assist every student, lack the training needed for issues that go beyond “typical college stuff,” or other limitations.

On the flip side, with teletherapy, college students can keep their therapist, even those going to a college outside of their home state! In my case, I can keep every student who began with me in high school and has since left for a college that is far away. The only requirement is that their primary address must still be in New York, which usually is the case for college students as they tend to “go home” during breaks.

Reduced Wait-Times

In an in-person setting, there may be a considerable wait time to get an appointment with a particular therapist. However, remote-based therapists tend to have more time slots open and allow themselves to be more available. For instance, if someone needs to reschedule a session with me, that is much easier to accommodate because I can log on during a time when I usually do not work. On the other hand, an in-person therapist may only be able to offer times that are bad for the client, or say they are completely unavailable because otherwise they may have to drive to the office for just one session.

Effectiveness (yes, teletherapy is just as good as in-person therapy!)

Evidence-based research supports that teletherapy is highly-effective for most clients, issues, and modalities – and generally, teletherapy is just as useful as in-person therapy. Sometimes it is even more effective since clients may feel more relaxed being in their homes.

It is only a myth that teletherapy is a “diluted” version of in-person therapy. In truth, most modalities (i.e., EMDR, DBT) can be easily adapted to an online version. For instance, there is a website I use for the bilateral stimulation used with my EMDR clients.

For more reasons as to why teletherapy may be the right option for you or your child, click here.

- Valerie Smith, LMSW

Doesn’t it drive you nuts when people tell you to “calm down” when you’re upset, anxious, panicked, or afraid? It drives me insane. I just think to myself, “Okay great…and how do I accomplish that without putting you through a wall?” Of course I don’t act on such thoughts! But I understand the frustration of feeling stuck in a dark, deep hole of anxiety while the bystanders at the top of the ditch are yelling down to me, “calm down!” or “it’ll be fine!” or “you’re overreacting!”. Which is why grounding techniques can be so beneficial when no one else can.

First, we should go over some basics of what anxiety and panic look like so we can better spot them before we feel completely unraveled in our experience with such symptoms. 

Fight or Flight Response

First, quick side note/science lesson…our bodies yield both the Sympathetic and Parasympathetic nervous systems. Housed in the Sympathetic nervous system is our “fight or flight” that prepares us to respond to danger. While fight or flight has always been essential to survival, the body can’t always tell what is a genuine danger versus when we are just emotionally uncomfortable or going through something. The Parasympathetic nervous system helps our bodies restore back to a state of calm when fight or flight is no longer needed. This information is important because it plays a GIGANTIC ROLE in anxiety, panic, as well as other mental health struggles. 

So when we have anxiety, there is constant worry that we can’t seem to shake most of the time in addition to maybe feeling restless, on edge, having a hard time focusing, feeling more irritable, physically tense, having a tough time sleeping and feeling easily fatigued quite a bit. I go through this myself and I can tell you firsthand that ignoring these symptoms will lead to feelings of anger and irritability, scatteredness, constant exhaustion, and like every little thing is an insurmountable task which will negatively affect your life across the board. Trust me, I know. 

What is Panic?

Panic is a bit different and more intense than your typical anxiety monster impeding on your day to day life. With panic, we actually feel like we’re having a heart attack or like we’re going to die! That’s right…there are instances when people have had to go to the Emergency Room because they thought they were having a medical emergency. Completely understandable given the symptoms of panic. If we look at symptoms of panic that include accelerated heart rate/palpitations, sweating, trembling/shaking, shortness of breath, feelings of choking, chest pain/tightness/discomfort, chills or heat sensations, numbness or tingling, feeling detached from ourselves or reality, fearing we are losing control, and fears of dying….it’s no wonder people may want to seek out a medical professional real quick. 

While I have never experienced a panic attack myself…I am willing to bet that if I ever do, I’m getting my butt straight to the Emergency Room because as humans, what are we supposed to think when all of that is going on without any clear medical explanation? I highly encourage anyone experiencing such symptoms, especially if this has never happened before, to seek medical attention immediately and rule out medical concerns before chalking this all up to panic!

However, once we rule out medical concerns and have an understanding of panic symptoms, we can better manage them without seeking unnecessary medical attention or escalating our anxiety/panic due to fear of the unknown. It is essential to understand that panic attacks are just that, panic. They cannot physically harm you and they tend to last about 10 minutes (while I’m sure it feels like forever!). So, we have to remember that it will pass and getting comfortable with discomfort is one of the first steps to getting through panic attacks. I’m sure that’s obnoxious to hear, but it’s true. 

Much of the time, what I’ve caught myself doing to alleviate my own generalized anxiety is to avoid, avoid, avoid. Whether it be avoiding a deadline or an uncomfortable conversation, dodging obligations/tasks all together feels good in the moment, for sure. While my education tells me that avoiding my anxiety like the plague only makes things worse, I admittedly engage in this behavior. And trust me, the education is correct…avoidance only feeds the anxiety monster that lurks beneath.

So what are we to do when anxiety and panic strike?  

Well, a form of coping called grounding skills seems to help many, including myself, to feel more centered in the present moment and ultimately activate my parasympathetic nervous system (that’s what we want). With grounding, we are essentially turning our attention to the present moment so that we can ultimately feel more calm and address potentially anxious triggers.

In grounding, we use our five senses to return to the present moment when feeling overwhelmed and like everything is on top of us. Grounding equips us with several skills to utilize healthy detachment from emotional pain with use of distraction until we feel ready to return to any given problem. The following 5 skills that I will list below can be used any time, in any place, and can be completely discreet. There are many more ways of grounding that will not be covered here but I encourage you to explore ways of grounding with your therapist to find the right fit for you. 

The 5-4-3-2-1 Technique:

This skill invites us to observe 5 things we can see, 4 things we can feel, 3 things we can hear, 2 things we can smell, and 1 thing we can taste. For example, if I am feeling overwhelmed I will stop and look around me, engaging in this technique to focus on something aside from my stressor for a few minutes until I can collect myself and face my problems with my head screwed on right. 

Body Awareness Technique:

Here, we are encouraged to focus our attention on sensations in the body and feeling of calm after the exercise is over. Below, you will find an example cited from Therapistaid.com.

  1. “Take 5 long, deep breaths through your nose, and exhale through puckered lips.
  2. Place both feet flat on the floor. Wiggle your toes. Curl and uncurl your toes several times. Spend a moment noticing the sensations in your feet.
  3. Stomp your feet on the ground several times. Pay attention to the sensations in your feet and legs as you make contact with the ground.
  4. Clench your hands into fists, then release the tension. Repeat this 10 times.
  5. Press your palms together. Press them harder and hold this pose for 15 seconds. Pay attention to the feeling of tension in your hands and arms.
  6. Rub your palms together briskly. Notice and sound and the feeling of warmth.
  7. Reach your hands over your head like you’re trying to reach the sky. Stretch like this for 5 seconds. Bring your arms down and let them relax at your sides.
  8. Take 5 more deep breaths and notice the feeling of calm in your body.”

Grounding Statements:

When having anxiety or panic, a way to cultivate acceptance of discomfort and better managing symptoms, we can be kind to ourselves. Does it seem ridiculous? Maybe… but it can work! Focusing on positive words you say to yourself over and over in the midst of anxiety or panic can help you remember that you are strong, resilient, and can overcome difficult things in this life. Some examples of what you might say to yourself would be, “This is uncomfortable but I can accept it”, “I will let my body do its thing and it will pass”, “I survived this before and can do it again”, “this isn’t dangerous”, “no need to push myself, I can take a small step forward as I choose”, “these are just thoughts, not reality”, or “don’t worry, be happy”. 

Diaphragmatic Breathing:

I’m sure mostly everyone has heard of some form of deep breathing and I often hear clients tell me, “this doesn’t work for me”. Upon closer inspection, I find that people may try this once or twice, and when it's not instantly working, they chuck it out the window. However, this form of deep breathing should be given a fair shot! Let me explain a bit more about how to engage in this skill, then I’ll explain why I feel so strongly that deep breathing really needs to be given a chance. 

So, how do we do this one? We put one hand on our chest and the other on our belly. Then, we inhale slowly through our nose, hold briefly, and exhale through our mouth. Some follow a formula of 4-6-4; ie. inhale 4 seconds, hold 6 seconds, exhale 4 seconds). Adjust to your comfort level. Make sure that upon breathing in, your belly is expanding out. Notice how your belly expands and falls with each breath. It is recommended to engage in this skill for at least 2-5 minutes daily.

The reason deep breathing works is because it levels out the oxygen and carbon dioxide in your blood. When you have anxious breathing, your oxygen and carbon dioxide levels are uneven, leading to the physical manifestation of anxiety that we talked about earlier. So to help activate the parasympathetic nervous system (the one we want) and ease the physical parts of anxiety, diaphragmatic breathing is a great one to try. Let me know how it goes!

Using Sense of Smell for Grounding:

It has been found that in anxiety as well as trauma, the sense of smell is largely connected to the emotional part of our brains. If you think about it, maybe something that smells oddly familiar to you but you can’t put your finger on it brings a sense of comfort and calm. I know for me, whenever I smell anything that resembles Thanksgiving dinner, I have a sense of ease thinking back to fun childhood memories, enjoying my grandmother’s cooking for Thanksgiving dinner. Her food is always on point!

So when we are feeling anxious and/or triggered in any way, we can use sense of smell to quickly return to the present moment. Ideas that some of my clients have found helpful over time is to keep a perfume and/or cologne soaked handkerchief on them, an essential oil bottle on them, or maybe a favorite kitchen spice. Candles and/or wax warmers at home can also bring a sense of peace and calm using pleasant scents. 

While anxiety can sometimes make us feel like we’re in a moving car with no driver, there are ways we can safely get back into the driver’s seat and navigate our symptoms safely, securely, and happily. Your therapist can help you navigate these tools and find out what may be the best suited for you and your needs. Anxiety will not get the best of us!

- Jaclyn Martinez, LMSW

In couples counseling, many cite communication issues as being at the forefront of relationship challenges. Giving/receiving the silent treatment, experiencing defensiveness, criticizing one another, and feeling misunderstood by your partner are a few signs that communication issues are present in a relationship. Every person has a different communication style based on several factors, including upbringing, personality, previous relationships, and beliefs regarding self and others. While communication styles can be varied, there are some common threads that unite effective communication.

Here is a list of 4 simple strategies to improve communication with your partner. Notice I said YOUR communication; not necessarily their communication with you. You cannot change others; you can only change yourself. However, in implementing these steps, you are ensuring that you are expressing your needs in a healthy manner.

Step One: Actively Listen

Sounds simple. However, it is easier said than done. Rather than listening, oftentimes we are waiting for our turn to talk. We may be nodding our heads, but inside we are formulating our responses, or in some cases, rebuttals. A lot of information can be missed by doing this. We hear what we think the other person is saying based on past experiences and not what is being said. You can improve your listening skills by pausing, exhibiting open and relaxed body posture, avoiding interrupting, reflecting back what the other person has said, and asking questions for clarification. Make it easier to actively listen by eliminating any distractions from the environment.

Step Two: Foster Empathy

Humans are self-centered by nature. We see things from our point of view day in and day out, so putting ourselves in someone else’s shoes and viewing things from their perspective takes work. Fostering empathy often allows you to see a situation more clearly, it allows you to broaden your perspective and reduce anger, which has been proven to cloud logic and reasoning. This does not mean making excuses for their behavior. You are simply acknowledging that everyone has their own emotional and behavioral reactions that may differ from your own. From this place of understanding, validation, and acknowledgement, positive change can be made.

Step Three: Do Not Personalize

It is hard not to personalize someone’s actions when they affect you or even worse, they are directed AT you. However, how someone treats you reflects how they treat themselves. It has little to do with you, and everything to do with them. It is only personal if you make it personal. Do not let the words or actions of another determine how you feel about yourself. When you take yourself out of the equation, you can see things in a more neutral and realistic light, therefore moving you away from emotion and closer to logic.

Step Fourth: Use "I" Statements

The use of “I” statements helps decrease blaming while increasing self-awareness and personal responsibility. “You-statements" tend to cause the other person to feel defensive and/or shameful. An example of reframing a “you” statement to an “I” statement goes as follows: “You never listen to me” changed to “I am feeling alone and misunderstood; I want to know how I can communicate with you to gain a closer connection.” Reframing your language in this manner helps move toward a solution in a quicker and more meaningful way.

Remember, communication is not a one-way street!

These suggestions can be counter-intuitive. It also may be difficult to put these into practice if your partner is not receptive, or continues to communicate in a non-productive manner. However, by implementing these strategies, you can begin to empower yourself; ensuring you are communicating in the most effective manner possible to get your needs met.

If you find you have tried these strategies and are still having difficulty in your relationship, it may be time to try couples counseling. Couples counseling can be used as a great tool to address relationship issues before they escalate to causing irreversible damage. Contact our intake department to learn more.

- Alexandria Baxter, LMSW

After a long day, rushing to get your work done, put dinner on the table, and solve the crises everyone runs to you for, you finally get a moment of peace while laying down to sleep. Unfortunately, for many of us, this time can be full of distressing thoughts including memories of the past, fears for the future, and analysis of ourselves. Some even find themselves unable to fall asleep due to these ruminations, making their next day even more tiresome.

Why Do I Overthink at Night?

Our nighttime thoughts are often a reflection of our daily lives. To a degree, thinking at night is our mind’s attempt to reflect, adapt, and prepare for challenges to come. What this means is that if our days are full of stress then our minds will try to anticipate future stress and prepare us for that stress in our only moment of respite.

Some people find that giving themselves a time, during their waking hours, to feel their stresses and accept them, have less of a tendency to think of these thoughts later on. This can be a difficult task to do, but a number of clinicians at Long Island EMDR can be there to help you get started. Learn about them here.

Overthinking Affecting Sleep

People who suffer from overwhelming life stress, anxiety, depression, and associated insomnia will often say that their unwanted thoughts make it harder for them to get to sleep each night. This insomnia can lead to decreased work or academic performance, depleted mood, low energy and fatigue, or many other functional impacts.

How to Focus on Trying to Sleep

As silly as it may seem: count sheep. More specifically, there is research that suggests repeating a word or phrase at specific rates (usually 3-4 repetitions a second) can impact our brain’s ability to think of other thoughts. This is called articulatory suppression. This phrase should be neutral so that it doesn’t trigger thoughts of other things to come to mind. Some people find syllables or articles (“the”, “an,” or “a”) as helpful choices.

Others find imagery to be exceptionally helpful in maintaining sleep and getting to sleep. Try this exercise: in your mind, craft a story around yourself doing something that you enjoy most. Do your best to picture the details: sights, sounds, smells, or tastes. By practicing this imagery, you are training your brain to use your imagination to distract yourself from your thoughts. If those intrusive thoughts come to mind, accept that they are there, and push them aside as you author your tale.

Remember, this is a learned skill. It may not come naturally and it may not work the first few tries.

Other things that you may be able to do to focus on your sleep include:

  1. Staying off of your electronics at least 30 minutes before bedtime.
  2. Not utilizing your sleep space for non-intimacy or non-sleep-related activities throughout the day.
  3. Eliminating caffeine or other stimulating substances.
  4. If you struggle to fall asleep within an hour and a half, get up and do something for 15 minutes. Then try again.
  5. Exercise in the day to drain excess energy.

What to do to Control Thoughts

Our brains are very much like a river: the water represents our thoughts and the land represents our mind. If we can place ourselves firmly in the river, and not get carried away with the current, then we can improve our wellbeing. For some, the current, or our intrusive overthinking, will carry us into anxiety, depression, and other negative mental places. So, we look to take some control back and stand up.

Some brief activities can help us to control our thoughts and thus improve our nighttime routines.

  1. Mindfulness meditation.
  2. Breathing exercises.
  3. Positive affirmations and rejection of self-judgements.
  4. Taking a meaningful break from daily stress.
  5. Identify what causes unwanted thoughts and our focus on them.
  6. Journal your thoughts and feelings.
  7. Talk with your therapist about Mindfulness and Acceptance based Cognitive Behavioral Therapy.

-Nicholas Costa, MSW Intern

Everyone ruminates. Whether it’s thinking about something we said to someone, something we did wrong, or some recent event that is stuck in our mind. Ruminating thoughts can be defined as repetitive and recurrent, negative, thinking about past experiences and emotions (Michael, et al., 2007). However, while everyone experiences ruminating thoughts at some point in their life, for some, rumination can be distressing, difficult to stop, and can lead to dysfunction in their day-to-day lives.

Why do we ruminate?

When we think about ruminating, it’s important to acknowledge that it often comes from an effort to cope with distress. For instance, analyzing an experience can better prepare us to encounter a similar experience in the future. Or it can help us mend some relationships that were negatively impacted by an event in the past. But, when these thoughts aren’t leading to any productive change we can see individuals obsess over these thoughts, become anxious and depressed, isolate, or begin using / increasing their use of mind-altering substances.

Types of ruminating thoughts?

Ruminating thoughts can be very diverse. For some, they may ruminate about their hands being dirty and that they may get sick. Others may ruminate about suicidal thoughts, including existential themes about the meaning of life. Some may continually think about a traumatic experience, like an assault or some form of abuse. As well, some of these ruminating thoughts may be untrue distortions of events. For example, repeatedly thinking about being sexually assaulted may come with false thoughts that the victim somehow provoked their assailant or deserved to be assaulted.

Are my ruminating thoughts true?

Our experiences mold our self-esteem, or the way we perceive our behaviors, abilities and traits. A traumatic experience can leave individuals with warped perceptions of themselves that can have a detrimental effect on their day-to-day lives. Especially the formation of a negative self-esteem, or negative self-concept, is associated with feeling disempowered, hopeless, and helpless. Ruminating on these experiences, or even these self-beliefs, has been shown to exacerbate and prolong negative moods, and hinder social interaction and problem-solving skills (Wang, et. al, 2018).

Are ruminating thoughts part of a diagnosis?

Ruminating thoughts can be associated with a number of mental health diagnoses, including:
● Depression 

● General and social anxiety 

● Substance abuse disorder 

● Bulimia 

● Binge eating disorder 

● Obsessive-compulsive disorder

● Post-traumatic stress disorder 

● Personality disorders, like borderline personality disorder 

There is hope!

Ruminating thoughts are treatable and manageable. Treatment often aims to interrupt the thought processes and improve coping skills to replace rumination. Some individuals find relief from medication management, cognitive-behavioral therapies, and mindfulness techniques. 

If you experience ruminating thoughts and are looking for a way to move forward, please call our office and schedule an appointment. Our licensed clinicians and therapists on staff would be more than happy to work with you.

-Nicholas Costa, SFT Social Work Intern

Being a parent is not easy. Being a mom is pretty rough too. I recently watched a show called “Better Things” about a single mother (working in Hollywood) raising her 3 daughters. At some point in the show, one of the daughters made a comment about single mothers. Another character said, “All mothers are single mothers.” That hit me hard. As supportive as my husband is, and as an amazing father he is to our two perfect little children, it wasn’t always like that. Today I can confidently say that I do not feel like a single mother. I feel like my partner contributes many things he once did not, whether it be with the children or with household responsibilities. At some point in my life with children, I felt like if I had to leave the house, I had to set my husband up like a babysitter and have diapers, wipes, cream, outfits, bottles, blankets, etc., all ready for him so he would have no hiccups during those times with the baby/toddler. 

That and along with the million other tasks I was responsible for, it became exhausting to say the least. I felt like I was on autopilot and not enjoying my life anymore. At that time, I was craving for my husband to just do and not be asked. It took a lot of therapy (individual and couples) for me to feel confident enough to communicate what I needed from him, and it took effort on his part to meet me halfway. We tell our children that we are a team, and everyone must do their part for each of us to feel happy and safe. My husband and I forgot what it meant to be a team to each other for a long time, and thankfully, today, I do feel like I have a trustworthy team member when raising our children. I do not leave my house with instructions for him like I would for a babysitter. I just leave knowing that he’s got this, and he does. In fact, he always was capable given the chance. 

We often feel overwhelmed and burnout because we feel like the only one on the team who is participating.  We plan most things, we are the ones packing for more than just ourselves for vacations. In the mornings, we get ourselves and 1,2, or 3+ people ready for the day, and then ready for bedtime at night. Learning and practicing ways to effectively communicate with confidence can help alleviate this feeling of burnout and make more time for us to be ourselves. 

The Mental Load

Kelly Gonsalves from mindbodygreen.com writes about The Mental Load that women typically go through in which she defines as: “The mental load is a term for the invisible labor involved in managing a household and family, which typically falls on women's shoulders. Also sometimes referred to as "worry work" or "cognitive labor," the mental load is about not the physical tasks but rather the overseeing of those tasks.” This comic explains it the best:   https://english.emmaclit.com/2017/05/20/you-shouldve-asked/

Breaking the Cycle

It’s easier said than done- for sure I’ve lived this life. But putting in the work I promise is worth it. Here are some tips that have helped me to improve communication with my spouse.

1. Listening

Listening to what the other person is trying to say. As well as listening, not only to my children and my partner, but to myself. Listening to your feelings, triggers, warning signs, body sensations, or anything that might tell you that you need a break. Tips to Help You Actively Listen:

Focus fully on who is talking. This means not multitasking mama. Put the phone down, stop doing the laundry, stop thinking of the 20 other things you need to do.  Engage. Make eye contact and be fully present with that person. If you find it hard to concentrate on what they are saying, repeating their words in your head it’ll reinforce them. Or check in on yourself- maybe you are not in the best emotional state to be having this conversation. If that’s the case take a break and tell them you will talk in an hour when your calm so you can be really present for them

Avoid interrupting or trying to redirect the conversation to your concerns. If you are coming up with a rebuttal or how to get the conversation back to your main concern- you're not really listening to them. You cannot listen fully and be thinking about what you will say next. If your doing this it can show through your non-verbal cues like your body language and facial expressions. 

Show you understand what they are saying. Ask clarifying questions. Repeat a summary of what you heard so they can clarify for you. A lot of time miscommunication is what happens when we think another person is inferring something or we get fixated on the words they use- losing the message behind the words. Clarify. Some examples: “when you said ‘x’ are you saying that you feel ‘xyz’”.”what do you mean when you say…” “is this what you mean..” “Sounds like you are saying…”

Focus on understanding not judging. When we judge others there are a lot of value statements about what is right and wrong. Understanding is trying to see why they think the way they do, even if we don’t agree with it. It’s about empathizing with their position and understanding their pain-points- that’s how you find solutions. NOT the blame and shame game.

2. Paying attention to the non-verbal cues. 

Both your body language and theirs. Make sure you are “open” with your body language. No crossing of arms or legs. Face should be understanding or neutral and your tone is important. If either of you are showing non-verbal cues that you're angry or anxious- table the conversation till you are both calm.

3. Managing your emotions

Being a mother means repeating yourself, having tiny voices repeat themselves around you, making messes everywhere, and invading your personal space all day everyday. It is easy to feel as though you might explode with frustration. Learning how to manage those explosive feelings and reactions can not only help you to feel sane, but can teach your children by example how to control themselves. Learning how to manage your emotions may come in the form of daily meditation, individual/couples therapy, or even with medication as prescribed and monitored by a psychiatrist. This also means paying attention to your triggers and warning signs and “tapping out” when you need a break. Walking away and taking space, even if it’s in the bathroom for 5 minutes, can help you to recenter yourself so you are not losing it on the family.

4. Be assertive

Being assertive to get what you want is not always easy, especially if you feel the burden of being the primary caregiver/housekeeper/shopper/activity planner, you know the be-all-end-all? Learning how to and practicing how to be assertive can change your life for the better and alleviate some of the pressures in life. It can also instill self-confidence in your children when you hold your boundaries and empower them to learn how to do for themselves!  Honestly- same goes for the spouse. 

5. Surround yourself with positive people that lift you up!

 Having the right circle of support is key to really beginning to make these changes! Let’s be honest, for most of us we have been conditioned from childhood to help and please others. To neglect ourselves, our feelings and our needs. If you don’t get some people around you who are cheering you on to break the cycle- so that your kids don’t have that inner voice that says “my feelings and needs don’t matter”- it’s just going to be constant criticism from the people around you who instilled that value! And that coupled with change being so uncomfortable to begin with is not a good recipe for success. 

Sound Like You?

It takes a lot of work and consistency for oneself to feel confident and empowered enough to set boundaries and expectations that are reasonable for everyone involved (including you momma!!). Joining a support group with people going through similar struggles can be a helpful way to join forces and empower each other to take back our voice, our alone time, our self-care, our guilty pleasures, and most importantly, the confidence to achieve these things in an appropriate and reasonable way.  We all deserve this, and the saying “it takes a village” doesn’t just mean to raise a family, it also means to support the caregivers and mothers in our lives in different ways. If you are interested in receiving individual therapy from a woman who has truly been there, schedule with me today. If you feel you need a support group of like minded-woman join inquire about our “Don’t Know How She Does It Group”. I would love to help you become the woman you were born to be!

Sending Love,
Kristy Casper, LCSW

Art therapy is a newer form of therapy. It is an integrative mental health practice that is designed to improve the lives of individuals, families, and communities through the process of art-making, creative process, applied psychological theory, and human experience within a therapeutic relationship.

Art therapy should be done by a trained professional of art therapy. This will improve the  effectiveness as art therapists are trained to create art therapy exercises that are designed to not only support you but also to help move deeper into your therapeutic goal.  Art therapists are trained to use their knowledge to support your personal and therapeutic treatment goals throughout treatment. Art therapy has been used to improve cognitive and  sensorimotor functions, help support a better relationship with self-esteem and self-awareness, produce emotional resilience, promote insight, enhance social skills, reduce and resolve conflicts and distress.

Art therapy is a wonderful tool therapists use to help patients interpret, express, and resolve their emotions and thoughts. This is a newer type of therapy and was first established in the 1940s however the practice did not become more widespread till the 1970s. Like other expressive arts therapy, such as dance therapy or music therapy, it draws on creativity.

Inaccurate Use of Term 'Art Therapy'

Often people mistake  “Art therapy” for things that are not necessarily due  to a lack of knowledge about the profession. However these situations provide an opportunity to offer accurate information and educate the public. This modality must be done by a trained art therapist or it is technically not art therapy. Some products that are mistaken for art therapy are adult coloring books and paint by numbers. Art therapists are not art teachers, their goal is not to make you a better artist but to help you improve your mental state through the use of art.

How Art Therapy Works

Many people ask "What is art therapy and how does it work?" It is all about  expression. The process of creating is the most important thing, not the end product which is why anyone can do it. Often many people shy away due to a fear of not being an artist but this type of therapy is for anyone. It is designed to use the expressive arts as a way for people to understand and respond to their emotions and thoughts with a valuable new perspective, not only that artistic expression is good for mental health as it is often related to relaxation.

During a session, an art therapist works with clients to understand what is causing them distress. Then the therapist guides the client to create art with an art directive that addresses the cause of their issue or explores it further. During a session, art therapists may:

Through different mediums and art techniques art therapy engages the mind, body, and spirit in ways that are not dependent on verbal articulation alone. Due to the way it engages the body and mind it causes various symbols to be created through the art process, this process also invites modes of receptive and expressive communication, which can benefit those who have limitations of language.

Who are Art Therapists

Art therapists are clinicians who are trained both in traditional clinical therapy and art therapy. Art therapists work with people of all ages and various populations. All art therapists are required to follow an ethical code. All art therapists are also required to have a master’s level education, as well as engage in supervision hours under a trained professional in order to obtain their license. This prepares them for various populations and gives them the ability to perfect their work.

Where Art Therapists Work

Art therapists work with individuals, couples, families, and groups in diverse settings. Some examples include:

Does Art Therapy Work?

There is growing evidence that art therapy helps conditions such as anxiety and depression, trauma, low self-esteem, PTSD, Bipolar  and similar disorders. It has also been used with those facing terminal illnesses such as cancer and those hospitalized experiencing pain, as well as it has been used with people working to develop effective coping skills, including prison inmates

Many clients are reluctant to explore art therapy because they think that they have to have artistic talent for it to work or see it as "arts and crafts" rather than see it as an effective tool. This mindset can be very limiting and can hinder the  effectiveness for these clients. It is important to go in with an open mind.

Is Art Therapy a Good Fit?

There's no way to tell for certain whether art therapy is a good fit for any given person. Therapy is not one-size-fits-all, and a client and therapist may need to use multiple different approaches and techniques in order to find what works best for you. However, if a patient is drawn to art or has had trouble expressing with traditional therapy, art therapy may be a wonderful fit for you.

When choosing a therapist it is good to consider the following. As a potential client, ask about:

Often you should be able to tell in 1-3 sessions if this works for you.

Think Art Therapy Would Benefit You?

If you feel like art may be a good avenue for you to work through your mental health concerns please call our office and ask for Jillian Martino. Jill is our art therapist on staff and would be more than happy to help you work through your concerns through art. Jill specializes in LGBT issues, trauma, children and couples. Contact our office today to set up a free 15 minute consultation.

-Jillian Martino, CAT-LP

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