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What Is CBT?

Author: Stephanie Camins – MA,LPC
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Cognitive behavior therapy (CBT) emphasizes the interaction between thoughts, behaviors and feelings.  Given any event, you can choose to think in positive or negative ways.    A negative, destructive thought about the event will lead to a response which is reactionary, impulsive, and maladaptive.  As a result, negative emotional states such as anger, anxiety, and frustration arise.  When you respond to the same event with positive or neutral thoughts or beliefs, you tend to react in a more proactive, solution focused manner and experience empowering, uplifting feelings.

What is the Goal of CBT?

The goal of CBT is to help develop constructive ways of thinking that will produce healthier behaviors and beliefs. CBT has strong empirical support and is the most widely used evidence-based practice for improving mental health. Studies have documented changes in brain activity, suggesting that this therapy actually improves your brain functioning as well.

CBT is a goal-oriented treatment method. It is "present focused" in its aim to change patterns of thinking (or core beliefs) and the emotions clients feel when being faced with distress or anxiety. CBT suggests that emotions, thoughts, and behaviors all influence one another in powerful ways. It is used to treat patients who have distorted thoughts that are unhelpful and irrational.  These thoughts don’t make sense and there is no evidence that they are true yet they are automatic and feel uncontrollable. Some examples include, “I’m not good enough, I’m unlovable, I have to be perfect, It’s all my fault, I’m a failure, etc.” CBT will help to identify inaccurate or negative thinking so you can view challenging situations more clearly and respond to them in a more effective way.

CBT Can be Used to Treat Many Problems Such As: 

  • OCD
  • Bipolar
  • Perfectionism
  • PTSD
  • Anxiety disorders
  • Depression
  • Grief
  • Sleep disorders
  • Phobias
  • Low self-esteem
  • Better manage stressful life situations.

CBT is most often a 16-week treatment plan which can quickly help you identify and cope with specific challenges.  Skills focus on changing 1. thoughts and 2. behaviors.  Once these two things have improved your emotions will shift.

Cognitive techniques:

  • Identify the 10 thought distortions
  • Learn strategies to restructure these distorted thought patterns
  • Replace negative thoughts with more realistic thoughts
  • Quiet your inner critic

Behavioral techniques:

  • Relaxation
  • Mindfulness
  • Journaling
  • Exercise
  • Organization
  • Goal setting
 CBT will help you to manage many distressful life events from managing symptoms of mental illness to coping with stressful life situations.

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What Is Telemental Health?

Author: Stephanie Camins – MA,LPC
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Telemental health is simply receiving therapy through electronic means whereby the client and clinician are in two different locations.  Video sessions are accessed through a secure video conferencing platform.   After assessing for a good fit for this form of counseling, I will provide you with log in information to the system.  I use Counsol for video sessions as well as client registration and billing.

What are the Technology Requirements?

To use telemental health for your therapy, you will need a secure setting for the session that will ensure your privacy, and a computer with internet connection.  The system is cloud based with point to point encryption which meets HIPAA criteria for privacy.  Platforms such as Skype and Face Time are not considered secure.

What are the Benefits of Telemental Health?

Telemental health provides easier access to counseling and expertise than traditional in office sessions.  It can save on travel time to and from sessions. You can use your lunch hour for sessions.  In circumstances where scheduling or distance is challenging, telemental health allows access to services that would otherwise be unattainable.

Telemental health provides an avenue for members of a family who are in a different location to participate in sessions.   For example, in the case of co-parenting, one parent may be too far away to make counseling reasonable.  Or one member of a couple may not be able to get across town at the appointment time and can participate through video.

This also gives people access to clinicians outside your geographical area who may have expertise not available in your area.  You are more able to pick a counselor that meets your needs without proximity being an issue.

Research which supports the use of telemedicine:

  • Multiple studies show online counseling as effective as “in-person” counseling
  • Depressed clients tend to stay in counseling longer online than in person
  • A higher percentage of online clients say then would seek counseling again

Who is Telemental Health For?

Telemental health can provide greater access to services in the following situations:

  • Military
  • Individuals who travel for work
  • Students
  • Work from home       
  • Stay at home parents
  • Health issues that keep you from leaving home
  • Rural communities lacking adequate resources
  • Nursing homes
  • Those with disabilities
  • No transportation to get to appointments
  • Fear face to face interaction
  • Prefer technology based interactions
  • Co-parenting when both parents can’t be in the office at the same time
  • Couples or family sessions when members are in different locations
  • Support groups with members in various locations
  • Weather restrictions
  • Convenience
  • Between session coaching and accountability

When is Telemental Health NOT Used :

Clients with severe mental illness that may require emergency services are not appropriate for this form of counseling and need to see a clinician in the office for the safety of the client.

Mental health professionals which are licensed to provide counseling services are only ethically and legally allowed to provide services in the state in which they are licensed. Although there are many advocating for licensing mobility, at this time clinicians are unable to provide services outside of the state they are licensed in.  There are a few exceptions to this, which can be addressed on a case to case basis.

Special considerations for the clinician:

  • Client comfort with technology
  • Explanation of technology used
  • Client Identity verification
  • Backup plans for technology issues
  • Identify location of client during session
  • Establish an emergency response plan and emergency contact person
  • Appropriate level of care for the severity of symptoms
  • Confidentiality in client’s environment ie.  Who might overhear session
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What Is Family Therapy?

Author: Stephanie Camins – MA,LPC
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Family Therapy

​Family therapy helps families build healthier relationships and cope with many different challenges. Family therapy can address a wide variety of relational and/or mental health needs. This form of therapy supports growth and communication for each individual within the family using a systemic method of treatment. Family therapy is also referred to as systems therapy. Systemic treatment looks at the roles of each family member and the dynamics that play out in the family.  At times these dynamics cause conflict and unhappiness. Family therapy is solution-focused, identifying specific and attainable goals to achieve an optimal outcome.  Issues are addressed within the context of the family system in order to improve the overall functioning of the family. Family therapy incorporates all ages and developmental levels and is tailored to the needs of each family. You will also come to understand your own impact on others and improve your ability to have healthy relationships in all arenas of your life.

What are the Benefits of Family Therapy?

Treatment can help families struggling with such concerns as: mental and emotional disorders, health and behavioral problems, and a wide array of relationship issues. According to the American Association of Family Therapists, “clients report marked improvement in work productivity, co-worker relationships, family relationships, partner relationships, emotional health, overall health, social life, and community involvement”. While learning healthy and productive communication, family therapy also provides a safe space for families to discuss important topics and share individual perspectives.

What Comprises a Family?

 Again, family therapy is also referred to as systems therapy.  It can be used with anyone you have a relationship with or any group with which you engage with.  This can be family and/or friends or even people in the workplace. It is the group of people who have the largest influence on a person’s daily life and decisions that are made. Even if these relationships have been broken by conflict or pulled apart by distance, family therapy can assist in repairing connections.

The American Association of Marriage and Family Therapists’ website: http://www.aamft.org/iMIS15/AAMFT/Content/About_AAMFT/About_Marriage_and_Family_Therapists.aspx

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What Is DBT?

Author: Stephanie Camins – MA,LPC
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Facts to know about Dialectical Behavioral Therapy (DBT)

  • Created in the early 1990’s as another version of Cognitive Behavioral Therapy
  • Originally created for women to treat symptoms of Borderline Personality Disorder
  • Can also treat depression and anxiety in adults
  • Useful to treat adults with depression who also suffer from co-morbid personality disorders
  • DBT has proven to have a lower dropout rate than regular psychotherapy
  • Patients treated with DBT have shown signs of reduced depression, anxiety, irritability, anger, and impulsivity, along with a reduction in suicidal actions or ideations and self-harm behaviors (Solar, et al., 2009)
  • Overall life satisfaction can improve if DBT is effectively utilized

Why is DBT so Effective?

Many people with mood disorders or personality disorders can’t regulate their arousal levels. Their nervous systems become over aroused easily and it is very difficult for them to calm down once they are activated.  They experience extreme swings in their emotional states.  DBT uses 4 areas of skill building to regulate thoughts, feelings and actions.

DBT has the same components of cognitive behavioral therapy which help clients identify and correct negative beliefs and assumptions about self and others. Clients work closely with the therapist to solve relationship problems, complete homework, role play better interaction solutions and practice self-soothing techniques. Through this therapy process, individuals learn to identify their strengths and build on them.

Why 4 is a Special Number for DBT

DBT is split up into 4 different types of services: For the more intense needs all four services are recommended in conjunction.  Some facilities offer the full DBT program. For skill building in relationships and mood symptoms, weekly therapy sessions and occasional phone consults are more cost effective and convenient.

  • 1 hour of weekly of individual therapy
  • 2.5 hours of weekly group skills therapy
  • Telephone consultations as needed for additional support outside therapy sessions
  • Therapy consultations for the therapist in order for them to be the best support possible for their clients

The skill building therapy follows 4 modules:

  1. Core mindfulness skills teaches awareness, presence, focus and acceptance
  2. Interpersonal effectiveness - teaches interaction skills with the people around you and in your personal relationships.  These include, assertiveness, problem solving, personal boundaries and conflict resolutions.
  3. Emotion regulation techniques -  involves properly identifying emotional states. If you find yourself over activated, these techniques teach you to lower your arousal.  It is important to identify obstacles you may be experiencing in shifting your emotional states.  These skills help to increase focus on positive events and decrease focus on negative events.
  4. Distress tolerance skills - help to lower impulsive behaviors by increasing the ability to tolerate emotional upheavals.  Four strategies are taught: distracting, self-soothing, improving the moment, and thinking of pros and cons and acceptance skills. (Stepp, Epler, & Seungmin, 2008, p.4)

References:

Solar, J., et al. (2009) Dialectical behavior therapy skills training compared to stand group therapy in borderline personality disorder: A 3-month randomized controlled clinical trial. Behaviour Research and Therapy, (47), 353-358.

Stepp, S.D., Epler, A., Seungmin, J., &Trull, T.J. (2008) The effect of dialectical behavior therapy skills use on personality disorder features. Journal of Personality Disorders, 22 (6), 549-563.

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How to Build A Support System?

Author: Stephanie Camins – MA,LPC
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Isolation is a major cause of depression in adults. As we move into adult responsibilities: work, parenting, marriages, we tend to let our relationships fade into the background. You may not be exposed to groups of people in your daily life like when you were younger. Many of us have jobs that are isolating.

The trend to work remotely has increased our isolation. In the ever increasing tasks of “adulting,” self-care often takes a back seat. Self-care includes Physical, Psychological, Emotional, Spiritual, Personal and Professional tasks. A healthy support system plays a role in all of these categories of self-care.

A support system is made up of individual people who provide support, respect, and care.

These are people who are in your corner. They do not judge you or ridicule you. They provide feedback that is genuine and in your best interest. Their support is not self-serving. They have a positive impact on your personal goals. These people may be close friends, relatives, or simply acquaintances. You may talk to them frequently or just occasionally.

Sometimes your support system includes people in your community.  Any interaction that is friendly and positive leaves you feeling happier. Frequent enough contact with that clerk, barista, or gym mate, is the foundation of building a network.  Any social connection can have a positive influence on your life. Being connected with others is vitally important to your happiness, self-esteem and ability to cope in difficult times. It also has a positive impact on self-acceptance and emotional health.

Most of us recognize the importance of this but it can be hard to build a network of supportive people, and stay connected to the support system we already have. Life is busy. It’s easy to find reasons why NOT to get together or call or email or even text. The excuse list is long:

  • I don’t have time.
  • I don’t know what to say.
  • ​It’s been so long since I’ve talked to them.
  • ​It will be awkward.
  • ​They’re probably too busy.
  • I don’t want to intrude on their life.

We all need people. I’m often asked how to overcome this list and build a support network?

Let's start by make a list of who is already in your corner.

Who do you already have in your life? Make a list of ALL the people you currently interact with. This should include family, friends, neighbors, and acquaintances. Think of your home, your work, your community, your church, your gym, your children’s school, your local Starbucks, any activity you do in your life that you are around people. You can also include professionals such as counselors, teachers, mentors, and clergy.

Go through this list and put a star next to each person who is supportive. Write next to their name what makes them supportive. Answer the following questions.

  • Do I feel respected by this person?
  • ​Do I trust this person?
  • ​Does this person bring out my best qualities?
  • ​Does this person allow me to feel good about myself?
  • ​Do I leave interactions feeling positive?

Make a point to contact these people and ask how they are doing.

How do I Build my Network?

You may find that your list is much smaller than you’d like. If this is the case, what is standing in the way of you building a support network? You may decide that seeing a counselor or talking with another professional advisor such as clergy or personal coach can help you develop your capacity to connect with others in a safe and supportive environment.

You might need help to identify the roadblocks you have created that keep you from connecting in meaningful ways with other people. A few examples of roadblocks include, low self-esteem, lack of confidence, depression, misguided life priorities, disorganization in your life, or difficulty asking for and accepting help from others.

Support systems are only effective if you use them.

Let’s work through the following roadblock example, "I dont like to rely on others." It’s hard for many of us to ask for help. Consider the following questions if this is an obstacle for you in using your support system.

  • When do I ask for help?
  • In what situations have I asked for help in the past?
  • ​When I ask for help, what am I feeling?
  • ​What do I think will happen?
  • Do I have negative or positive expectations?

Identify one situation you are dealing with in your life right now that you are overwhelmed with. Look through the list of supporters you made in this exercise, pick one person you can ask for assistance…and ASK.

Your support system should be just that, supportive. If you find that certain people tend to take much more than they give, if you feel drained after each interaction, this isn’t considered supportive. In relationships there is an ebb and flow to support. Each person takes turns being the supporter as life happens.

However, if this support isn’t balanced it may be time to set healthy boundaries for yourself -See my article: Setting Emotional Boundaries in Relationships. 

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I've created a helpful e-book:

Boundaries in Relationships

  • Why do People Abuse Relationship Boundaries?
  • Setting Emotional Boundaries in Relationships
  • What Makes a Healthy Relationship?
Stephanie Camins
MA,LPC

Why Mediation?

Author: Stephanie Camins – MA,LPC
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Benefits of mediation

  • Voluntary
  • Confidential
  • Impartial
  • Time Saving
  • Empowering
  • Flexible
  • Cost Effective
  • Cooperative
  • Respectful


What is Mediation?

Mediation is a cooperative, problem solving process, which aids parties in exchanging views and exploring solutions to conflicts. It is an informal, voluntary and confidential process. Mediators are trained, neutral third parties who assist people in reaching a mutually acceptable settlement. A mediator guides the communication process so that parties can manage emotions and reach an agreement which respects the needs of all individuals involved.


How Does Mediation Work?

All parties must first agree to participate in the mediation process. Sessions are usually scheduled for a 2 hour duration. Additional meetings are scheduled as necessary. The session begins with an explanation of the process. Each party is then encouraged to present their views. The mediator facilitates discussion and problem solving to aid parties in developing an agreement. Upon the completion of an agreement, the mediator will document the specifications and provide copies for each party to sign. Mediation agreements are informal documents unless incorporated into a court order or divorce decree.


What Types of Problems Can Be Mediated?

I specialize in Adult Family Conflicts and Divorce and Child Custody issues. Adult family conflicts include, adult siblings working to agree on eldercare issues for their parents, step family or in law problems. Plans for children include parenting time and decision making authority. We aim to help parents understand the developmental needs of children and make decisions which reflect their best interests. Effective conflict resolution aids in the adjustment to divorce, leads to better agreements and improves co-parenting relationships.

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What is Play Therapy?

Author: Stephanie Camins – MA,LPC
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Play therapy is to children what counseling is to adults. When adults have problems it often helps if they can share their thoughts and feelings with a therapist or a trusted friend. Children don’t have the cognitive ability to express themselves with words like adults do, so it is difficult for them to “talk” about things that worry or bother them. Play therapy allows children to communicate through play, their most natural form of expression, learning and developing. The play therapist strives to understand the metaphorical content of a child’s play and to help the child express their needs and discover solutions in a safe, therapeutic environment. The toys in the playroom and the relationship established with the therapist offer children the opportunity to use the power of their own natural creativity and imagination to heal and grow. Play therapy allows the child to create a world they can master, practice social skills, overcome frightening feelings, and symbolically triumph over minor upsets as well as traumas that have stolen their sense of well being.


Who may benefit from play therapy?

In the process of growing up, many children experience difficulty coping at some time. Although many childhood upsets are healed without therapy, play therapy offers children a natural, safe, and non intrusive method to hasten recovery from common distressing events as well as major traumas, or to simply enhance the self esteem of the child.


Play therapy can be helpful for children who:

  • Demonstrate emotional distress such as excessive anger, anxiety, fear, sadness or shyness, have low self-esteem or talk about not wanting to live.
  • Exhibit physical symptoms such as headaches or stomach aches which have no medical cause.
  • Exhibit problem behaviors which are immature for the child’s age, interfere with making friends, or are difficult to manage at home. These can include tantrums, defiance, and/or problems with eating, sleeping or elimination.
  • Experience stressful events such as:
    • Death, illness, or injury of a family member
    • Divorce or separation of parents
    • Additions to the family including new siblings, remarriage and blended families
    • Natural disasters or catastrophic events
    • Chronic illness or hospitalization
    • Family conflict and violence
    • Physical, emotional or sexual abuse
    • School anxiety
    • Separation anxiety
    • Disruptions in normal functioning
    • Social difficulties

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What is EMDR?

Author: Stephanie Camins – MA,LPC
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Eye Movement Desensitization Reprocessing aims to move disturbance to adaptive resolution. Disturbing events are often the basis of unhealthy, negative symptoms. EMDR is an approach to psychotherapy which incorporates knowledge from many therapeutic approaches. It utilizes an accelerated form of information processing used within a comprehensive treatment plan to promote recovery. EMDR is comprised of 8 phases which address thoughts, emotions, memories and bodily sensations. It uses not only eye movements, but other forms of bilateral stimulation (activation of both sides of the brain) to pair your own adaptive information processing abilities with memory networks. This associative process allows for the alleviation of disruptive symptoms and the enhancement of one’s own sense of well-being.

Why EMDR?

When something traumatic happens to you, that memory is stored with all five sensory components. These old experiences can cause uncomfortable symptoms in the present when triggered by current experiences. The sensory components of the original memory can create dysfunctional symptoms in the present. There may be times when you feel helpless in the face of these unexpected emotional responses. EMDR is one of the most thoroughly researched methods of therapy. Studies indicate 84-90% of people with a traumatic experience no longer experienced symptoms of PTSD after receiving EMDR treatment.

What issues are appropriate for EMDR?

Problems stemming from early psychological problems Trauma (abuse, neglect, accident, surgery, crime victim, natural disaster).

Performance Enhancement (for work and personal goals).

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Choosing a Therapist

Author: Stephanie Camins – MA,LPC
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Choosing a therapist can be a daunting task.  Here are a few points to remember.

It is important to choose a therapist who is a good match for you.  This is a very personal decision.  Even the most professionally respected therapist in the world will not  be a good match for everyone.  Remember that different people work together in different ways.  You should feel comfortable with the style of your therapist.  Sometimes it takes a few “tries” to find a good match.  It is OK to shop around until you find the right therapist for you.

Feel free to interview a prospective therapist, asking questions about their style of therapy and training, fee structure, cancellation policy, insurance reimbursement, how long they have been in practice, and if they are familiar working with the kinds of issues you want to work on in therapy.

Expect and demand ethical practices, including issues of confidentiality.  Be sure to ask about the therapist’s license.  While not all therapists are required to have licenses by all states, and while licensure is no guarantee of quality, it is useful for you to know that a person receiving a state license has met the requirements for education and training mandated by your state.

Some Questions To Ask Yourself When Choosing a Therapist:

  1. Is the therapist warm and accepting?
  2. Does the therapist have a sense of humor?
  3. Is the therapist willing to challenge you when necessary?
  4. Does the therapist seem emotionally healthy and seem to feel at ease?  (in other words, does not seem anxious, arrogant or depressed)
  5. Does the therapist accept and encourage the idea that clients are entitled to shop around for a therapist before they commit?
  6. Does the therapist accept the idea that consultation or second opinions may be helpful in the course of therapy?
  7. Does the therapist let you explain your problems without prematurely trying to fit you into a preconceived box?
  8. Does the therapist have more than one clinical orientation and can fit their approach to your specific problems?
  9. Does the therapist present you with clear office policies, including the limits of confidentiality, client’s rights, etc?
  10. Does the therapist seem flexible in many ways but still able to maintain clear boundaries?
  11. Does the therapist communicate well with parents when treating children and adolescents?
  12. Does the therapist seem to be able to balance the need to respect an adolescents privacy while keeping the parents informed?
  13. Is the therapist flexible about who can be a part of therapy? (at times, it is helpful to bring your friend/partner, child or parent with you to therapy)
  14. Does the therapist conduct regular evaluations of progress in therapy, including the discussion of  treatment plans?
  15. Does the therapist listen to your assessment of what is helpful and what is not during the course of therapy?

Remember that therapy, in the hands of a skilled therapist, is a powerful and life changing experience.  It has been shown to be effective for a variety of illnesses and problems.  If you need therapy and work as an active participant in your own treatment, you can expect it will be well worth the time and money you invest.

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