COVID 19 & Teletherapy
Seeing a therapist used to imply being in the same room with them, but not any longer. Teleconferencing has made it possible to see a mental health professional from a distance.
With recent requirements for social distancing, many therapists and clients have had to either pause their work or make other arrangements, including meeting by video conference.
I've been providing teletherapy services for a few years now. Here are some common questions and issues that come up when thinking about making the transition.
Will My Therapist Agree to Online Sessions?
Some therapists (myself included) are enthusiastic about using teletherapy, some won't use it at all, and a large number of therapists approach it with some reservations. I've been surprised how many therapists are now moving to it with the COVID-19 outbreak and resulting social distancing. Most therapists generally seem to find that it's a very beneficial approach.
Even among therapists I know who were skeptical about online sessions in the past, the majority have opened to the idea. They seem to recognize it as a good option to avoid an untimely break in the therapy relationship, and to provide continuity of care.
Will It Be Weird?
If you're generally comfortable with communicating through a screen (e.g., Skype, FaceTime), you'll probably be comfortable moving to online therapy. If you can't stand this form of communication, you'll likely have a harder time with it. Of the dozens of clients I've treated through teletherapy, most seem to find the transition to be smoother than they expected. Therapy tends to be intense, and quickly enough you're likely to forget about the medium and focus on the work.
That said, expect some differences with teletherapy. It's different when you're not in the same room with someone, and you're experiencing them in two spatial dimensions instead of three. It can also be harder to pick up on body language through a video. And while most of my clients seemed to be comfortable with making the switch, a few were not, or found the transition to be quite challenging. Occasional tech issues come up (like a delay in the audio and video), but typically can be handled with a little patience and humor.
Is It Effective?
Research suggests that therapy by video conference can be very effective, which has also been my clinical experience. It depends on you and your therapist, of course, but in general you should expect it to be helpful if you were finding in-person therapy helpful.
Personally, some of the most powerful clinical experiences I've witnessed have occurred through teletherapy. In my own practice, I've seen it work for people dealing with things like depression, anxiety, obsessive-compulsive disorder, insomnia, relationship issues, grief, and trauma.
Will Insurance Reimburse Me?
A growing number of insurance providers seem to be willing to cover online therapy sessions. They'll probably require the standard things for reimbursement: your identifying information, the provider's license and so forth, a diagnostic code, and a session (CPT) code. Check with your insurance provider before starting your sessions if you'll depend on reimbursement to cover the sessions.
How Does It Work?
You and your therapist will agree on a platform to use (or in some cases may decide to forego video and simply speak by phone). Some rely on Skype or FaceTime, although those options are not HIPAA compliant. More secure platforms include VSee, Zoom, and Doxy, among others. There may be a fee for your therapist to use the technology depending on the service, but it should be free for you (aside from your therapist's session fee, of course).
How Should I Prepare for My Sessions?
Some important and finer points about the logistics of teletherapy:
Do a test of the software beforehand for your own peace of mind and to be sure it will work, and verify that you have your therapist's contact information (e.g., VSee username).
Find a place in your home where you'll have as much privacy as possible. This could be a challenge if kids are out of school or other family members are always home (or work from home).
Along those lines, I recommend ear buds for privacy and also better sound quality. That way your therapist's voice won't feed back into your microphone and out their speakers.
Make sure you're sitting somewhere you'll be comfortable for the length of your session.
Have your screen on a stable surface, since excessive movement can create a feeling of seasickness for your therapist. If they're new to teletherapy and their screen is bouncing around, ask them to do the same.
A finer point: try to have the top of your head near the top of your video screen, rather than in the bottom half of the screen. That way when they're looking at your face they'll be looking more or less into their camera (assuming it's at the top of their computer), so it will feel like they're looking at you.
Be sure to close email and turn off notifications that could be distracting and dilute the experience for you. You'll want to have your full attention focused on your session.
Also close programs that could slow down your computer's processing ability and interfere with the quality of the video.
You may also need to work out payment arrangements with your therapist if you generally pay in person. Some therapists will keep a credit card on file for you; others will ask that you mail a check. Find out what they prefer.
Are There Other Advantages to Online Therapy?
One plus of online therapy you'll notice right away is that there's no travel time involved, so your sessions will probably take up much less of your day. With that in mind, you may want to build in some transition time into and out of therapy, since travel time often provides a buffer before and after your session. It might be challenging, for example, to return directly to childcare after an emotional session. Even a 10-minute break to process and digest the session can make a big difference.
You'll also never have to cancel for weather (assuming you have electricity and Internet), and there are no concerns about whether you could pass along a sickness to your therapist (or vice versa) if you're well enough to meet but possibly contagious. It's also possible to see your therapist when you're traveling, just as I've been able to see clients when I've been on the road.
What If My Therapist Won't Do Online Sessions?
If your current therapist isn't open to doing teletherapy, you might consider speaking with a new therapist who does offer online sessions. Obviously it's not ideal to have to start over with someone new, especially if you've been seeing your therapist for a while. But it may be your only option if you're committed to continuing therapy with as little interruption as possible.
If you don't want to start with a new person, consider other resources during the hiatus from seeing your therapist (and work with them on the plan, if possible). For example, there may be books, brief online courses, or other resources that will help you to continue the work. Your therapist might be open to having brief phone check-ins during this time.
Seek out additional support from loved ones, as well, and be sure to take care of your basic needs like sleep, nutrition, and movement to keep your body and mind healthy. You might find journaling to be helpful during this time, as it's been shown to be an effective way to process thoughts and emotions.
Keep in mind that there could be unexpected benefits to taking a therapy vacation. While it may not be ideal, an unplanned break from therapy can lead to surprising growth, as the work you've done settles in and takes hold.
The Bottom Line
If you're considering teletherapy, talk it over with your therapist and see if it's worth giving a try. You don't have to know in advance if it's the right decision for you—you can always plan to do a limited number of sessions to see how it goes. If it works well, it could be a convenient and time-saving way to continue the important work of therapy.
Find the fill article here.
If you're looking for a therapist who provides online sessions, I invite you to contact me to schedule your free phone consultation today! Contact Me Here
Demystifying Couples Therapy
There’s a stigma around couples therapy, we don’t end up having those conversations, and we can wind up feeling alone when, of course, that couldn’t be further from the truth. People associate it with divorce. However, most people who come to couples therapy are not getting divorced—they’re building a healthier relationship.
Q: What can you expect to get out of therapy as a couple? And what can’t you expect?
A lot of people come to therapy thinking that they’re going to change something about their partner. When you come to couples therapy, you have to be prepared to make changes yourself. You can’t change another person. But you can influence another person. And that’s why it’s important to know that if you make changes, you will instigate change in someone else. Meaning you can’t tell someone to change, but if you change your behavior, they will change in response to you.
We think: How can we get them to do something that we want? But really, the way we can do that is by helping them first. If you can do something in a way that helps them, you will get back something that helps you.
Q: How do you take the first step?
By the time a couple gets into an office, there’s often some resentment. And because of the resentment they don’t feel generous toward each other. They have to remember that they do love this person, and that the person isn’t acting in this way to harm them; the person is acting this way because they are also struggling. If you can look at it that way, you might have more compassion for your partner, because you’re not the only one who’s struggling in this relationship. When you have more compassion, you can carve out a place of generosity for the fact that your partner is struggling, too.
Your partner’s reality doesn’t cancel out your reality. Just because your partner sees the situation differently from how you see it, it doesn’t mean that that person is wrong or that you’re wrong. It just means there’s room for both. Sometimes people don’t want to take the first step because they think: I need you to see it this way. I need you to see it accurately. I need you to see it my way. It’s important for both people to listen to how the other person sees it, but that doesn’t mean they have to agree with it.
Q: When is going to couples therapy a good idea?
Sometimes there’s a concrete issue, like you don’t see eye to eye on something like money or how much time you spend with the other person’s family. Or you have different ideas about how you are raising the kids. You want to go before it gets to the point where you’re both backed into your corner and you can’t listen at all to the other person’s point of view. A good time to go is when you can say, “Hey, there have been a few times when we’ve gotten really agitated when we talk about this with each other. Maybe we need somebody else to help us learn how to have this conversation, because it’s a really sensitive topic for both of us, and it’s hard for us to hear each other.”
Q: How do you approach the idea of therapy if your partner is averse to it?
It’s very important not to make it sound like, “We’re going to therapy because you have problems.” Some people even say, “We’re going to therapy because I can’t handle what you’re doing.” Or “I can’t handle something about you.”
Try something along the lines of: “We’re going to therapy because I love you so much, and our relationship is so important to me, and it breaks my heart when we argue. I would really like to go talk to somebody so maybe we can get some help with that.”
Q: How do you go about finding the right therapist?
Word of mouth is a great way to find a couples therapist, but if you’re hesitant to do that, you can look on Psychology Today. Look at therapist profiles in your area and see which ones have an approach that feels comfortable to you. But really, you won’t know until you get into the room and you see what it’s like when all three of you are sitting there.
“It’s tricky, because there’s so much shame around couples therapy—even more than with individual therapy. People associate couples therapy with divorce. But in my experience, most people who come to couples therapy are not getting divorced—they’re building a healthier relationship. The people who end up getting divorced are often the people who never got help.”
It’s really important to know that couples therapy is hard work, but it’s also very rewarding. You’re very exposed in a way you aren’t in individual therapy. In individual therapy, you can present yourself the way you want to present yourself. In couples therapy, your therapist is going to see you and your partner and the way you two interact with each other. You can feel very vulnerable. And you should—that’s largely the point, to be real with each other.
After your first session, did you feel like the therapist heard both sides of what was happening? Did you feel like the therapist understood some of the ways you two interact? That’s a good way to assess initially.
(Also, take a look at my post about how to find the right therapist)
Q: What else can you expect from that first session?
You should feel that the therapist can hold both of your realities at the same time. You should also walk out knowing there’s a definite possibility that you have some flawed assumptions about your partner’s motives, and maybe some of those will come out in the first session. And that he or she has some flawed assumptions about yours. The therapist can help point out that maybe you were thinking that the reason your husband is never home for dinner on time is because he doesn’t want to be, or because his work is more important than you, or vice versa. But your assumptions are often wrong. A good therapist can help you learn something new—even in that first session—about the way your partner thinks and feels about you that isn’t as harmful or hurtful as you had imagined.
It’s always helpful for the therapist to reframe for people: “Hey, the reason that this or that might be happening is not because your partner doesn’t care about you. The whole reason that you’re both here is because you care about each other. If you didn’t care, nobody would be sitting in this room right now.”
Q: What kind of commitment is couples therapy, emotionally and timewise?
It depends on what’s going on and how long it’s been going on. That’s why people need to come in earlier, because if something is a relatively new issue between a couple, that can be resolved pretty quickly. If something has been going on for decades, it can’t be undone in four sessions. That might take a little bit longer.
The good news is that once you start seeing the underlying patterns, it changes most of your interactions. It won’t just change the one thing that you came in to talk about; it will change the way you see each other. You’ll see each other with more generosity and more compassion. You will take what your partner is doing less personally, and you will feel less injured by the other person’s behavior. That helps globally in the relationship. You don’t have to keep coming back every time you have a problem, because now you know more about each other in a way that helps you to resolve your own problems.
Q: How does couples therapy work in conjunction with individual therapy, if one partner already has a therapist?
Lots of people do that. You get different things out of them. You learn a lot about yourself individually in couples therapy, but sometimes people need extra support, or they’d like the extra support. Or they’re working through something personally that they need an individual therapist for. A couples therapist will generally not see either member of a couple for individual therapy, because we want that relationship to be clean. We don’t want any perception of the therapist favoring one person over the other. There’s often a lot of sibling-like rivalry in couples therapy, where people feel like they want the therapist to take their side, or they want the therapist to like them better. It’s not really in their awareness. People want the therapist to validate their position, but we’re not there to do that—nor would that be helpful.
Q: What are some tools that couples can try using to resolve conflict?
A lot of people say, “You’re not listening to me. You’re not listening,” as they’re talking over somebody else. Before you say you don’t feel heard, consider how well you listen.
People don’t realize they do that. They feel so unheard that they don’t realize that they’re making the other person feel unheard. You will be heard much more expansively by the other person if you truly listen to them. A lot of people don’t realize that they’re terrible listeners; they really just want to get their point across.
One of the most important things is to realize that you’re two separate people: You’re going to have different ideas and perceptions. And you don’t have to convince the other person of the truth of your perception. It’s important only that they understand how you feel about it. But neither perception is more valid than the other.
Q: How do you know when you can pause on couples therapy?
When the couple feels like they’re relating to each other better. When they feel like whatever they came in for isn’t really happening anymore, or at least it’s not happening to the same degree. Or even if it’s happening, they are able to stop before it escalates and not go down that rabbit hole the way they used to. It’s about changing the pattern between them.
All couples do a dance. If one person changes the dance, either the other person is going to fall flat on the floor or they’re going to have to change their steps. Usually what happens is the other partner changes their steps, too. And now the couple’s doing a different dance, and if they’re doing a different dance and it’s working for them, then they don’t need to be in therapy anymore.
Sometimes people are scared to leave couples therapy because even though their problem has gotten better or is mostly resolved, they fear that if they leave therapy, they will backslide at times. But that’s to be expected. I say, “Go out there and try it, and if you backslide, come back in. You know you can come in for a tune-up.”
There’s nothing wrong with coming in for a tune-up, but I do want clients to learn to trust themselves, to trust that they can do this and that they are going to backslide. We all have longstanding reactions that are very visceral, and sometimes we screw up. But that’s okay—nobody’s perfect. It doesn’t have to be very significant. It’s kind of like when people go on a diet and they eat two pieces of cake and feel like their entire diet is ruined. It’s not—you ate an extra piece of cake, and you move on.
You can always come back to therapy. It’s a conversation that you have with the therapist and with each other. But it’s not as though everything needs to be perfect for you to stop. No couple is perfect.
Read the full article on Goop.
If you live in the Los Angeles or Westlake Village area and are interested in therapy, I invite you to contact me via email at: tanyasamuelianmft@yahoo.com . I provide a 15-minute complimentary consultation. Check out my services to see which one might fit your needs. Contact me now to see if we might be a good fit to work together! Or book your appointment here!
This New Year, Get Back to Basics and Create Your Own Definition of Self Care
When your wellness routine—AKA the rituals and habits you embraced to make your life better—is stressing you out, things need to change. And for so many people this year, the line between constructive self-care and pure anxiety trigger (as in, just another thing on your already-jammed to-do list) became blurrier than ever before. In 2019, it’s time to simplify, simplify, simplify. And get that wellness-loving mojo back.
In the age of social media, the pressure people feel to engage in performative wellness creates anxiety, self-doubt, and depression. The industry boom—and the staggering number of new fitness, food, and lifestyle options to choose from—is partly to blame. New data shows that since 2015, the global wellness industry has grown 12.8 percent, from $3.7 trillion to $4.2 trillion. That increase is reflected in myriad new and expanded companies, products, and trends—which means more decisions to make. And when people have more choices than they’ve ever had in history, and whenever you have a lot of choice, it can be overwhelming.
So, make 2019 the year when you get real about what’s doable on a daily basis. The indications are there already— “staying in is the new going out” has been a trend for a while, and bonding over the desire for a simpler life has become a national pastime.
Basically, this new wave of self-care involves reclaiming your time. While opting out of all social media likely isn’t going to happen for most of us in 2019, a back-to-basics wellness revamp is a chance to get back to what made you fall in love with self-care to begin with.
If you live in the Los Angeles/Westlake Village area and are interested in therapy, I invite you to contact me via email at: tanyasamuelianmft@yahoo.com . I provide a complimentary consultation. Contact me now to see if we might be a good fit to work together! Or book your appointment now!
Unpacking Emotional Baggage
When dealing with emotional baggage, you are constantly struggling under the weight of baggage, bad filters, and triggers. In any situation, nothing that is said is evaluated objectively. Everything is going through a filter that distorts the original message. It stops being about the content of the message, and instead becomes about our perceptions of the sender, and more importantly, about us. We have let ourselves get to the point where we're not really hearing anymore, we're just judging. If you've reached this point with someone, it's time to unpack your baggage.
Here are a few things that contribute to the problem and understanding them is important tp changing the situation:
Your brain processes most information using primitive filters looking only for the most basic information about threats that should be attended to.
Attention errors make it likely that you'll pay more attention and give weight to information that confirms your original point of view.
You don’t get to hear the intent of people’s messages; you only to get hear how their words come out and to feel how the message impacts you. The disconnect between intent and impact is at the heart of many strained relationships.
Start with a Positive Assumption
The next time you react to something someone else says, turn the situation on its head. Start with a positive assumption, rather than a negative one. Instead of assuming that a person is attacking you, start by assuming they are adding value.
Instead of having your normal reaction to what is said, really think about it. Repeat what they said in your head before responding. Think about the words, without reading between the lines or thinking about the back story. Hear the words coming out of someone else’s mouth—how do you interpret them now?
Pay attention to the positive, rather than the negative components of the message. Did the person start with a compliment and then share some constructive feedback? Focus on the compliment for a moment. Let it soak in.
Think about the possible positive intentions they might have had. How might the person have been trying to help? What were they trying to get at? What value are their comments adding?
If you start with a negative assumption, you waste all the value that others could be providing. A positive assumption is the only thing that gives you a chance.
If you live in the Los Angeles/Westlake Village area and are interested in understanding your emotional baggage and unpacking them, I invite you to contact me via email at: tanyasamuelianmft@yahoo.com . I provide a complimentary consultation. Contact me now to see if we might be a good fit to work together! Or book your appointment now!
Made The Brave Decision To Go To Therapy...Now What?
I’ve made the brave decision to go to therapy…now what?
We’ve all been there - feeling overwhelmed, confused, thinking we could benefit from seeing a therapist. But only some of us make it through the door and get the help we need. Why is that? Looking for a therapist can be a grueling process.
Searching for a therapist can feel extremely impersonal, leading you from profile to profile on the web only to find yourself lost. The whole process can feel like a massive load - that’s why breaking it down into smaller manageable parts can be a great way to maximize your search. Here are a few tips to consider:
Check in with yourself. I always ask my new clients what they’re looking for out of therapy - what are your goals? What do you want to work on? Is there a specific type of therapy you want to try: individuals, couples, family, etc.? Are there certain qualities you want your therapist to have?
Pro Tip: I suggest taking time to imagine the kind of therapist you want to work with. Write down the traits that feel important to you, and traits that are deal breakers. Ideally what you are looking for is finding a therapist that puts you at ease.
Consider your therapy budget: Therapy is expensive. While I believe it is one of the best investments we can make in our self, there are real financial barriers that can make it hard to do so. Depending on the community you live in, therapy can range from $80-$200 per session.
One option is to consider using your insurance for therapy; it is important to first find out what type of reimbursement, if any, your insurance company offers. If it is a requirement to see someone “in network,” ask for a list of providers and begin looking them up online. Some insurance companies will provide reimbursement for therapy that is '‘out of network'‘ and your therapist can provide you with a “superbill” each month to submit to your insurance.
Pro Tip: Look at your overall spending and see where you can make adjustments. Saving could be as simple as bringing lunches to work and making coffee at home. It is a choice, like everything else, and you must weigh the financial commitment you are willing to make.
Ask people you trust for recommendations: Asking people you trust for recommendations is a great place to start. This could be a friend, family member, colleague or other health professional.
Pro Tip: If you have a friend or family member who is a therapist, they would also be a good person to ask as well. Therapists tend to have reputable colleagues who they can refer you too.
Use the web: The Internet is a great resource for reading about and finding local therapists. Psychology Today and Good Therapy have a comprehensive listing of therapists and allows you to search based on several different factors. All therapists listed in those databases must prove that they have an advanced degree and an up-to-date professional license. You can read profiles or click through to individual therapist websites. Yelp is another great way to search for local therapists.
Interview therapists: Once you narrowed down your list of potentials, it’s time to start making calls. I offer all new clients a free 20 minute consultation to see if we might be a good fit to work together. Pay attention to how you feel on the phone. Do you feel comfortable talking with him or her? Do they sound clear and confident while answering your questions? Is their style of communication relatable? If yes, go ahead and book an intake session at the end of your phone call. Feel free to do this with more than one therapist if you like the idea of “shopping around.”
Pro Tip: Have a few questions prepared before calling, such as:
How would you describe your style of therapy?
What do you charge per session?
What insurance plans do you take?
Do you provide a sliding pay scale?
How often will we meet?
How does therapy work?
Found the right person…now what? Your first session with your therapist will cover a lot of material. You will be asked to share what brought you into therapy, parts of your personal and family history, and the current symptoms you are experiencing. Your therapist will ask you personal questions and, depending on your relationship to vulnerability, this may feel challenging. This is normal and to be expected. Your therapist should never rush your process. Your pace and comfort level must be respected.
“A person’s relationship with their therapist frequently mirrors their relationships outside the therapy office. We often unconsciously recreate dynamics from other relationships with our therapist giving us the opportunity to process negative feelings and work through maladaptive patterns in a safe space. A good therapeutic relationship can be a corrective experience: We are accepted for who we are, encouraged to look inward and connect with our true natures, and supported in growing into our real selves.”
If you live in the Westlake Village Area and are interested in individual or couples therapy I invite you to contact me via email at: tanyasamuelianmft@yahoo.com
major credit to The Every Girl for the guideline to this very important post!