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5 Tips for Managing Work Stress from Patricia Hernandez LCSW, Therapist in Austin, Texas

5 Tips to Reduce Work Stress with Patricia Hernandez, LCSW a Therapist at Heading in Austin, Texas

5 Tips to Reduce Work Stress with Patricia Hernandez, LCSW a Therapist at Heading in Austin, Texas

Working in a high-pressure job can take a toll on mental health. 

 

Truth is that 85% of Americans note their workplace as stress as significant, and 25% say that work stress is the biggest stress in their life .

 

Whether it’s on a shift, in the office, over a virtual all, or a bit of all of it, workplace culture and the demand of our jobs has significant impact on mood health, and wellbeing. Changing an entire workplace culture, the style of our boss and colleagues, or finding a dream job with broad flexibility are not things that are in the average worker’s control. Most people when they find themselves in a stressful work environment don’t have the luxury of quitting their job to find something else. 

 

But, that doesn’t mean there are things every individual can do to make their work experience better. 

 

Patricia Hernandez, LCSW, a therapist at Heading in Austin, Texas, offers practical tips to help you reduce stress at work. Implementing these tips can improve your productivity, well-being, and overall satisfaction at work.

Tip 1: Empower Yourself with a Calm Space.

“Curate calm within the chaos,” Patricia notes.

It’s essential to create a sense of calm within your workspace, especially if your job involves a lot of chaos.

 

 

Patricia suggests doing this by adding personal touches to your workspace, such as pictures of loved ones, or objects that make you feel happy. Using your favorite mug for coffee or tea can also bring a sense of comfort and calmness, setting a routine of self-care amidst an otherwise stressful routine. 

 

Take a look at your desk. The images on it may help you reduce pain. In fact a study showed that looking at images of loved ones had pain-relieving effects.  Similarly, calming images such as looking at nature, space, or beautiful art – like taking a mental vacation – can reduce tensions and anxiety. 

 

Taking small steps to create a more positive and pleasant work environment can go a long way in reducing stress.

Tip 2: Don’t Skip Your Lunch Break

Patricia suggests, “Don’t work through lunch. It may seem counter-productive, but it’s the very thing that will give you a boost for the rest of the day.”

It’s easy to fall into the trap of working through lunch, but it’s essential to take a break and allow your mind and body to rest. Use your lunch break to step away from work and recharge.

 

Working lunches may seem like a great way to maximize your output and time, but they tend to have the opposite effect. 90% of workers who take lunch breaks note that they feel more refreshed,, less stress, and ready to tackle the rest of the day with a better outlook. Workers that feel less overwhelmed tend to be more productive, and effectively manage their time. Breaks are good for employees health and good for company morale.

 

You can take a walk, read a book, or simply enjoy a quiet meal. Taking a break from work can help you come back feeling more refreshed and motivated, ultimately improving your productivity and well-being.

Tip 3: Socialize at Work

“We spend a lot of time at work. Developing relationships while working is good for our wellbeing. Find a work buddy to chat and occasionally vent, but don’t co-ruminate,” Patricia recommends.

Sometimes, it can be helpful to have someone to talk to when you’re feeling stressed at work. Find a colleague who you trust and feel comfortable venting to about work stress. However, it’s crucial to ensure that you’re not ruminating on the stress and negativity, which can make things worse. Instead, focus on small talk and building a positive work relationship that fosters a sense of belonging and community.

 

For those worried that workplace friendships might derail their day, don’t fret. Research shows otherwise. A Gallup poll found that workplace friendships increased job satisfaction, boosted overall productivity, and even lessened workplace injuries. So, circle up to the IRL or virtual water cooler and chat up a friend.

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Tip 4: Use all of your vacation time.

“Use your PTO. It’s your benefit to use, and everyone needs and deserves time away from work,” Patricia states.

Most people don’t use all their allotted PTO in a year, but it’s essential to take time off work to rest and recharge. Using your PTO can help you break away from the daily grind, relieve stress, and give you time to engage in activities that bring you joy and fulfillment. Whether it’s taking a vacation or just taking a mental health day, using your PTO can be a powerful tool for reducing work stress and improving your overall well-being.

 

But taking breaks is not limited to just lunch and PTO. It’s important to step away from the screen throughout the day. Taking short breaks throughout the workday can be incredibly beneficial for your mental health and productivity. Even if you’re pressed for time, taking five minutes to step away from your desk and clear your mind can make a significant difference in how you feel. You can take a walk around the office, stretch your body, or practice mindfulness meditation. Remember, taking a break can help you come back feeling more refreshed and focused, ultimately boosting your productivity and reducing stress.

Tip 5: Bring Mindfulness Into the Workplace

“When you’re feeling stressed at work, taking a few deep breaths can help you calm down, and refocus. Use a powerful mantra that resonates with you, and repeat it to yourself as you inhale and exhale,” Patricia coaches.

The term ‘mindfulness’ is more mainstream than ever. But without regular practice the concept can seem like nothing more than a fluffy feel-good idea, or a even a little too new-age for a serious go-getter at work.

 

However, nothing could be further from the truth. People who take the time to regulate their nervous system through breathing, meditation, and simple movement like walking have a happier time at work and less difficulty engaging in decision making, and managing their projects. Mindfulness practices may look different from person to person, but the goal is the same: to move out of a reactively highly aroused state of mind, to a more calm, focused, and present state of mind. This can help you feel more centered, grounded, and present, ultimately reducing your stress and anxiety levels, and feel more in control of your actions at work.

 

In conclusion, reducing work stress requires intentional effort and self-care. By implementing these tips from Patricia Hernandez, a therapist at Heading Heath in Austin, Texas, you can take control of your mental health and well-being at work. Remember to prioritize self-care, take breaks, and seek support when you need it. These small changes can have a significant impact on your stress levels and overall satisfaction at work.

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anxiety Blog depression

Mental Health Awareness Month: What Experts Want You to Know

Mental Health Awareness Month:
What Experts Want You to Know

Mental Health Awareness Month: What Experts Want You to Know

May is Mental Health Awareness Month, a time for promoting education, raising awareness, and reducing stigma around mental health. 

 

This year’s theme is More Than Enough highlighting the importance of encouraging all people to show up – fully themselves – with less shame or doubt.

 

This is especially important for people who are struggling with mental illness, and may feel that their struggles define them or that by speaking up they risk being seen by others as less-capable or merely 2-dimensional.

 

Taking part in a vision of people and communities that are more mentally well requires collective effort. As we kick off this important month, we asked our providers what it means to help people thrive. We also wanted to know what our providers wished everyone knew about mental health, and asked them to to share simple tools they suggest to support mental wellness. Throughout the month we’ll share their answers.  Here’s what they had to say to start:

NAMI.ORG

Mental Health Must Be A Priority

“As a mental health care provider, I envision a world in which mental health is prioritized and openly discussed,” said Patricia Hernandez LCSW who offers virtual therapy to patients across Texas. 

 

While attitudes towards mental health are changing, stigma is still a huge barrier. In fact a World Health Organization survey reported that people wait, on average, 11 years (and often more) before seeking help. Adding to the urgency in reducing stigma, and increasing access, is the fact that depression is a leading cause of disability and missed days at work. As employment interruption grows, the symptoms a person is experiencing can increase, feelings of self-worth and quality of life can diminish, and a person’s financial ability to address the problem and find appropriate support increases – thus accelerating the cycle.

 

Mental health care providers play a critical role in reducing stigma by creating safe spaces for people to talk about their mental health struggles without fear of judgment or discrimination. By offering compassionate, non-judgmental care, providers can help individuals feel seen and heard, which is essential for building trust and promoting healing.

 

However, the responsibility is not all theirs. Everyone can take part in reducing stigma, and since each person will be affected personally or know someone they love who is affected by mental illness, the importance of prioritizing mental health cannot be understated.

 

Anxiety and Depression Symptoms Aren’t Clear Cut

 

“I wish everyone understood that emotions are complex and often difficult to pinpoint. [For example] you can be anxious, but perhaps not recognize yourself as anxious emotionally,” explained Tyson Lippe, MD, a leading psychiatrist at Heading Health based in Austin, Texas.

 

Mental health struggles are often invisible and can be challenging to describe or identify, and they aren’t ‘all in the head.’ Unlike an x-ray that might clearly show a broken bone mental health symptoms aren’t always so obvious. 

 

“Something that is often misunderstood about mental illness is that it presents so differently for everyone. For some it may be avoidance, others self neglect, etc. It can also be tricky to see and easy to miss even with close family members,” noted Ryan McWhiter, psychiatric nurse who works with Dr. Lippe at Heading’s Austin Texas center.

 

By promoting mental health literacy and helping individuals recognize and name their emotions, providers can help reduce the shame and isolation that often accompanies mental health challenges.

 

Physicality and Physical Spaces Matter

 

While a physical change is not a ‘fix-all’ for mental health concerns, and appropriate treatment is always recommended, mental health care providers recognize that mental health is not just about addressing what’s going on between the ears. Physical sensations and physical experiences have an impact on overall wellbeing. 

 

“Personally, I think it’s helpful to recognize the physical side of mental health, and I like to approach mental health from the physical side. If you’re feeling anxious, you can touch something cold like a bowl of ice, or do box-breathing (there are so many videos [on the internet] for help). Focusing on how what you can sense really helps,” shared Ryan. 

 

“While the physical connection to mental health is discussed more often now, I truly want people to know that regular exercise, a healthy diet, and good sleep are just as important for mental health as they are for other parts of your health,” Dr. Lippe shared.

 

Being physical means considering the inner environment of the body, and it also means the external environment and surroundings. Research agrees. Stress management is not simply getting control of thoughts, but also acknowledging that stress responses exist in the physical body. Physical activity has a positive impact in the reduction of symptoms of depression and anxiety in both near and long term ways, from improving stamina, cognitive function, and healthy sleep patterns. 

 

What the physical body senses, takes in, and observes is also impactful. While not everyone has the ability to completely overhaul their physical space at home, and at work, there are simple changes that can be made.  Physical space can influence mood and creativity, and purposeful use of space can be a simple way to boost feelings of positivity and wellbeing. “Chaotic environments make it harder to think and process. Take charge of what you can. Soothing colors. Declutter your space. Allow the doorbell and phone to be tools, rather than notices that demand your attention,” suggested Sunne Hogan, LPC who offers virtual therapy to patients in Texas.

 

Patricia agreed,”Nurture a plant. Choose the mug you love. Play and dance to music. Use candles and aromatherapy that stimulate your senses. Declutter your space. These are all ways you can improve the environment around you, and promote better mental wellbeing.”

 

Addressing Mental Health Isn’t Just For Those Who Struggle

 

Mental wellness is not just about avoiding illness, but also about promoting a sense of thriving and flourishing. Most people at some point in their lives will be directly impacted by mental illness, be it their own health or someone’s close to them. Learning tools to support mental wellbeing can be a lifelong if and when struggles do arise.

 

“Mental wellness is not just the absence of mental illness but also the presence of positive emotions, thoughts, and behaviors,” shared Kirsten Jarvis, Psychiatric Nurse at Heading Health in Austin, Texas. 

She continued, “Mental wellness is essential for overall health and is a critical component of a fulfilling and productive life. To me, mental wellness is developing the skill to ride the waves of life.”

 

Like any other skill, it takes practice. 

Seeking Help is Strong

 

“Seeking help does not mean that you are weak or ‘crazy.’ It just means that you know that something’s happening in your brain and body, and you may not have the energy or understanding to get yourself through it alone. Help is available,” explained Sunne. 

 

The work that is done in psychiatry and counseling sessions can be deep and challenging.  There’s nothing ‘weak’ about addressing vulnerabilities and difficult emotions.  Counselors, like Bonnie Morphew LCSW, wholeheartedly agree. Bonnie said, “A former patient of mine once told me to tell every new patient this: It’s hard work – but it’s always worth it in the end. And I couldn’t agree more!”

 

By promoting help-seeking behaviors and reducing the shame and stigma around mental health struggles, providers and lay people alike can help individuals feel supported and empowered to take charge of their mental health. Reducing stigma not only encourages more people to seek the help that they need, but it also amplifies the personhood of all people struggling with mental illness. No one deserves to be defined by their struggles.  Rather they should be seen as a whole person, with struggles, and also with strengths, values, goals, dreams, skills, and ambition. 

 

What is clear, this Mental Health Awareness Month is that embracing the concept of More Than Enough is not just an inside job – it’s everyone’s job.

 

If you or someone you love is struggling please know that help is available! You can contact a practice, like Heading, to scheduled an appoint. If you are in crisis call or text 988, or call 911.

Categories
depression

Combatting Agism in Behavioral Health with Dana Ebeling, PMHNP

Agism in Mental Health with Dana Ebeling, PMHNP

Agism in Mental Health
with Dana Ebeling, PMHNP

Dana Ebeling is a psychiatric nurse practitioner who advocates for better mental health care for aging and elderly and works with Heading a mental health provider with locations in Austin and Dallas-Fort Worth. 

 

With over 30 years of healthcare experience, including working as a medical director of a nursing home, her work has taught her the importance of resilience and valuing the unique life experiences of each individual. 

 

In this article, we explore Dana’s expertise in psychiatric care for the elderly, including the unique challenges faced by this population, supporting anxiety and depression especially when they cooccur with physical diagnoses, and the importance of collaboration between mental health professionals and primary care providers.

 

The heart she brings to care is coupled with a passion to ensure that mental health is not overlooked as people age. Good care of wellbeing and emotional landscape of a person’s life cannot be overshadowed by physical health, and Dana discusses how they go hand in hand. 

 

Resilience and Time

 

Dana has a deep appreciation for the resiliency of the elderly population. She believes that time on Earth and lived experiences shape who we are, and that the elderly have a unique perspective on life. The wisdom of her patients is something Dana felt blessed to witness when she started her career as a young nurse. 

 

To kick off the interview, Dana shared a story about one of her patients, a woman she calls Jewel, to illustrate this point:

 

“Jewel was one of the first patients I ever worked with as a young nurse. She suffered multiple fractures from a head-on motor vehicle accident. She was determined to get well and worked hard every day, despite chronic pain, nausea, fatigue. Yet, she was always so concerned about me, her nurse. ‘Was I working too much overtime?’ ‘Did my family need me at home?’ She was so kind and also so determined. She made a full recovery and was discharged to home.”

 

Dana noted that she would meet Jewel again over the years, as her husband became ill and he eventually passed away. Then, Jewel herself became ill and moved to a nursing home. Despite her own struggles, Jewel always focused on others. Dana shares one of their conversations:

 

“[Jewel and I] would sit together and chat about growing old, what it was like to give up your home and move to a nursing home, struggles with living with chronic illness and kidney disease. Yet, in all this, I noticed she continued to focus on others even as her own health was failing.”

 

When asked what she learned from this experience and what she wished more mental health care providers would consider to better serve the elderly, Dana went back to why she began to specialize in this area in the first place. 

 

Unique Challenges in Psychiatry and Therapy for the Elderly

In her experience as a nurse, Dana found mental health to be a crucial aspect of aging that is often overlooked. In fact, it was her experience as a medical director at a nursing facility, as well as her time spent in acute rehab facilities, that inspired her to seek the mental health route as the next phase of her career. 

 

“Mental health focuses on aging as a normal part of life. We can experience loss, trauma, symptoms of depression, anxiety at any age. Mental health professionals should value the individual, not the ‘age’.”

 

Dana stressed that an assumption of life experience, including adverse life experience, as part of the norm – in addition to physical illnesses often becoming more prevalence – the care aging patients are provided heavily focuses exclusively on their physical decline and often ignores their emotional wellbeing. 

 

This brings up one of the biggest challenges in mental health care for the elderly –  the increased prevalence of medical conditions and chronic illness in older adults. This requires providers to maintain close collaboration with other members of a patient’s medical team. Dana explained, “Often with aging, there is an increase in medical conditions that may require close collaboration and consideration when prescribing psychiatric medications.”

 

“Chronic illness and depression, and pain and depression are like bad marriages. It doesn’t mean these things aren’t linked, but that also doesn’t mean the depression shouldn’t be addressed for what it is – and that’s what’s important. We can’t chalk their depression up to ‘just getting old.’ We have to dig in and really get concerned about quality of life,” Dana suggested.

 

Generational Stigma

 

Dana also notes that there is often a stigma around mental health in older adults. She shared, “Mental health care providers need to consider that their patients may have grown up in a society where mental health was not discussed or considered at all.”

 

However, she did note that she has seen a shift in attitudes over her 30 years in healthcare, with adult children often encouraging their parents and grandparents to seek help.

Dana added, “I think the most important thing is to listen to their story, to be compassionate, and to meet them where they are at. It’s really about building that relationship, building that trust, and being a partner with them in their healthcare journey.”

 

In terms of specific approaches to working with older adults, Dana suggests taking the time to understand their cultural backgrounds and how that might impact their attitudes toward mental health. “There’s a lot of diversity and generational differences within the older adult population,” she says, “and it’s important to recognize that and to approach each person with an open mind and an open heart.”

 

Combating Agism in Healthcare and Mental Health Care

 

“I think ageism is fairly present across all medical disciplines in some capacity,” Dana shared. “Ageism is also prevalent in society. American culture tends to idolize the physically young and strong. Growing old is considered a weakness because, well, our bodies do age – but that doesn’t mean life is over. If you read stories by centenarians, you find commonalities like a continual interest in life, learning, socializing, and engaging in the community. A continued pursuit of life!”

 

Research confirms Dana’s findings too. In fact elderly populations living with mental health conditions report feeling age discrimination twice as often as their counterparts without mental illness.  Additionally studies have shown that people 60 years of age and older who have previously experienced agism are more likely to develop signs of negative mental health and more likely to experience depressive symptoms, and anxiety. 

They also may begin to anticipate agism occurring in their interactions which could impact the quality of relationship built with their providers – especially as advances in technology continue to change the delivery of care, and as provider shortages continue to stress and already pressured medical community. 


Continued education, research, and proactively seeking feedback can be helpful for providers to address any gaps in care or blindspots they may have when it comes to offering care to those in later stages of their life. Opportunities exist in virtual care as well including finding ways to support older patients as they navigate technology. Virtual care can improve access for those who live rurally or are less mobile, but the technology and care team support must be there as new systems are learned.

 

“This work is incredibly rewarding for healthcare providers. Working with patients who have wisdom and life experience is an honor. We should offer extra support, and consider it a privilege not only to provide care but also to learn from them,” Dana concluded.

 

Wise words, indeed.

Categories
Blog depression Ketamine spravato Uncategorized

Who Is Not a Good Candidate for Ketamine Therapy?

Who is and is not a Good Candidate for Ketamine Treatment?

Ketamine treatment is a breakthrough for people who have not experienced relief from traditional modes of treatment or medications, or the effectiveness of these methods of care has diminished. Unlike traditionally prescribed medications which can take several weeks to show effectiveness, patients receiving ketamine often report a reduction in symptoms within the first few sessions.


Research shows that Ketamine  may be suitable for people with various mental health conditions such as depression, anxiety, PTSD, OCD, and chronic pain, who have not responded to traditional treatments such as therapy and antidepressant medications. Specifically, Ketamine treatment has shown promising results in treating treatment-resistant depression, suicidal thoughts, and chronic pain. FDA approved drug Spravato® is approved for the treatment of treatment-resistant depression, and has changes the lives of many who have received this line of care.


There are many reasons why a traditional medication may stop working, or is otherwise not suitable for someone with treatment-resistant depression, or chronic, long-standing stress disorders like anxiety, or PTSD. For example some patients cannot tolerate the side effects of traditional medications. However, it is important to note that each individual’s circumstances are unique, and it is recommended to consult with a qualified medical professional to determine if Ketamine treatment is a suitable option for their specific condition and medical history.


Ketamine and Spravato® are breakthroughs for many, but are not right for everyone.  In this article we look at some factors that may play into Ketamine candidacy and important safety considerations.  

Factors to Consider for Ketamine Candidates

It is important to consult with a qualified medical professional to determine if Ketamine treatment is appropriate for an individual’s treatment of depression, anxiety, or PTSD. At Heading we conduct an intervention treatment Q&A with a care coordinator as well as a 60 minute psychiatric consultation session to establish a personalized care plan and also to determine candidacy prior to a patient receiving treatment.

 

It’s important to note that candidacy works hand in hand with outcomes and patient goals. Both of these should be monitored continually through the process, and the process is not ‘one-and-done’. Prior to every in-center ketamine or Spravato® appointment several factors are monitored before treatment. Keeping optimal outcomes, and safety in mind patients have access to their care-team during treatment sessions, immediately after treatment sessions, and throughout the course of a treatment protocol. 

 

Ketamine is becoming more well known as an interventional treatment for depression and anxiety that have not responded well to other treatments. Ketamine offers rapid relief for many people, especially when other medications have not worked.

 

That said, the results for any depression treatment method are not the same across the board, because every patient’s individual needs are different. That’s why it is important that a mental health care-team always consider the best course of treatment for an individual.

 

As a patient considers ketamine treatment there are factors to keep in mind.

 

Ketamine may not be the right choice for someone if:

  1. They have uncontrolled high blood pressure or heart disease. Ketamine can cause an increase in blood pressure and heart rate, which is why it is important for prescribers and care teams to be aware of a patient’s cardiovascular health history prior to receiving treatment.

  2. A patient has a history of schizophrenia or schizoaffective disorders. Ketamine may have adverse side effects and worsen symptoms of these conditions.

  3. A patient has a history of substance abuse or addiction. Ketamine has the potential for abuse and care teams are careful to ensure that treatment will not trigger relapse. 

  4. They are pregnant or breastfeeding. There is limited research on the safety of ketamine use during pregnancy and breastfeeding, and it is not recommended.

  5. They have certain medical conditions, such as liver or kidney disease.

  6. They are unable to participate in the requirements for the protocol such as payments or co-pays, the time-investment is not suitable for that moment in life, or making arrangements for care such as getting a ride to a center if they are receiving treatment at a medical office or making time for the length of treatment is not feasible with their schedule. 

It’s also important to note that this is not an exhaustive list, and a thorough consultation under the direct care of a psychiatric medical professional is crucial.  Since the goal of ketamine therapy is to experience relief from long-standing and hard-to-treat mental health disorders, if the protocol isn’t working for a patient – that’s ok! There are always changes that can be made, and other treatments.  Personalized approaches including combination therapies, and a team of mental health care providers working together can make all the difference – as mental health care is not one-side-fits-all. 

Ketamine In Center Care and Safety

The two most important goals of determining candidacy are:

1) patient safety, and 

2) the best possible outcome for feeling better and healing.

 

 

Methods of receiving ketamine vary, and patient preference, insurance coverage, and access plays a large part into whether or not they seek treatment in a center, or through another means.  However, in-center treatments, under a doctor and medical team’s supervision, have added benefits to meet high standards for safety and outcomes.

 

 

“Patients receiving ketamine in a clinic or medical center receive an entire team of people who are supporting the best possible outcomes. Safety is, of course, paramount. Patients also take comfort in knowing that they have a medical team who can immediately make them more comfortable and answer any questions or concerns they may have in real-time. These are also the same medical professionals you will see time and time again. Developing therapeutic relationships requires trust, and building trust over time with your care team enhances the experience,” shared Dr. Arif Noorbaksh M.D. a leading psychiatrist at Heading who practices out of Dallas, Texas and offers virtual psychiatric services and medication management to patients statewide.

 

In addition to having medical professionals immediately available to monitor physical metrics before a treatment such as blood pressure and weight, some patients receiving Ketamine also feel more comfortable receiving treatment knowing that they are in a safe medical center with nurses and doctor’s just a few steps away as the medication takes effect.  Ketamine can induce a dissociative state, sometimes this is referred to as a ‘trip’, and the patient may feel out of body, like they are flying, or experiencing a range of sensations outside of their normal state of being.  In-center treatment options provide a patient with immediate options for assistance, and a team of medical professionals determining when a patient is ready and able to leave treatment. At Heading a ride to and from an appointment is required as it is not advised to drive or operate machinery until a patient has had a good night sleep after treatment. 

 

Thoughts When Considering Ketamine

  • Ketamine is an effective medication offering rapid relief for depression, but not everyone is a good candidate for treatment.
  • Safety is a top priority. Work with providers who offer thorough screenings and care throughout the process
  • Effectiveness is key. There’s no point in starting or continuing a treatment protocol if it is not proving to be effective. Select a psychiatry provider who will offer a holistic assessment of your needs, including honest feedback about whether or not Ketamine is a good choice for you, as well as what additional treatment protocols they might recommend such as additional medication options, lifestyle changes, or the addition of psychotherapy which can be important in both behavior change as well as integration of the Ketamine experience.
  • Consider your own personal preferences for set and setting. How would you feel in a center with medical professionals steps away versus another method?
  • Ask a lot of questions in your intake and consultations. No question is dumb or unnecessary. You deserve care coordinators and psychiatric professionals who take time to answer all your questions, and ensure your needs are being met throughout the process.
  • Become aware of insurance, payment, and coverage options. There may be expenses related to your care. Ask questions up front, and consider how investing in your mental health impacts your wellbeing and life overall.
Categories
anxiety BIPOC Mental health Blog depression Provider wellness women's mental health

Care Insights: Multicultural Care for International Women in the U.S. with Asha Hussein

Care Insights: Multicultural Care for International Women in the U.S. with Asha Hussein, LPC

March 30, 2023

Having a Multicultural Approach

March is International Women’s Month, a time dedicated to place attention on all of the contributions that women have made and causes important to gender equity and equality. As the month comes to a close Heading took the time in this edition in Care Insights to speak with multicultural counselor and therapist, Asha Hussien.  Asha is a Licensed Professional Counselor at Heading who sees patients virtually across Austin, Dallas, and state-wide in Texas.  

 

 

While Asha offers excellent care to patients from all genders, ages, religions, identities, and backgrounds, she has a particular expertise in offering multicultural counseling to women, especially those who have migrated to the States.

 

 

Asha discusses her own experience being a trailblazer in her own family when she decided to seek therapy for herself, and pursue a career in counseling, and how the experience of therapy is different for her female patients whose culture, family heritage, or country of origin is not the U.S.  She also offers insights for therapists who want to improve their skills in multicultural counseling.

Acknowledging Cultural Perceptions of Mental Health

A cultural acceptance of going to therapy and mental health parity itself within the medicine and insurance is still relatively new in the United States. That said, more and more, the conversation around mental health is out of the shadows. Mental health diagnoses are increasingly being talked about more openly, and there are employer anti-discrimination protections in place for those suffering from mental illness. While there is still a long way to go, for those from  countries whose cultures are not as open to discussing mental health seeking therapy may come with additional shame, embarrassment, or concern about social or familial acceptance. Asha, who emigrated from Somalia, discusses the gap in cultural acceptance between the U.S. and her country of origin as the conversation opened. 

 

“I studied philosophy in college and no one, at least no Somali I knew, studied philosophy. I remember my aunt said ‘Asha people study science or math. What African have you ever met that does philosophy? How are you gonna use that in your life?’ And, so I’ve always been interested in social sciences about the human experience. That already had made me different in my community. But I’m happy that I did that because it showed me that there’s this bigger part that we don’t talk about as humans,” Asha began.

 

Asha Hussein reflected on her unique experience within her community.  After studying philosophy in college and prior to her career as a counselor Asha also worked as a teacher for a few years, specifically in an Islamic school, where she taught middle and high school students. She observed that many of her students struggled with suppressed emotions and parental issues, which often led them to act out in the classroom. Asha felt a deep connection to her students and empathized with their difficulties. She realized that the traditional rule-based system of teaching did not work for these students and eventually left the teaching profession.

 

Subsequently, Asha became an ESL instructor at a college, where she noticed that there was a significant need for mental health services not only within her own culture but also within Hispanic, Asian, and Arab cultures. 

 

“For young people, or younger families, often they’re the ones that come to America. Younger immigrants or asylum seekers often still have aging parents or extended family still struggling in their home country. So they become the beacon of hope for the whole family, and it’s a lot of pressure,” Asha offered. 

 

Overall, Asha’s unique experiences have given her insight into the importance of mental health services for marginalized communities, immigrants and asylum seekers. She also offered that for international women, the problems with seeking help are amplified. Asha explained, “In Somalia, before we came here, we dealt with war and with hunger. It’s a lot better now. But, dealing with the mental aftermath of the struggle is not really encouraged. As a matter of fact, it’s not even discussed. That ignites my passion for mental health, especially for international women. I want to make it as normal as possible, destigmatize it.”

 

She also shared, “Usually when I do talk to my community or other women who immigrated to the States, I tell them my own mental health story. For example, I was prescribed an antidepressant from my primary care provider, and I once told a woman from my community. She got scared for me, told me to throw it out and that it was addictive and harmful. But I don’t shy away from telling my own journey so other women from communities like mine don’t feel like they aren’t alone in their struggle, and they don’t feel isolated or ashamed or stigmatized.”

 

Helping Women Who Worry About Family Acceptance

“In many African cultures, and where I’m from [Somalia] it’s really looked down on even admitting that you have a mental health issue like postpartum depression or that you’ve been feeling depressed or anxious. Or, god forbid, something like bipolar disorder,” Asha explained.

 

“As a woman’s need increases the more she’s likely to be outright labeled: you are crazy. But, it’s not just name calling. If she’s ‘crazy’ people might keep their distance, and just hope that the woman won’t have an ‘episode’. And then the woman is scared that she will lose the acceptance of her family or be ostracized in her community.”

 

 

Psychology researchers argue that understanding cultural beliefs about mental health is especially important for immigrants, refugees and asylum-seekers, as there may be significant differences between dominant models of mental health and treatment in their home countries and those available in their host countries. There is a need for comprehensive investigation of the barriers to help-seeking such as financial resources and access. Experts also emphasized that taking into account perceptions of mental health and treatment is one of the principle barriers to overcome.

 

 

As an experienced mental health professional, Asha has encountered many clients struggling with mental health issues, but when she works with women from international backgrounds she knows the process may need to be slower. To demonstrate a common scenario of how the prospect of therapy could be particularly intimidating for a woman from another country, she shared a story about a patient from an Arab country whose husband was struggling to understand her struggles. “Her husband was so confused as to how to deal with the situation. From the way he was raised he feels that because she’s a mother and a wife it should be sufficient for her and enough to make her happy,” Asha explained.

 

 

However, Asha’s patient secretly felt purposeless and struggled with perfectionism, depression, and manic episodes. She felt she was failing because she didn’t feel completely fulfilled just being a wife and mother. Asha took on the role in therapy to remind her of her other qualities outside of being a mother and wife. “She had amazing qualities outside of being a mother, outside of being a wife, and I had to remind her of that,” Asha said. “So with clients like that, I really take it very, very slow. So that, that way, they can process their own pain, and feelings, and struggle.”

 

Asha noted that such situations often lead to secrecy and fear of divorce. However, her main focus is helping her clients prioritize their mental health. “For this client, she was definitely afraid that her husband would leave her. We had to sort through her priorities for feeling well and not hiding parts of herself without judgement. My client shared that her priority was to feel well, and so we started from there.” Asha said.

 

 

“This isn’t the case with every patient, but with her we knew that it wasn’t necessarily the case that her husband is going to leave. He just didn’t understand what was going on or how to help. The husbands aren’t therapists. They can’t know it all. And so once that becomes an understanding we could move forward. Eventually she started coming to sessions wearing makeup, with lists of the jobs she’d applied for, and ultimately got a job at Microsoft” Asha explained.

 

 

But the problems, Asha explained, are not solely with men not understanding women. In her experience Asha explained that women she’s treated who come from cultures in which gender roles are strongly cemented, pressure to hide things like postpartum depression, depression, or anxiety comes from extended family members too. 

 

Embracing Curiosity.

“Listen. And, listen more.”


When asked about what she would recommend other counselors do if they wish to have a richer multicultural approach Asha didn’t skip a beat, “I could talk all day about this topic, because it is so important.”


Her first piece of advice was for counselors to take a class and additional training to gain an overview of various cultures, taboos, and customs. 

Next, she said, “Listen, and listen more.”


The need to listen to understand the clients’ perspectives, expectations, and roles, especially gather information about their role as a woman in their culture – and their perception of these roles. Asha also reminded counselors to prioritize the client and always bring it back to them, “It’s so common for the women I see to start talking about their husbands, their husband’s needs, and his feelings.”


Instead of focusing on their husbands or their feelings Asha suggested this redirect, “We’re here to talk about what’s going on with you, not necessarily about your husband or his feelings. How do you feel?” 


She also cautioned against quick judgement of cultures, stating that each culture is unique and has its beauty. She said, “Just because it is patriarchal does not mean that culture is always bad or being harmful. It just means that’s their culture. So your job is not to judge.”


Asha stressed that understanding cultural differences and showing empathy and respect towards clients is crucial for establishing a comfortable and productive counseling relationship. She explained that even small things like direct eye contact could make some clients uncomfortable, so counselors should be mindful of such differences. She concluded, “You want to have insight into these things so that your patients feel comfortable with you. That’s always the first step, no matter who you’re seeing, right?”


Asha Hussein is a Licensed Professional Counselor who offers therapy to patients in Texas through Heading. Heading offers virtual therapy, virtual psychiatry, and in center Ketamine treatment in Austin and Dallas. To learn more about Asha visit her profile here. 

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Blog depression Ketamine Provider spravato wellness women's mental health

Brain Change with Psychedelics

The Depressed Brain may Rewire with Psychedelics

March 29, 2023

Researchers are discovering more information about why psychedelics may improve the symptoms of depression, and it's not all about the 'trip'.

Some psychedelic drugs, such as psilocybin and MDMA, how promise in treating depression and post-traumatic stress disorder. They do this by encouraging the growth of new connections between neurons in the brain. This ability of the brain to make new connections is called plasticity. However, exactly how these drugs promote plasticity has been unclear.


It’s important to develop related drugs that can promote brain plasticity without causing ‘a trip’. 

Dr. David Olson and his research team from the University of California, Davis, have developed a sensor that can tell which drugs that attach to a receptor called 5-HT2AR in neurons have hallucinogenic properties and which do not. This study aims to figure out why only some of the drugs that bind to 5-HT2AR are capable of promoting brain plasticity. Brain plasticity refers to the brain’s ability to form new connections. Improved plasticity can help treat mental health disorders like depression and post-traumatic stress disorder.


Researchers discovered that a compound’s ability to enter a neuron and bind to receptors inside the cell determines how well it can promote the growth of dendritic spines. Dendritic spines are structures that help to connect neurons in the brain. The research team also found that clusters of the 5-HT2AR receptor could be found both inside and outside the neurons. The compounds that could bind to the receptors inside the neurons caused the dendritic spines to grow. But, the compounds that only bind to the receptors on the outer surface of neurons, such as serotonin, did not have the same effect.

When they used an electrical current to allow compounds like serotonin to enter neurons, the compounds promoted dendritic spine growth. Similar results were seen in neurons engineered to make a protein that can pull serotonin into cells. Neurons that took serotonin inside formed new dendritic spines. Neurons where serotonin could only bind to exterior 5-HT2ARs did not. When they tested this phenomenon in living brains of mice engineered to make a protein that can bring serotonin into neurons, the mice formed substantially more dendritic spines than in mice without the protein. The mice also showed improvements in a behavior test thought to be relevant to depression.


These results suggest that the 5-HT2ARs inside and outside of neurons activate different cell-signaling pathways. The researchers hope that these results will help develop better drugs that can safely activate the pathways for brain plasticity while avoiding hallucinogenic effects.


Interventional psychiatric treatments like Ketamine and Spravato® are already in use for depression including at Heading Health centers in Austin and Dallas. The addition of more psychedelic treatments, and understanding of each one’s particular best use is continuing to be researched with promising results offering hope that psychiatric researchers are moving closer to understanding how psychedelics can be safely administered for the rapid treatment of long-standing stress disorders. 

The research is now focusing on decoding the biological mechanisms behind how psychedelics can affect the brain and how the effects of these psychoactive drugs can be harnessed for therapeutic benefits. 


The research team is exploring the effects of psychedelics on the body’s serotonin, glutamate and dopamine systems, as well as their impact on the hypothalamic-pituitary-adrenal axis, which plays a key role in the body’s stress response. They hope that by understanding the underlying biology of these substances, they can develop more effective treatments to help people suffering from mental illness. In addition, they are also studying the potential of psychedelics to enhance cognitive performance, creativity and even spirituality. Ultimately, the researchers hope that by better understanding the biochemistry of psychedelics, they can develop more effective treatments to help people suffering from mental illness and even improve overall well-being.

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Care Insights: Why Team Approach Is Key in Treating BPD with Dr. Darren Fred and Andrea Marquez, LCSW

Why a Team Approach is Best for those with Long-standing and Complex Conditions like Borderline Personality Disorder with Dr. Darren Fred and Andrea Marquez, LCSW

March 21, 2023

Collaboration is Key

Diagnoses carry weight. They not only impact the patient’s own view and understanding of what they’re going through diagnosis can also influence care plans and treatment. Getting the diagnosis right is crucial, and when it comes to a diagnosis of borderline personality disorder finding specialized providers who collaborate on care improves outcomes. 

 

Outside of in-patient care where a patient experiences a dedicated team consistently working together on their case, outpatient practices with a team of psychiatrists and therapists who directly work together are less common. Given the known shortage of mental healthcare providers –  and additional shortage of providers who specialize in BPD –  collaboration between providers and providers who seek to develop an expertise in the care of people with a BPD diagnosis is needed. 

In this Care Insights we spoke with Dr. Darren Fred, a psychiatrist at Heading Health who treats patients across Texas through virtual psychiatry. We also heard from Andrea Marquez, LCSW a therapist at Heading Health who offers virtual therapy also for patients in Texas. Both Dr. Fred and Andrea Marquez have experience and expertise when it comes to caring for patients with trauma, and complex including Borderline Personality Disorder. They offer their insight into the diagnosis itself, why a direct, team approach offers superior care, and how having a practice that employs both prescribers and therapists can be a game changer for patients living with difficult-to-treat disorders.

 

“Collaboration in just about any work field is ideal, and that holds true in medicine and specialties such as behavioral health – especially with long-standing or difficult to treat conditions,” said Dr. Fred. 

 

Direct communication between therapists and psychiatrists working with patients with borderline personality disorder is beneficial in overcoming barriers to treatment, and potential missteps which may impede care. Stigmatization and marginalization of patients diagnosed with personality disorders has been studied as a significant obstacle in finding care, and finding providers on both the medical and therapeutic sides of care can be difficult.

Improving Mental Health Care Through Efficient Communication

“A team approach for managing patients with a borderline personality diagnosis is ideal and has many benefits for the patients,” started Dr. Fred. 

 

“The most obvious benefit is that both treatment parties, the therapist and the prescriber, work together to be on the same page when it comes to diagnosis and treatment.”

 

 

“I completely agree with Dr. Fred’s point of view,” offered Andrea.  “If you have a patient with an inaccurate diagnosis, or if it takes too much time to get information shared between providers, it affects a patient’s therapy experience, too. Misdiagnosis and delays in care means someone who is struggling waits even longer to experience the improvement in their symptoms that they need, or achieve goals they have for quality of life.”

 

 

Not only is ensuring that an agreed upon diagnosis is accurate and made clear between providers, Darren and Andrea pointed out how a team approach benefits the patients experience handling the logistics of care, can improve the provider’s knowledge of the patient’s case, and can motivate a patient to take a more active role in treatment itself.

 

Reducing Frustration for the Patient

“When a patient has a diagnosis that should be addressed through a combination of therapy and medication they will be attending a lot of appointments – which may seem obvious – but it can be overwhelming to juggle especially for people who are already dealing with significant struggles,” said Dr. Fred.

 

“In my experience with both psychiatrists and therapists under one roof, regularly participating in provider meetings, and being able to send quick, secure messages to one another removes barriers and improves the patient outcome and experience.”

 

It’s not uncommon for a patient receiving mental health care to shuffle between several places. Often the everyday mechanisms of communications, paperwork, and scheduling that creates delays in care. Seemingly simple tasks such as patients signing release forms to be faxed to a separate medical office takes time. From there both providers have to try to align time between seeing patients to share notes. Minimizing the burden of these tasks accelerates treatment.

 

“In my private practice days, where I was a solo practitioner, it could be very difficult to get in touch with a psychiatry provider to consult on a patient – especially when it required connecting with a provider who had a lot of experience treating a patient with borderline personality disorder. I feel very fortunate that I work in a practice where a patient has a team. As a therapist, directly connecting to one of my patient’s prescribing providers is a normal part of operating.  In our practice here at Heading we message one another to collaborate on a patient’s care,” Andrea shared.

 

Spotting Common Misdiagnoses

When it comes to psychiatrists and therapists who specialize in personality disorders, collaboration can also help spot misdiagnosis and ensure appropriate treatment.

 

 

“Collaborating with other providers can also help address misdiagnosis. Patients with borderline personality disorder often have trauma histories, other diagnoses such as PTSD, and most often a mood disorder diagnosis,” explained Dr. Fred. “Unfortunately many patients will see one provider who gives them, for example, a bipolar mood disorder diagnosis. Then, another provider might tell them they do not have bipolar disorder but rather unipolar depression.  This can be frustrating and confusing for patients, especially when one provider is suggesting treatment specific for bipolar disorder, and the other is suggesting treatment specific for depression.”

 

 

Dr. Fred’s elaborated on the additional concerns that come with common misdiagnosis for borderline personality disorder noting that not only does that change the treatment protocol, but the medications prescribed may be simply ineffective, or worse, the patient may be prescribed a medication with many side effects, but never experience the intended relief due to not addressing the appropriate problem.

 

 

“Take for example a common diagnosis differential of depression or bipolar depression. From a prescriber standpoint these different diagnoses have huge ramifications,” Dr. Fred cautioned. “If a patient with borderline personality disorder is diagnosed with a co-occurring bipolar disorder, but does not actually have bipolar disorder, it can lead them down a road of being prescribed medications that may be more sedating, and have more intense side effects such as weight gain, or something more permanent like tardive dyskinesia – which is a complication from antipsychotic medications – and all the while their depressive symptoms are being undertreated, their mood is not improving, and the aren’t feeling better.”

 

 

“I completely agree with Dr. Fred’s point of view,” Andrea noted. “Bipolar Disorder is one of the most common mistakes we see on the psychotherapy side as well when it comes to borderline personality disorder and co-occurring diagnoses.  I have seen so many patients come in for therapy who are diagnosed with Bipolar Disorder and what they actually are managing is Depression, Anxiety, and/or complex PTSD and they also meet criteria for Borderline Personality Disorder.  

 

Empowering Patients Through a Team Approach

Prescriptions aren’t the only concern. Misdiagnosis also affects therapy too. Darren shared that the psychoeducation a patient has around their diagnosis influences the decisions they may, or may not, take in terms of their own care. Andrea agreed.


“Mood symptoms can be managed by medication but trauma needs a different lens,” shared Andrea.


When it comes to changing thoughts, behaviors, and ultimately feeling better patients who feel empowered to make change, and are encouraged to an active role in their care will have better outcomes.


“It’s not uncommon for a patient who has been struggling for a long time to assume they have no control of their behaviors especially if they are on medication and it’s not working as they thought it would.  Misdiagnosis delays a patient becoming empowered to make the positive changes necessary for them to live a more fulfilling life, and rely less on coping mechanisms that have painful consequences,” summarized Dr. Fred. 


With psychoeducation, appropriate diagnoses, and a team that collaborates the impact is not only the selection of more effective prescriptions and therapeutic techniques, it also inspires the patient to take an active role. To demonstrate how impactful a collaborative, specialized team can be for patients who have difficult and complex diagnosis,  Andrea went on to share this care story:


One of the most successful cases I have seen has been while working with the providers here at Heading.  A colleague of mine, a prescriber, and I were working with the same patient.  The prescriber noticed that the medications they had prescribed the patient were not working well and they looked at my notes and sent me a message to do a quick call.  


I was able to give my opinion that I did not see a cyclical pattern of symptoms but that there was a consistent set of issues causing chaos in her life that were causing acute stress symptoms that were insomnia, restlessness, intense emotions, impulsive temper outbursts and some self-medicating.  We discussed steps forward.


And a month later I was able to go back to the prescriber and share more revelations after working with the patient for another couple of weeks.  I was able to report that there might be some subclinical Bipolar Disorder symptoms there because of persistent cyclical sleep and mood changes that could not be explained because acute stress had subsided.  


We are still working with this patient and the patient has started asking us to share information they forgot to tell in an appointment or therapy session.  to tell one of us something and she would like the other to know.  Because they have a team, this patient has become more connected in their care and is taking an active role – which is wonderful!


Living with a complex mental health diagnosis, like borderline personality disorder, comes with a long list of symptoms and struggles that severely impact the quality of a person’s life and their relationships. Ensuring that the care team supporting a person’s journey is specialized, collaborative, and has easy access to clear communication not only makes the patient’s experience easier, it improves their ability to find healing. 


 People struggling with mental health disorders, and their loved ones, should feel confident in asking their doctor about how they approach care when it involves multiple providers.  Finding the right team of providers who make it a priority to maintain open communication and collaboration helps a patient achieve the best outcome possible.

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Blog depression Ketamine Provider spravato wellness women's mental health

10 Helpful Facts About Ketamine Therapy

10 Helpful Facts About Ketamine for Depression and Anxiety

March 15, 2023

When it comes to feeling better it is understandable that people with treatment-resistant depression feel nothing will work. Ketamine is an option that is changing the story and offering hope.

Ketamine is a powerful drug that has been used in medical settings for decades, but it is now gaining attention for its potential to treat depression, anxiety, and PTSD. 

 

 

Here are 10 surprising facts about the drug that you should know. 

 

  • Ketamine is used in medical settings as an anesthetic, but it is also being used in psychiatric care as a treatment for depression, anxiety, and PTSD.
  • Ketamine is a dissociative anaesthetic that has psychedelic effects. It produces a feeling of altered consciousness and can cause hallucinations.
  • Research suggests that Ketamine positively impacts neuroplasticity, which is the ability of the brain to form new connections and reorganize itself. So, while the ‘trip’ may be all the buzz, the positive impact is has on brain connections overtime that is really exciting for patients who have experienced treatment resistance.
  • Ketamine is often used in combination with psychotherapy to help treat mental health conditions, and a therapist who is trained in offering care to patients in ketamine therapy can help patients process their treatment experiences and maximize its benefits.
  • Ketamine is generally considered safe but can cause side effects such as dizziness, nausea, and confusion. Seeking treatment within a center under medical supervision may be optimal as having a medical care team present to support treatment can both enhance safety and puts some patients at ease knowing if they are anxious about the experience.
  • Spravato® is a medication that is a variation of ketamine that has been FDA approved for treatment resistant depression. It is administered as a nasal spray.
  • Ketamine is not recommended for people with certain medical and psychiatric conditions, including heart disease and high blood pressure. This is why it is important to get a thorough consultation with a psychiatrist who specializes in this treatment, and can continually meet with you to monitor care.
  • Ketamine is not recommended for recreational use. 

Ketamine is an exciting area of research, and it has the potential to help many people who suffer from depression, anxiety, and PTSD. If you or someone you know is considering using Ketamine for mental health treatment, consider setting up a consult with Heading where you could receive ketamine or Spravato® treatment in our centers in Austin or Dallas-Forth Worth.

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Myths & Realities About Anxiety

Common Myths and the Realities about Anxiety

March 2, 2023

Myth: The Signs of Anxiety Disorders are Obvious
Fact: Anxiety Disorders Have Many Easy to Miss Symptoms

While the internal experience for someone with anxiety may feel loud, uncomfortable, and shaky often to people on the outside it may be hard to tell that someone is in distress. 

 

In fact many people with anxiety disorders are hypervigilant which can, from the outside looking in, seem like they are simply very disciplined, proactive, or ‘on top of everything’.  

Myth: Anxiety is In Your Head
Fact: Anxiety Is a Very Real Physical Experience

Anxiety disorders create effects on the body due to stress, which in turn can lead to additional ailments over time.

 

These physical symptoms are numerous and varied, but common symptoms include digestive issues, trouble sleeping, lowered immunity, irregular heartbeat, headaches, trouble concentrating, feeling lightheaded, changes in eating habits, and changes in sex drive.

Myth: Medication is the Only Treatment
Fact: Many People Find that Therapy & Mindfulness Techniques Help Too

Medications will not cure anxiety they can help manage the symptoms. For many people medication is an effective tool for feeling better as it can help calm anxiety well enough for a person to address the causes and their behaviors that may be impacting anxiety. 

 

 

However evidence suggests that a combination of therapy along with medication can be more effective than a single treatment alone in treating chronic and longstanding anxiety. In therapy people struggling with anxiety will learn skills to cope with anxiety, as well as behavioral change that can help someone making choices and take actions that support a healthier life.  Some people stay on medication for a while, and others only for a select period of time. This is normal, and when it comes to long-term support therapy may be the most effective option. 

 

 

In addition to medication and therapy, lifestyle choices including improving diet, exercise, and sleep habits can also be important aspects of treating anxiety.

Myth: Anxiety Is a Real Disorder Because Everyone Gets Stressed Out
Fact: Anxiety Disorders are Different Than Having Everyday Worries

While everyone experiences anxiety at some point in life, anxiety disorders are not simply worry.

 

Generalized Anxiety Disorder is persistent, and symptoms are more intense and last for longer than common worry.  Additionally anxiety disorders can cause interruption to daily living, and create problems at work, and in relationships. Because anxiety disorders also have physical symptoms as well as psychological symptoms, and can interrupt a person’s life so significantly, those with anxiety disorders are more likely to turn towards substances and other coping mechanisms to try and manage the experience. Those with anxiety disorders are also more likely to experience other mental health issues like depression. 

 

For these and many other reasons it’s important to take anxiety seriously, and to work with professionals who understand how to treat anxiety that has become more than just a passing worry. 

Myth: Avoiding Stress and Anxious Thoughts Will Cure Me
Fact: Surpressing Thoughts and Avoiding Everday Life Stress Won't Make Anxiety Better

The realities around avoiding stressful situations and thoughts may seem counterintuitive. Contrary to popular belief trying to ignore or suppress anxious thoughts may help temporarily but often they simply come back stronger. Similarly while there may be unnecessary stressors that can be eliminated from life, stress cannot be completely avoiding. Avoidance behaviors can backfire and reinforce feelings of anxiety and overwhelm. Instead therapy can help support a person in finding ways to navigate stress with less overwhelm, and feeling more empowered. 

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Care Insights: Black Maternal Mental Health with Meghan Murchison

The Positive Impact of Therapy in Maternal Care with Meghan Murchison, LPC

February 24, 2023

Getting Therapists Involved in the Maternal Healthcare Conversation

In this edition of Care Insights we spoke with Meghan Murchison, a therapist with Heading Health who is based out of Houston, Texas.  Meghan’s passion for counseling started from a desire to reduce the stigma surrounding seeking therapy, especially for Black and BIPOC people. Now, Meghan says it is her journey as a mother that continues to fuel her passion to support people in finding mental wellness.  She offered insight from her own life as well as her professional expertise on the subject of maternal mental health, what she thinks is important for pregnant people to know, and how she feels therapists and doctors can do better when it comes to helping new mothers and parents thrive. 

 

“I have a passion for maternal mental health and focusing on women and the very broad spectrum of motherhood. My personal goal is to decrease the amount of deaths related to childbirth and post childbirth,” Meghan began.

Moms Need More Than Screenings

“I would like for us all to remove the stigma attached to postpartum depression, and how people have been solely categorized as having postpartum depression and not exploring other very real things like access to resources and support, PTSD after difficult pregnancies or traumatic births, OCD, anxiety, and even psychosis which can also occur during pregnancy and after childbirth,” she offered.

 

“After having a baby you go to doctor’s office and they do this little check-off list but I personally, as someone who completed the list and have clients who have completed the list,  I don’t feel that it is thorough enough. It’s a start, but we need to do more” Meghan noted.

 

“Physicians could do better in making sure that they partner with psychiatrists and partnering with therapists, and keep those referral pathways top of mind. Women should be getting help immediately, and preferably long before this 6 week checkup because finding a therapist after you’ve had a baby is probably the very last thing on your mind.” 

 

The checklist that Meghan is referring to is a screening that typically occurs while a woman or pregnant person is in the care of an OBGYN. The American College of Obstetrics and Gynocology recommends that doctors and providers screen postpartum for depression and anxiety. ACOG also recommends screenings occur before and during pregnancy to help ensure that comprehensive follow up also happens after birth as well. While screenings are common, studies have found that OBGYNs may need to do a better job ensuring referrals and resources make it to the patient. A 2020 study concluded that screening may not be enough, which echoed Meghan statement. Rather, increasing awareness and increasing resource availability seemed to be missing pieces to supporting the over 15% of postpartum people diagnosed with depression after birth. 

 

“Screenings just aren’t enough,” said Meghan.

 

When asked what therapists could be doing better, Meghan didn’t skip a beat.

 

“Expecting mothers need help and someone who listens. And it doesn’t matter if you have five kids, two kids, or it’s your first pregnancy, it is – to me – imperative that people receive therapy throughout the entire process of pregnancy, birth, and postpartum because it’s a reeling experience. Changes in your body physically and chemically. Changes in your work and social life. Changes in your relationship, and your sex life. And so many of the activities that you used to love may not be on the table any more, or at least for a while. Not to mention pregnancy can also be dangerous for some people. So it can be a scary time,” she said.

 

Advocacy and education seem to be missing pieces according to Meghan.  Very often people don’t seek out therapy until after there is a known problem, or someone in their life suggests it. While routine and regular physical checkups with a physician or midwife are involved in pregnancy healthcare, mental healthcare checkups with a licensed therapist are not considered routine. 

Improving Outcomes for Black Women

“Advocating for seeking therapy before and throughout pregnancy is something I would love to see for all moms, but I believe it is very important for Black mothers because there is still an inequity in Black maternal mortality rates,” Meghan noted when expanding on her desire for therapy to be considered more routine in prenatal care.

 

 

“Expecting moms, especially Black women, can benefit by having a therapist who helps them develop the skills necessary to advocate for their needs during pregnancy care. As a black woman, not only do I have to worry about the fact that my provider may not listen to me, or take my needs or wants into consideration because there is still a very real bias that exists in healthcare.”

 

 

Meghan discussed not only her professional experience witnessing Black women navigate difficult pregnancies, but she shared personal stories as well, “With my second child I was so afraid. I mean you’re already afraid as a mom. You’re just worrying about each day. Let me get this baby to the next day. Let me get this baby to the next week. Let me get this baby to the next month but then when you throw in  preeclampsia or gestational diabetes it raises the bar. I was so frantic because diabetes is already something that heavily affects the Black community.” 

 

 

Statistically Black women do experience more complications during pregnancy, higher maternal and infant mortality rates. While maternal mortality rate has experienced disappointing numbers in general over the last two decades, the gap for Black maternal mortality rates has increased and seems to have peaked during the pandemic.  Additionally, Black women report, on average, less satisfaction with their care, less trust in their providers, and a larger concern about bias among providers. 

 

 

“And ours is a community that already experiences a lot of disparity. For many Black women just securing a job with good benefits is a really big deal. So to be able to keep that job and keep that insurance often becomes the priority rather than really focusing on getting adequate rest and care.”

 

 

“My own pregnancy was very nerve-wracking and scary. But, luckily, I had a therapist that I’d been speaking with consistently. It made a huge difference in the way I approached my prenatal appointments, the questions I asked, and, how I spoke to my doctors. Just having someone who can help you feel more confident in every appointment can really improve the experience and the health of a pregnant person,” Meghan concluded.

Empowering The Expecting

“There is a huge opportunity for mental health providers to lean towards this community,” Meghan suggested.

 

Therapy for those experiencing pregnancy for the first time is shown to reduce rates of anxiety. Meghan proposes that it may also have a positive effect on how a person feels about the care they receive during pregnancy as well, and empower them to feel strong about the role they  play in the health of their pregnancy and new baby. 


“Therapy offers an outlet, as well, as a space of accountability,” Meghan explained.


“Going to therapy is a bit like going to see a trainer in the gym. You learn the moves, and practice them, and you have a coach guiding you on how it’s done. Then you go work out on your own. In the early stages of pregnancy, those tips and guidance are essential, because everything is new. The outlet [of therapy]  can be very cathartic and it helps a woman feel like she’s not alone because of pregnancy and learn how to use her voice.”


Therapy is often thought of as a place to share feelings, or examine events and how they influence responses. Cognitive behavioral therapy, for example, helps patients recognize when a thinking pattern may be faulty and influences a behavior or reaction that is unhelpful, and it is a widely used therapeutic modality for anxiety and depression. However, therapy is not solely CBT. 


Therapy also can involve reframing a narrative, or belief system, about oneself, as well as coaching for a pregnant person who may be feeling intimidated by doctor’s appointments. Using a therapy session as a training ground to practice establishing boundaries, practice speaking up for themselves at appointments or during labor and childbirth, and discussing plans, fears and desires can be a outlet to process difficult emotions in a safe space. Additionally many therapists employ mindfulness techniques, and can offer education and practices that support nervous system regulation which can be helpful during moments of anxiety including birth itself. 


“I can share from my own experience that I had a doctor that solely focused on  having a safe delivery – and my birth preferences were not really part of the discussion. ‘Get the baby out safely’. That’s fair, but I wanted to enjoy my experience. I told my therapist that I was a little concerned that my doctor wasn’t not listening to me. My therapist was able to give me the feedback I needed. She told me ‘ok you have to be assertive and you have to tell her ‘this is what I need. Where can we meet in the middle?’ She also suggested I get a doula and encouraged me to write down a birth plan,” Meghan shared.  


“I heavily encourage talking about that birth plan with your therapist. Birth can be scary, but also it’s beautiful, and more times than not that mom and baby are both healthy. A therapist can help you focus on the positive potential outcomes too, especially when you’re feeling very anxious. So talking to your therapist is helpful in gathering those plans and empowering you to speak your truth.”


When considering her bottom line and what she hopes for the future, Meghan was clear.


“I personally believe that all Black women should know that they have a right to control their medical experience specifically. In birthing and caring for a child we have a history of pain, and a story that needs to change. Dating all the way back to slavery black women often had no autonomy over their experience as a mother, many times their children were ripped away from them or they spent all their time caring for other people’s children without being able to dedicate the same time caring for their own. And so I want black women to know that they are powerful, that this is their experience, and their experience only,” Meghan concluded. 


“If someone makes you feel bad about speaking up for yourself, then they are not the provider for you. They are not a support person for you. You have to find another support person and not to give up on finding that person or people who will help you make your birth the best possible experience for you and baby.

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