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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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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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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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Care Insights: Sex & Therapy with Jestina Franks, LPC-S, AASECT Certified Sex Therapist

Talking Sex & Therapy with Jestina Franks, Sex Therapist & LPC-S

February 13, 2023

Psychology, Sex, and Intimacy

Whether it’s framed as a “Hallmark” holiday, or a tradition that couples around the world take seriously as a date to engage or reengage with romance, Valentine’s Day raises feelings, questions, and desires to the surface for almost everyone. When those feelings, questions, and desires feel uncomfortable, painful, or completely new, it can be the very best opportunity to talk to a therapist about sexuality, and intimacy.

 

In this edition of Care Insights Jestina Franks shared her perspective as a counselor and sex therapist on why talking about sex in therapy is an important conversation for deepening personal understanding, and life satisfaction – whether you’re coupled up or not. 

 

So, we talked about sex.

Jestina works with Heading Health, and is a LPC-S and AASECT Certified Sex Therapy who offers virtual therapy to patients in Texas. To kick off the conversation about sex and therapy, Jestina thought it was important to set a baseline understanding of why sexual intimacy is such an important topic even though it’s often ignored or skimmed over in therapeutic settings.

 

 “Sex is an important part of who we are.  We see many images in social media and think this is what my sex life should look like and this is how I should feel when I have sex.  Those images can be further from the truth and can create anxiety.  It’s important to talk with your therapist about these concerns,” Jestina offered.

 

Sex and Satisfaction Beyond Biology

Discussing sex in the world of psychiatry often stops with conversations of physical performance, as mental illness itself and some medications prescribed to treat mental health disorders can negatively impact a patient’s sex life. Be it medication side effects or the impact of long standing stress, mental health takes a toll on intimacy and sex.  Finding a balance between effective management of concerning symptoms of anxiety and depression can come with a trade off. 

 

“There can be some psychological barriers that can impact our sexual functioning. Also some psychiatric medications can have side effects that can affect your sexuality.  It is important to educate yourself how medications can affect your sex life, and ask questions,” suggested Jestina.

 

“While some issues with sex and intimacy may have physical causes, very often psychological causes are at the core. Sexual dysfunction can be caused by anxiety, self-confidence issues, and trauma. These are things that are not just affecting life inside the bedroom, but also everyday. So proper screening can shed light on deeper issues that could easily be overlooked if the right questions aren’t asked.” Jestina shared.

 

The door also swings both ways as well, and collaboration between mental health care and physical health care providers is crucial for optimal care. “Mental health professionals need to collaborate with physical health providers too to ensure that sexual health issues are not medical, “ she noted. “Sexuality is a part of who we are as humans, and it’s not a one size fits all. It’s a unique part of who we are and it’s different from everyone else.  Our sexual health contributes to our overall wellbeing.”

Seeing a Therapist who Specializes in Sexual Health

However, it’s not always that simple as stigma around sex is still a large barrier. Jestina sees a parallel between sex and mental health in the way that culture, and the medical system, has been slow to invite an open dialogue. 

 

“Sex is so taboo. It’s a part of ourselves that we keep hidden and don’t talk about. Mental health was just like that at one point, and still is in a lot of ways. But, what a lot of patients, and even many providers, don’t consider is that sex therapy is a specialization within behavioral health that is focused on sexuality and sexual functioning. While you can talk to your therapist or psychiatrist about sex, getting referred to a provider with specialized training in sex therapy offers tremendous benefit – especially for those who have experienced sexual trauma, or are seeking support surrounding their sexual orientation, sexual identity, or have had a major life experience that has impacted their experience of sex and intimacy” 

 

The conversation can also be much more fluid when speaking with someone trained in sex therapy because the elephant in the room isn’t being ignored; it’s front and center. “Sex therapists are there to educate on communicating openly and honestly with your partner, find the root of sexual issues or challenges and move towards a fullfling, and pleasurable sex life.”

 

Something that many people are surprised to find out is that this work is not just for couples. 

 

 

Sex therapists very often work with individuals, especially when someone is working through a history of abuse or trauma, or when someone is  seeking support for issues of sexual preference, orientation, or identity, or experiencing a big life change like dating after divorce, medical illness, or another large life transition.  “Having a therapist who is sex positive, knowledgeable, compassionate, and empathetic empowers people to take control of their sexual health and wellness, and you don’t have to wait until you’re having sex with someone else or partnered up,” encouraged Jestina.

How to Pick a Sex Therapist

Not every therapist is going to be able to offer the same level of skill as a therapist who has specialized training. For those who feel that their therapist may not able to provide support Jestina suggested asking for a referral. Jestina also empowered people looking for a sex therapist to consider the qualities that would support them best, “Sex therapists are trained to help process concerns such as low libido, mismatched libidos, lack of desire, pain during sex, erectile dysfunction, sexuality and identitiy, and alternative relationships such as polyamay or open relationships and a host of other sexual health or wellness concerns,” Jestina explained.

  

“I would encourage people to ask questions and advocate for yourself. You can ask about a therapist’s education and qualifications. For example some sex therapists are AASECT certified which means they have gone through extensive training. You also will want to know if the therapist has had experience working with a population similar to yours.” 


Cultural sensitivity and community experience can have a positive impact in building rapport, and people may with to seek out sex therapists within or allies of the LGBTQIA+ community, have experience working with people who have a history of sexual abuse, or  people experiencing issues with sex and intimacy post divorce or loss, and  aging populations may want a therapist who has insight in maintaining a positive sex life in their golden years. According to Jestina sex therapy needs to be culturally sensitive, and inclusive, otherwise it will completely miss the mark.


“There’s a need for therapists who want to get more training in sex and intimacy. For those interested in the field I would encourage them to check their bias at the door. What appeals to a client may not appeal to you, but it’s not your job to judge. Those unique desires and preferences may be key pieces to that individual’s overall identity and experience of the world. It’s a sex therapist’s job to guide and support the healthiest and most authentic experience of sex and intimacy for the person they are helping,” concluded Jestina.


And, for those still nervous to talk about sex during therapy, or unsure of the benefits, Jestina had this to say, “Seeking professional help can give you the tools and resources to process what you have experienced. [Sex therapy in particular] will give you a safe space to process your trauma, learn coping skills, explore ways to feel safe in your body, learn how to create and set boundaries, and use positive communication skills.”

Important skills for everyone – no matter their relationship status. 


For those interested in learning more about sexual health, sex education, and sex therapy, the American Association of Sexuality Educators, couselors, and Therapists has resources for patients and providers at AASECT.org

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Care Insights: Community Health & Black Mental Health with Shaunae Tolson, LPC

Therapy Insights: Community Health & Black Mental Health with Shaunae Tolson, LPC

February 6, 2023

Black Mental Health & Black History Month

In this Care Insights we spoke with Shaunae Tolson, LPC.  Shaunae is a counselor who offers virtual therapy services to Texas, and is part of the care team at Heading Health.


Shaunae shared with us her inspiration for entering the field of mental health, her perspective on providing mental health care and receiving mental health care as a Black woman, and what she feels is the duty of the medical system and those in health care when it comes to not only serving individuals but also being the change she hopes to see for all patients.

February is Black History Month, a month that serves to recognize the contributions and achievements of Black individuals, with special focus on sharing important stories of the people and moments in Black history that have and continue to play a central role in U.S. history, and offers a powerful reminder that Black culture is American culture.  In our conversation with Shaunae, she shared what this month means to her and how Black Mental Health should be part of the conversation, this month and every month.

 

 

“Well, obviously, being a Black woman I grew up black with all the challenges that come with growing up Black. And for me, and many people in my community,  mental health was not mentioned or talked about or acknowledged. The closest thing you get to counsel is ‘go to church’, ‘give it to God’, or you’re told to pray or talk to the pastor,” Shaunae reflects.

 

 

“I think that’s why it’s important to talk about Mental Health when we talk about Black History.”

 

 

Mental Illness, PTSD and Survival

Shaunae grew up in what she called a ‘rough, inner city neighborhood’, and recognized that most people in her community were experiencing significant challenges. Now, as a therapist she is able to empathize with her clients who have been raised in similar circumstances. Shaunae shared that she feels that what may be labeled as ‘mental illness’ is often survival mechanisms and habits for coping.  The impact of living under extreme stress for a prolonged period of time often creates mental and physical health symptoms that aren’t always obvious, because surviving becomes another part of daily living.

 

 

“I was an inner city kid. And I feel like a lot of inner city kids suffer from PTSD. For me, having family members that have gone through the legal system, we suffered, but we had to suck it up. No one really talks to inner city kids about the exposure they have had to really difficult circumstances, and what impact witnessing these things is having on them”

 

 

“What I know now about PTSD, as a counseling professional, is that it’s just survival tactics really.  You’re often forced to learn them and sometimes just don’t have a choice in the matter. It can come with aloofness, a numbing, pretending like you’re unbreakable, or coming across as standoffish or disrespectful. But what people need to realize is that at the end of the day – basic needs always win. You do what you think keeps you safe.” Shaunae shares.

 

 

Shaunae’s personal experience concerning the difficult nature of mental health diagnoses, and even misdiagnoses, when dealing with trauma echoes broader issues of racial disparity in mental health care. A 2018 study from Rutgers University compared the diagnoses given to over 1600 people and concluded that very often Black men with a diagnosis of schizophrenia were much more likely than non-Black individuals with a schizophrenia diagnosis to also qualify for a diagnosis of major depression and PTSD. Yet, the screening for mood disorders and diagnosis of major depression was often not given.  Discussion of this study also noted the finding suggests a bias towards screening Black individuals for psychotic symptoms over mood disorders.

 

 

Undertreated major depression is significant, as it is a misdiagnosis of schizophrenia, in both instances the potential for inappropriate treatment or undertreatment comes with significant health risks.

 

“You know with police brutality, lack of opportunity, crime, and a lot of what happens in rougher neighborhoods relates to people doing what they know to do based on the demands of their environment. And it takes time and perspective, and really the ability to step away, to realize that sometimes coping techniques are dysfunctional, and understand that your feelings do matter.  But it’s hard to form that sort of perspective if you’re stuck or you’re unsafe. You have to survive first. Mental health or emotions are not going to be seen as a priority, because they’re emotions. They don’t feed you, put clothes on your back or keep the electricity on.”

 

The challenge of offering support to an individual when societal factors play a large role in a patient’s suffering is an aspect of her job that Shaunae embraced, ”I think that’s why it’s such a  passion of mine. The work is complicated because I’d often have to say to someone, ‘You’re right, you still have to survive, unfortunately, because of the cards that you were dealt and the situation that you’re dealing with’.” 

Doing Healing Work In a Broken System

The resilience of the people Shaunae supported in her time in community mental health stoked a passion for her career in counseling. When Shaunae reflected on her time in community mental health she shared that one of the most difficult aspects of that work was not being able to change the environment she was sending people back into after their session, but that community centers were the heart of change for neighborhoods like the one where she raised.

 

 

“I’m a huge advocate of community centers,” Shaunae shared excitedly.

 

“I worked in community mental health. So, I dealt with, you know, America’s true people. And I’ve heard a lot of things, and witnessed a lot of emotion that stem from really horrible experiences. Even though I couldn’t necessarily change their experiences or what they were going through, I  saw the impact of just being heard, and having a safe space for letting it all out,” Shaunae remarked.

 

 “We can’t fix the situation. Most times we have to send them back to where they came from and they have to continue to survive. But I don’t think people understand the impact of just having a brief moment of not having to worry.”

 

Community centers are often frontline areas of support for low-income people who live in inner city environments. While the American Affordable Care Act did begin to close the insurance gap, Black individuals still trail behind in coverage, and are much less likely to have private insurance making access to quality mental health care difficult and cost prohibitive. Safe spaces where counseling, support groups, social services, and recreation, become centrally important in providing low cost and zero cost access to meaningful access.

 

 

“When you’re worried about basic needs emotions are not going to be a priority. But there can also be some acknowledgement and support. And that goes a long way. Just a space for releasing is impactful.”

Need for Black Mental Health Professionals

When asked about her perspective on receiving mental health counseling for someone of the same race, Shaunae’s response was nuanced and thoughtful. It was clear this is a topic she’s considered often in her own life and in her career. 

 

“I have a mixed perspective. It’s not always necessary for your therapist to look like you, but sometimes it can help. Some of the greatest therapists I saw were white women. I never felt like they couldn’t help me because they didn’t understand my struggle or that I couldn’t meet with them, but I also will add that at the time I was already studying this work. So I had some awareness. But, in reflecting back, the biggest reason I was able to navigate [having a white therapist] was because growing up my mom always made a way to ensure we were able to go charter schools. I was not a stranger to being in predominantly white environments.”

 

One important aspect of reducing stigma and improving care and access for the Black community relates back to a greater need for diversity in the mental health field in general. The APA reported that as of 2015 the field of psychology was less diverse than the nation as a whole, and that only 4% of professionals in the psychology field identified as Black. While beneficial care is not reliant upon racial, gender, or sexual orientation matching between patient and provider, there are real benefits to care when a patient feels more comfortable building a rapport with someone of their own background. 

 

In Shaunae’s own therapy journey, connecting with a therapist who was a Black woman made a difference for her. She shared, “When I got my first Black therapist, that shifted things for me. I can’t even pinpoint the exact shift, but it took my treatment to a deeper level. Having that connection of culture was significant. A lot of the things that I explore with my current therapist, who is a Black woman, are also things that I explored with white therapists. However, now with that shared connection I’ve been able to revisit those topics and process the experiences more deeply. Her understanding of the Black experience, and being able to ask certain questions about the Black experience and being a Black woman especially, helped.”

 

Rapport is a significant indicator of therapeutic success, even more so than a specific theory or modality used in session. Research on cultural competency and its relationships to therapeutic outcomes is gaining more traction though a precise definition of what it means to offer culturally competent care is still difficult to pinpoint. But, research shows that providers can unintentionally contribute to increased racial and ethnic disparities in care, and on the whole the system needs improvement. Though the fact remains that racial and ethnic minorities are less likely to receive psychological care than the white majority, and in order to meet the need more BIPOC are needed and white providers need to become more immersed in providing care to a culturally diverse patient population.

 

“For Black people who may be resistant to therapy, or nervous to talk, having someone that they immediately feel like they can trust and relate to might make a big difference. Someone of a different race, who’s just very textbook, just not aware and simply feeding what CBT told you to say if a client says a certain thing – that’s a turn off.”

 

 

Given that the overwhelming majority of psychology professions are white there is a tremendous need for learning and education around what it means to offer culturally competent, sensitive, and relevant care. Shaunae shared, “Clients who have come to me after experiencing a white therapist or someone who just wasn’t culturally aware said it was off putting and it made them quit there because to them it’s like, ‘I don’t need you to tell me what the textbook said or to watch calming soothing videos, I don’t need that, I need you to hear me and know what I’m talking about.’”

How Mental Health Practices and Providers Can Support Change

“When it comes to changing Black Mental Health I think first of access. Access provides the opportunity for a powerful trifecta: Awareness, Perspective, and Trajectory. Awareness comes through psychoeducation and therapy to unlock the path to psychological freedom. This leads to a shift in perspective, and that unlocks hope. Hope is needed in order to change the trajectory of one’s life; a life that may have seemed unattainable.”


Facilitating space for hope can be a change with insurance gaps, and difficulties in access – even with the advent of virtual therapy.  When asked what she thinks mental health practices and providers could do to influence systemic change and promote greater access, Shaunae had very concrete ideas of what she’d like to see.


“Educational assistance, and medicaid. I don’t know the logistics behind convincing more companies to accept medicaid, or how to improve the care that comes with it, but when I was working in community mental health accepting Medicaid was huge. Unfortunately when it comes to medicaid, people don’t always get the best care, and we need to change that too. I believe mental health practices and providers have a responsibility to figure it out.”


In the short term, Shaunae challenged practices and providers to align and support organizations already offering care to those who need it. 

“I remember when I was growing up in the projects there was a community center. It was just a place for us to escape. It had recreational activities, and people we could talk to if we needed. Simple things like that. Mental health care practices should support the places in the community that are already doing the work. Centers are monumental because there’s no transportation barrier, and financial barriers aren’t there. Growing up, I didn’t know what yoga or Pilates or meditation was. Community centers are starting to bring some of these things that we, even I, preach to our clients.”


From Shaunae’s perspective an action everyone who cares about improving mental health care equity can do is to find ways to support safe spaces, “We need places where at least you get a break, because we all need a break.”

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Care Insights: Treating Severe Depression & Anxiety with Julie Isaacs, SVP of Operations & Therapy

Therapy Insights: Treating Depression & Anxiety with Julie Isaacs, LCSW

January 24, 2023

The Intersection of Depression, Anxiety, and Trauma

Depression and anxiety disorders are different mental health conditions that can have similar symptoms and can even co-occur. However, they have different causes that often require different types of treatment.

 

Julie Isaacs, SVP of Operations & Therapy at Heading, offered her insight into how depression and anxiety disorders intersect and the role of specializing a therapy practice to address long-standing and extreme stress.

Related Yet Distinct Diagnoses

“Anxiety and depression are like first cousins; they relate very well to one another and often share a lot of similarities. That said, the experience of depression, anxiety, or post-traumatic stress disorder (PTSD) is also unique to the individual person, and the therapeutic tool kit should be personalized as well,” shares Julie Isaacs

 

Diagnostic criteria for mental health disorders are helpful for research and developing treatments and support, but like other aspects of health problems often coexist. Depression is considered as a mood disorder and is often characterized by persistent feelings of sadness, hopelessness, and a lack of interest or pleasure in activities. Anxiety disorders are conditions that include excessive and persistent feelings of worry or dread, and typically comes with edginess, difficulty concentrating, fatigue, increased muscle tension and discomfort in the body, and trouble sleeping.  Trauma is a criterion of PTSD and the result is a response or set of responses to a deeply distressing or disturbing event, such as a natural disaster, a car accident, or a violent crime. People who have experienced trauma that results in PTSD experience anxiety and fear,  may have flashbacks and nightmares, and become hypervigilant to situations that remind them of the event or carry a perceived threat. Avoidance of uncontrollable situations and hypervigilance are coping mechanisms that promote personal safety. However, they often snowball into more rigid and isolated ways of being.  Over time, this increase in rigidity and isolation, along with the fear, anxiety, flashbacks, and nightmares, can leave those with PTSD at risk of developing depression as well as a substance abuse disorder. 

 

While PTSD can cause depression, depression is less likely to have been brought on by a single traumatic event. Instead, depression’s causes are more varied. It might be set off by a stressful life event that gives rise to sadness with a life of its own. Evidence suggests there may also be biological triggers that can put the condition in motion even in the absence of difficult circumstances. Often, it’s a more complicated combination of factors.

 

“Depression is sometimes experienced as ‘anger turned inward’, and this anger is also  experienced with anxiety disorders and PTSD especially if a person has gone untreated or undertreated for a long time,’” shares Julie.

 

Julie has dedicated her career to the treatment of severe depression and anxiety disorders. Through her years of experience working with individuals struggling with these mental health disorders, she has gained unique insights into the best approaches to helping people find healing and improve their quality of life. She also has vast experience mentoring therapists who want to specialize in these areas and knows firsthand how rewarding and challenging the work can be.

 

Understanding both the intersection of symptoms, and causes are important for appropriate care. However, the skill of understanding what someone is going through is not only a science but also an art as every individual’s personal experience of their mental health is expressed differently.

Naming the Unspoken Symptoms of Mental Illness

While diagnosis is essential for many aspects of treatment, it can come with strong feelings of shame due to the stigma associated with having a mental health condition. 

 

 

“Overcoming shame is a big part of developing the courage to seek treatment, and a therapist needs to know how to not only ask the right questions or identify the right symptoms but also how to build trust and rapport,” Julie points out. “Some patients might tell you right away what they’re going through. But it’s also very common to have a patient who is reluctant to use the words ‘depression’ or ‘PTSD.’ And that could be for many reasons. They may feel it will threaten their job, their standing, or their personal identity.”

 

 

As such diagnostic labels, while necessary and valuable for many medical and therapeutic reasons, carry substantial weight for the individual, which should be seriously considered. 

 

 

Julie also noted that stigma can have a different impact on men and women, especially when it comes to how they express their symptoms and whether they seek treatment. 

 

 

“Men struggling with severe depression or anxiety often seem ‘functional’ by going to work and doing their best to appear ok outside of the home, but when they come home there is often a big shift in their behavior and they might shut down. Men are also more often slow to seek treatment. Women on the other hand are more likely to pull the covers over their head and have a hard time leaving the house, but are more likely to feel comfortable seeking treatment. We have to break through gendered conditioning to really address the heart of the matter – no matter the gender expression or societal norms – all people should feel comfortable seeking help.”

 

 

Unlike a broken bone there’s no x-ray for depression or anxiety. Through experience and training therapists build the skills to hear what’s going on even if a patient has a hard time talking about it. While people may not come right out and say, ‘I have major depression’ or ‘I have PTSD’, they might say other things that indicate they are struggling. For example, they might say  ‘I’m not sleeping,’ ‘I’m having trouble thinking’ ‘No matter what I do, I just don’t feel like myself,’ or ‘I experienced X and just can’t stop thinking about it.’  While it’s gotten better, there’s still certainly shame and stigma around getting help, especially among men, in certain cultures and social circles, and among those with jobs where they need to be perceived as extremely competent or feel a diagnosis could jeopardize their employment.  

 

 

According to one study, 29 percent of male participants said the reason they haven’t spoken to anyone about their mental health is because they are too embarrassed to speak about it.

 

 

Forty percent of men in the study said it would take thoughts of self-harm or suicide to get them to seek help. 

 

Shame will take many different forms depending on the individual, their background, and their lived experience. Shame often comes with feelings of isolation, failure, and embarrassment.  In a traumatic event, or repeated traumatic events, there can be significant fear and shame associated with it as well and which can spur negative thoughts about one’s self. Similarly, with major depression, one might feel guilt or disappointment for not being able to deal with the symptoms ‘on their own’ are common. Trained therapists and psychiatrists are able to help their patients identify these thought patterns in themselves, and dismantle their strong grip.

Addressing the Whole Person in Therapy

Over years of treating patients, Julie notes that, in addition to common mental symptoms, there are also common physical symptoms of both depression and anxiety disorders.

 

“To be honest, no one is sleeping,” notes Julie.  “When we’re dealing with a major mental illness, we’re either sleeping too much with low-quality sleep, or we’re not sleeping enough. But, in truth, no one is rested. And there’s only so much you can do when your body is exhausted. Therapists need to be curious about what’s going on in someone’s body and not just their mind and emotions; depression and anxiety don’t simply exist from the neck up.”

 

The conversation about mental health is becoming less and less siloed from other aspects of health. Mental illness has a strong physical component.   Both anxiety and depression can involve changes in appetite, sleep, and energy levels, as well as difficulty concentrating. Studies show that mental illness can even impact our immune systems and cause or exacerbate other physical conditions such as heart failure, high blood pressure, and cancer

As such, many people benefit from a holistic approach to healing that includes biological and lifestyle interventions, mindfulness practices, and regular exercise. Additionally, more and more the field of psychiatry is also turning towards interventional treatments like ketamine, and psychedelic research, to address the neural pathways within the brain in ways that traditionally prescribed medications do not.

 

Comprehensive treatment is often needed when depression, anxiety, and PTSD become severe or recurrent. When this happens, it’s particularly helpful to have a team that is highly trained in these specific disorders to deliver personalized treatment.

Improving Therapy & Mental Health Outcomes

The shortage of mental health care providers in the U.S. is a known problem, with a recent survey indicating that 60% of psychologists are unable to take on new clients. Many states, such as Texas,  are also short on psychiatric staff in hospitals and centers.

 

What is less talked about is what this means to mental health of providers, especially those treating patients with severe depression and anxiety. “The stakes are high. And among therapists, burnout is real,” shares Julie. “While it can be an issue for all therapists and providers, those focusing on more severe cases of depression and anxiety may be more likely to experience it.” 

 

Her remarks are well-backed up by recent studies. One report found that 50 percent of behavioral health providers reported feeling burnout out, and that a lack of training was a common source of stress. The consequences for those with severe mental health conditions can be devastating.  

 

“Undertreated mental health struggles can absolutely be lethal,” shares Julie, underscoring the importance of proper staff and adequate training. To address the issue, Julie says we should focus on education. “Providers dealing with more severe cases need access to continued education as well as personal support through supervisors, mentors, and peer groups.”

 

Other mental health professionals feel the same. When discussing the problem of mental health care in rural Texas, Dr. Steve Bain, founding director of the Institute for Rural Mental Health Initiatives, also highlighted the importance of training. 

 

“Knowing the patterns among diagnoses certainly helps a therapist connect the dots within their patient’s experience, but it’s also important not to jump to conclusions. This is where peer support, continued education, and mentorship relationships within the field can be incredibly helpful. We can’t practice in a vacuum. Making the effort to continue our own education and develop a network of peers and mentors who challenge our thinking improves the quality of care,” notes Julie.

 

“And like in any profession there may be a time when it is helpful to niche ourselves diving deeply into a few disorders to develop the level of quality and experience a patient with severe struggles needs. That can be challenging and it takes time. But I do know that therapists who are willing to go the distance in their education and experience to support severe mental illness can truly save lives.”

Hope For The Future of Mental Health Care

Despite the prevalence of depression, anxiety, and PTSD the diagnoses themselves can come with a strong degree of stigma. But as the conversation around mental health continues to make its way out of the shadows and into the mainstream, more people will feel ready to seek help.

 

Julie notes that things are moving in the right direction, “I’ve witnessed a huge shift in the conversation around mental health since I first started as a therapist. Big picture, the fact that more people are talking about mental health is promising. Insurance plans, and employers are also starting to take mental health more seriously which is absolutely needed.”

 

“But, we also have a shortage of mental health care providers nationwide. Caring for people who have severe or longstanding mental illness is a demanding job. Providers need training, support, and resources that allow them to their job effectively, and their patients need access to a dynamic tool kit for care for better outcomes. The future of Mental Health will require tearing down silos around treatment modalities, continuing to embrace technology for improved access and education, and for the medical system to take mental health as seriously as physical health. Change has started and I’m hopeful we’ll get there” Julie concludes. 

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Categories
anxiety BIPOC Mental health Blog depression LGBTQIA Mental Health men's mental health Provider therapy wellness

Yes, It Matters if You Like Your Therapist. Here’s Why

Yes, It Matters if You Like Your Therapist. Here's Why

January 17, 2023

When searching for the right therapist, you might focus on things like how much experience they have, what conditions they specialize in, and the types of therapy they are trained to provide. 

 

What you may be less likely to prioritize are features that might impact how much you’ll like or connect with them. In some sense, this is perfectly reasonable. Much like seeing a doctor for your physical health, it may seem that all that matters is that they know what treatment to give and how to deliver it. 

 

While this may be true when it comes to your physical health (though it’s questionable even then), there are reasons for thinking that therapy is different. Above and beyond being able to deliver the proper treatment, it matters that patients like, connect, and relate with their therapists. Often talked about in terms like ‘therapeutic rapport’ or ‘therapeutic alliance,’ studies have found the quality of patient-provider relationships to be a significant predictor of how well they respond to treatment. 

 

Explore why this matters, learn some common factors that impact whether patients and providers connect, and check out what you can do if you and your therapist aren’t vibing.

Why It’s Good if You Connect with Your Therapist

There are a variety of reasons why it’s good to relate to and connect with your therapist. Here are some of the most significant ones. 

#1 You’ll Be More Likely To Share Important Information

Therapy often requires patients to bring up and share personal details at the heart of their anxiety and depression. This is an understandably difficult process. Therapy requires a deep sense of trust and psychological safety. If you feel your therapist will understand where you’re coming from and won’t judge you for your experiences and reactions, you’ll have an easier time opening up and delving into what’s bothering you.

#2 You’ll Be More Open to Their Suggestions

While therapists are not typically ‘advice-givers’ they will offer insights and suggestions.  It’s natural to wonder if it will really work for you, and we’re more inclined to seriously consider the suggestions of people that we admire and respect. 

 

Not connecting with your therapist can undermine your sense that they understand how to address your problems or effectively personalize your treatments.

#3 You’ll Be More Likely to Stick with Treatment

While therapy can be rewarding, finding the motivation to stick with it can also be challenging. When you’re on the same page as your therapist, this becomes less of an obstacle. Studies have found that the stronger the therapeutic alliance, the more likely the patient is to adhere to the treatment. 

 

Additionally, if you aren’t taking your therapist’s advice because you don’t connect with them, you may not be seeing the results you were looking for, which can make you wonder whether therapy is right for you.

How to Find a Therapist You’ll Connect With

While the list of factors supporting a solid connection is endless, several common traits are particularly important to look out for. Here are a few.

Style

Remember why you are seeking therapy. It’s not always best to simply find someone that is exactly like you. However, there may be aspects of your life that you may be more comfortable opening up about if the person in front of you seems to have a level of personal understanding. Consider your willingness to be challenged, or your learning style. Do you want someone who is more directive and straight to the point? Or would you like someone who is conversational, and funny? Typically during an intake session you will be asked about your preferences for therapy and that would be a good time to bring up any aspects of therapy that might be important to you.

 

Cultural or Ethnic Background

A shared cultural or ethnic background can help for several reasons. For one thing, different groups are more likely to deal with specific stressors due to their lived experience with issues like racism and oppression. To best help patients develop effective coping mechanisms, it can be important for their therapists to have similar cultural or ethnic backgrounds.

Gender

Gender plays an important role in our experience of mental health and our mental health outcomes. For example, men are more likely to be diagnosed with substance abuse disorders. They are also less likely to seek treatment and more concerned with mental health stigma. A therapist of the same gender may be better equipped to address these and other gender-specific issues.

LGBTQ+ Allyship

Members of the LGBTQ+ community are disproportionately likely to experience mental health problems. According to The Trevor Project, 45 percent of LGBTQ+ youth considered suicide in 2022. Of those who did not receive mental health care, 43 percent said they did not see a therapist because they feared their concerns would not be taken seriously. Therapists with clear LGBTQ+allyship are desperately needed to help this community.

What Should I Do if I Don’t Like my Therapist?

Let’s say you find yourself in therapy, and despite all your research, you just don’t gel with your therapist. What should you do?

 

There are a few options.

 

Depending on where the disconnect is, you can discuss it with your therapist. Sometimes, you can try resolving disagreements. Speaking up and voicing your opinions may also allow your therapist to demonstrate empathy, compassion, and a willingness to adopt new strategies to better suit your needs. 

 

It’s not always possible to close the gap between you and your therapist with some quick conflict resolution. When this happens, it’s time to break up with your therapist. If you are going to end the relationship, it’s best not to ghost them. Instead, open up a conversation where you explain why you want to look for a different provider. Not only does this give the therapist the fix the issues, but it also helps them learn for future clients so that they may avoid whatever mistakes they made in your case. 

 

While this can seem scary, it’s really an easy process. Mental health professionals generally understand the importance of fit and won’t judge you for wanting to find the therapist that works best for you. “Remember, you are under no obligation to stick with a particular therapist,” shares Patricia Hernandez, LPC.  “Whatever your reasons for wanting to find a new one are, they are valid.”

Takeaway

There’s nothing unreasonable about wanting to like your therapist. In fact, feeling connected to your mental health provider may be one of the more vital ingredients in a successful mental wellness journey. From helping you feel comfortable discussing challenging and personal topics to strengthening your ability to stick with therapy, a close patient-provider connection can have a significant impact on treatment outcomes. 

 

When looking for a therapist, check for things that might impact how well you’ll connect. This may include a shared culture or ethnicity, gender, LGBTQ+ allyship, and more. If you find you don’t like your current therapist, that’s no problem. You may not get it right on the first try, but fortunately, switching is no big deal. 

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