I saw this quote and unfortunately it is more true than I would like to believe! The words people say to us strongly affect our mood and esteem. Many times, sticks and stones would be better.
"Before you diagnose yourself with depression or low self esteem, first make sure that you are not, in fact, just surrounding yourself with assholes." William Gibson
Setting Goals, Not Resolutions
It is that time of year when people reflect on their lives. It is the beginning of a new year and resolutions are set, only to be broken in a month, a week or even a day. Expecting one day to bring change and a new you is unrealistic and setting yourself up for failure. I used to set resolutions only to be disappointed in myself year after year. I still like the idea of a new year and improving myself so I have begun to set goals instead of resolutions. Goals that are set in a realistic manner make more sense than resolutions and help you celebrate the success of accomplishing your goal. Here is one way that I have found that helps me to set and keep goals.
When setting goals, I use the acronym S.M.A.R.T. I did not come up with this idea, but have found it useful to successfully completing my goals. This method can work for long term or short term goals. I have found it most helpful to start with baby steps and small goals. These small goals can be independent or be the pathway to longer term goals. I am going to explain each of the letters in the acronym and give you some examples. I hope this helps create goals and be successful in achieving them.
S-Specific: Goal setting has to be specific. Wanting to lose weight or be a happier person is a good idea, but what does that mean to you? Does it answer the 6 “w” questions: who, what, where, why, which, and when. For example, one of my goals is usually health-related. If I decide “I want to exercise more” what does that mean? How often, what type, when and how do I keep track of my progress?
M-Measurable: Having concrete criteria for measuring your progress lets you see your progress and celebrate your success. Answering such questions as: “How much? How many? How will I know when it is accomplished?”. Saying “I want to lose weight” is different than “I want to lose 10 pounds in 5 weeks.”
A-Attainable/Achievable: When setting your goal, it should be challenging yet not something that is impossible. What may seem impossible may not be. Is the goal something that is worth what you will need to sacrifice to attain the goal versus what you will gain? Knowing yourself and your skill set is useful when setting goals.
R-Realistic: What is the objective of your goal? Will completing that goal give you what you actually want? Is the goal relevant to you and your life? Losing 10 pounds to find a boyfriend is less realistic than losing 10 pounds to be healthier. Running a marathon may not be impossible, but does it give you what you ultimately want out of life.
T-Timely: By setting a time frame for your goal it creates a sense of urgency. It also helps to see progress the completion of your goal. You can celebrate small successes along the way to your final goal.
Mental Health Teletherapy
The increasing availability of technology has created an opportunity for mental health services to be accessed by those who have never before been able to access these services. This opportunity has also created a lot of concern and debate about the confidentiality and ethics of mental health services provided electronically.
I have recently had the chance to receive training to provide mental health therapy over the Internet, specifically by video technology; one of the most well known providers of video-conferencing is Skype. This new way of providing mental health therapy is surrounded by questions: is it confidential, is it HIPAA compliant, what about interruptions in service and on and on. Even when a service is HIPAA compliant there can be concerns.
After completing the training, I thought that supplying video therapy sessions was an innovative way to provide therapy for those who faced certain barriers. I elected not to use Skype, since it is not HIPAA compliant and to use a video technology provider that is compliant. Confidentiality concerns are no different than with conventional mental health therapy. And unlike texts, emails or other forms of written communication, there is no saving of the content. This minimizes the likelihood that information can be accessed.
Another concern about mental health teletherapy is having a computer freeze, not unlike a dropped call. This is a concern if the client is in an intense or emotional place, but with continuing developments in technology, I believe it will be an uncommon issue.
Issues such as insurance payment, is the client of age, and state of residency are other concerns that have been discussed. At this time insurance will not always approve payment for this type of service. This is an issue even with conventional therapy and changes are slowly being made. Is the client at the age of consent can come up when there is no direct contact although again this can be an issue even in conventional therapy. The same methods of proof can be used in person as well as with video therapy.
Finally what I consider to the biggest challenge to mental health teletherapy is state of licensure. I am licensed in the state of Washington and can only practice in this state. If my client is on vacation and has teletherapy is that considered legal and ethical? What about college students who live in one state part of the year and another state another part of the year? This is an issue that must be addressed by each individual therapist who is providing this service. Personally, if the client’s permanent residency is in Washington state then I feel comfortable providing teletherapy while the client is on travel.
So what are the upsides? For the first time, people who live in rural areas can have access to therapy without having to drive sometimes hundreds of miles to an office. A person with mobility constraints can have therapy and not have to rely on someone to help them get to an office. Have agoraphobia? No problem. Embarrassment and stigma can be minimized; the list goes on and on.
If practiced thoughtfully and with awareness, I believe that the positive contributions of mental health teletherapy far exceed any downside.
If you are interested or know someone who can benefit from mental health teletherapy please visit my website: www.insightcounselingllc.org or call 425-458-8100.
1. There is a push for quick involvement and commitment. "I have never felt like this before about anyone."
2. He is jealous. He* calls or texts constantly or waits for you at your work or home. He visits you without notice.
3. He is controlling. He wants to know where you are, who you are seeing and who you are talking to. He may check your receipts to verify you were where you said you were. You need to ask permission to go anywhere.
4. There is isolation. You aren't allowed to see your family or friends. He may want you to quit your job or won't let you have access to a car.
5. It is always someone elses fault. He doesn't take accountability for his actions and you are to blame for everything including his moods-"You made me mad" or "You made me do it by being so..."
6. He is like Dr. Jekyll and Mr. Hyde - he seems like two different people.
7.There is verbal abuse. He calls you names, criticizes you or degrades you. He uses things you have told him in the past against you.
8. He threatens to hurt you or does hurt you.
The book "Why Does He do That-Inside the Minds of Angry and Controlling Men" is an eye opening book into the minds of the men who abuse. It is written by Lundy Bancroft and many of my clients have said, "He was describing my partner exactly!" I suggest that if you see any of the signs above to read this book even just the first few chapters. It is available at the library and on Amazon.
If you have a "gut feeling" that something isn't right in your relationship, trust those instincts. Too often these instincts are excused away, "He's having a bad day", "He had a terrible childhood", etc. Over 90% of the time our instincts are correct. Check out "The Gift of Fear" by Gavin de Becker for more on this.
* I use "he" because the majority of abusers are men although anyone can be a victim of abuse.
Myth: It is physical abuse.
Truth: Domestic abuse is not just about physical violence. There are many types of abuse that are more common and many times more hurtful. These include mental, emotional, verbal, sexual, financial, and legal. Any time a person takes away the power and control of another, it is abuse. Below is the power and control wheel.
Myth: It only happens with married people.
Truth: Domestic abuse can happen to anybody, married, boyfriend/girlfriend, divorced, or with same-sex couples.
Myth: The abuser just needs to control his/her anger.
Truth: Domestic abuse is not about anger, it is about power and control. Anger management classes do not work for abusers. Abusers are able to control their anger when they are relating to others and often come off as charming and successful.
Myth: The victim must be to blame, at least for part of it. Relationships are 50/50.
Truth: Domestic abuse relationships are different than other relationships. They cannot be saved through marriage counseling or by the victim changing their behavior. With a domestic abuse relationship, the victim has no control and can take no blame.
Myth: It only occurs in poor,uneducated and/or minority families.
Truth: Domestic abuse occurs in any and all types of families, regardless of income, education, ethnicity or race.
Myth: Drugs and alcohol cause domestic abuse.
Truth: Drugs and alcohol can exacerbate the abuse, but batterers tend to use these as an excuse for their behavior.
Myth: He said he was sorry and it wouldn’t happen again. He is being so nice and giving me gifts.
Truth: These behaviors are all a part of the cycle of violence (see below) and are all a part of the abuse.
Myth: The victim can always leave.
Truth: The most lethal time for a victim is when they threaten to leave or do leave. The abuser can track and threaten the victim and/or her children. In addition, the nature of domestic abuse
causes financial insecurity and social isolation.
Call 9-1-1 if you are in immediate danger
LifeWire helpline: 1-800-827-8840 or 425-746-1940
National Domestic Violence: 1-800-799-7233
The power and control wheel
The cycle of violence
Trauma is defined as “Psychological or emotional injury caused by a deeply disturbing experience”. Trauma for one person is not necessarily considered trauma by another. Many people associate trauma with an incident that is intense and major. However, trauma can be caused by many different things and can be one incident or many. Shock and denial are usually the first symptoms of trauma with longer term reactions such as flashbacks and nightmares, or physical symptoms such as nausea and headaches.
Most people have resiliency and the symptoms are resolved in time. They are able to move on and lead a life similar to the one they had before the traumatic incident. There are important
steps to take in order to re-establish emotional well-being and a sense of control:
-time: allow yourself to mourn your losses and be patient with your emotional changes
-support: a strong social network including friends, family and others who have experienced similar trauma
-communication: expressing yourself in journaling, art, or in other ways that are comfortable to you
-support groups: a group can be helpful if you have limited social connections
-healthy behaviors: establish a healthy diet and get plenty of rest. Avoid alcohol and drugs as coping behaviors.
-establish routines: this includes eating, sleeping times, scheduling in walks or other exercise. Incorporate positive routines such as a hobby or time with friends
-avoid making major life decisions: changing careers, moving or a relationship change only add more stress at an already stressful time
When trauma symptoms are not resolved the result can be post-traumatic stress disorder (PTSD).
In my next several blogs, I will discuss resiliency and PTSD.
When opening my private practice, one of the things I needed to decide on was whether or not to be on insurance panels. Ultimately I decided not to bill insurance. This was a tough decision for me in that I believe that all people should have mental health therapy available to them. The deciding factors for me were all tied to conflict of interest and my moral beliefs. I believe that by accepting insurance there are times that I would have to make a decision that would put my best interests in direct conflict with my clients’ best interests.
Below are a few of the reasons I decided not to accept insurance.
A diagnosis needs to be made in order to bill insurance. It can’t just be any diagnosis; it has to be a covered disorder. This goes into your record both at my office and at your insurance company. This information becomes a permanent part of your medical records and might increase the cost of your future health insurance premiums. If you do not have a covered diagnosis, I will have to give you a diagnosis that is more severe than is true and can cause moral, ethical, and social problems for all.
Quality of care
The insurance companies want a diagnosis and will then determine how many sessions they will cover under this diagnosis. Insurance companies demand regular progress updates, dictate treatment plans and limit the number of covered sessions. This can restrict the work you and I can do together even though we are more qualified to determine your needs.
Insurance companies are allowed to ask to see your client records. I don’t like the idea that I can be required to share my client’s personal information with an unknown person or number of people. I am a believer in complete confidentiality. I realize it is difficult to share your most intimate details. The idea that I would have to give this information out for payment raises a moral issue with me.
Insight Counseling, LLC
Linda McGarvey, LPC, LMHC, NCC
Plantation Business Center
Phone: 425 458-8100
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