What Self-Care Is (and What it Isn’t)

Self-care is often mistaken for the occasional indulgence—a massage, a long bath, a big vacation, or a special treat. While those things can be nice, true self-care for therapists is about consistency. It’s about creating habits that support our emotional, mental, and physical well-being. This could mean setting clear work-life boundaries, engaging in activities that bring joy (like dance workouts or journaling), or simply being mindful of self-talk. Small, intentional acts make a big difference over time.

Listen to our interview with therapists about how they manage stress and burn-out:

How to Know if You’re Burned Out as a Therapist

Therapist burnout doesn’t happen overnight… it builds up over time from work stress for therapists. A little bit of stress is normal and can even be motivating. But if you’re noticing some of the following signs, it’s probably time to make some changes:

• Feeling emotionally drained after most sessions
• Increased irritability, cynicism, or feeling detached from clients
• Decreased empathy or feeling numb to clients’ experiences
• Difficulty concentrating or making decisions
• Questioning your effectiveness as a therapist (“Am I even helping anyone?”)
• Chronic fatigue, even after a full night’s sleep
• Frequent headaches, muscle tension, or stomach issues
• Trouble sleeping (either too much or too little)
• Procrastinating on case notes, emails, or session prep
• Avoiding certain clients or feeling dread before sessions
• Increased self-isolation or withdrawing from colleagues
• Difficulty “turning off” work thoughts, even after hours
• Noticing a drop in job satisfaction (feeling stuck, unmotivated, or indifferent)
• Finding it hard to be present with clients or feeling “checked out” in sessions
• Thinking about leaving your job more often than usual

One of the most impactful books I have read in my career was “Trauma Stewardship” by Laura van Dernoot Lipsky. This book discusses the physical, mental, and emotional toll of working with trauma or in helping professions. It helped me to recognize my own “warning signs” and how to do this work well without sacrificing my own mental health.

Checking In With Yourself

Regular self-assessments can help prevent burnout from creeping up unnoticed. Tools like the Professional Quality of Life (ProQol) scale can offer insight into stress levels, compassion fatigue, and overall well-being. It’s easy to keep pushing forward without stopping to check in, but a little self-reflection can go a long way in maintaining a sustainable career. In our podcast episode, Shelby shares that this is an assessment she regularly gives to the clinicians at her clinic.

Let’s face it: It’s easy to get so caught up in taking care of others that we forget to check in with ourselves. If you’re feeling stretched thin, overwhelmed, or just off, these questions can help you assess where you’re at and what might need to change. Feel free to just think on these questions, journal about them, or use them with your clinical teams:

• Am I practicing what I encourage my clients to do for self-care?
• Do I feel guilty when I take breaks or set boundaries?
• Am I dreading sessions, procrastinating, or zoning out more than usual?
• Do I feel like I can actually keep up with my workload?
• How often do I check emails or think about work after hours?
• Do I have a solid routine to decompress after work, or do I carry everything home with me?
• Do I still find meaning in this work, or does it just feel like a burden?
• Does my workplace support my well-being, or is it a major source of stress?
• Does my workplace align with my values, or do I feel disconnected from its mission?
• If a friend told me they were this stressed at work, what advice would I give them?

Effective Self-Care Strategies for Therapists (Tips from Our Therapists)

From small resets between sessions to after-work rituals that help create a clear boundary between work and personal life, these strategies can make a real difference in managing stress and preventing burnout. Let’s talk through some tips from our therapists.

The Power of After-Work Rituals

Having a clear transition from therapist mode to personal life can make a huge difference. Whether it’s listening to music on the drive home, taking a walk, or changing into comfy clothes, these rituals help signal to your brain that the workday is over. Without them, it’s easy to let the emotional weight of the job bleed into personal time, leaving little space for rest and recovery.

In the podcast interview, Taylor talks about having a moment on her way home where she stops thinking about work:

“I’ve learned something from other therapists—they find a specific place on their drive home where they mentally stop working. For me, when I lived in Lee’s Summit, there was a ‘Welcome to Lee’s Summit’ sign. It’s kind of weird, but every time I saw it, I started telling myself, Alright, no more work. That sign became my boundary. Just like in EMDR, where we talk about containers, I imagined leaving all the stress, frustrations—even the victories of the day—right there. That was my mental shift: I’m home now, it’s time to focus on my personal life.”

Practical self-care practices for mental health professionals during the work day

Self-care doesn’t have to wait until after work. Small moments throughout the day, like stretching between sessions, taking deep breaths, and stepping outside for a few minutes can help maintain energy and focus. Even something as simple as having a mindful moment between clients can reset your nervous system, keeping you present and engaged.

I know, it’s easy to resort to doomscrolling on your phone, but when was the last time you finished that and felt better? Here are some alternate ideas for workplace self-care strategies:

1. Deep breathing exercises – Try box breathing (inhale for 4, hold for 4, exhale for 4, hold for 4).
2. Progressive muscle relaxation – Tense and relax different muscle groups to release tension.
3. Grounding techniques – Use the 5-4-3-2-1 method to refocus on the present moment.
4. Desk stretches – Stretch your neck, shoulders, and wrists to release tension.
5. Take a short walk – Even a quick lap around the office or outside can help reset your mind.
6. Watch a short funny video or share a joke with a coworker. (I am totally guilty of watching a Nate Bargatze stand up show in between sessions before when in need of a “palate cleanser”)
7. Organize your workspace – A clutter-free desk helps reduce mental clutter.
8. Prioritize tasks – Use the Eisenhower Matrix (urgent vs. important) to reduce overwhelm.
9. Take a nap—I’m convinced that at some point every therapist has taken a nap on their couch.

During the podcast episode, Taylor added:

“Sometimes we overcomplicate self-care. At its core, it’s about basic human needs—eating meals, sleeping, drinking water, moving your body. These things feel like givens, so we devalue them, but they’re essential. During my day, I make sure I have snacks, I drink water, and I pay attention to what I need between sessions. If I feel social, I chat with coworkers. If I need to decompress, I stretch or meditate.”

When Self-Care Means Quitting your Job

Not all burnout is personal—sometimes, it’s the environment.

Signs it’s time to leave your job as an act of self care.

 If a workplace demands endless emotional labor without proper support, no amount of self-care will be enough. In some cases, the best self-care decision may be to seek a setting that truly values and supports your well-being.

Work-Life Balance and Setting Boundaries for Therapists

When I was younger, work-life balance to me meant working long hours, hustling to make enough money for big trips and taking PTO whenever I could. It felt like self-care in those moments was a one-off event, something that was planned in big bursts, like a vacation or a weekend getaway.

Now, as a parent, work-life balance has taken on a whole new meaning. It’s about scheduling my time around my daughter’s soccer games or my son’s daycare breaks. It’s no longer about sprinting to make a big event happen but finding a rhythm that works day to day. It’s more like a marathon now,  sustaining a better pace so that I can show up for my family while still doing what I love professionally. Work-life balance and setting boundaries in my own therapy practice looks like:

• Having firm boundaries on when I’m done with work (not feeling pressured to work until 8pm at night or come in on my day off)
• Keeping work calls and emails to business hours, and not feeling like I need to answer on weekends or when I’m on PTO)
• Not giving my personal contact information out to clients
• Being intentional and choosy about the clients that I see (sticking to my niche)
• Having coworkers I know that I can reach out to for consultation or venting
• Having the flexibility to adjust my work hours or session times to better fit with my life.
• Feeling supported by my boss and my employer to do these things.

Leaning on Support Systems

We preach the importance of support to our clients, but let’s not forget that we need it just as much. Having a therapist, peer consultation group, or trusted colleagues to debrief with can make all the difference when experiencing work stress and burn-out. Processing our own stressors in a safe space allows us to return to our work with clarity, perspective, and renewed energy. This is one of the things I love about being a group supervisor—getting to create a supportive space where we can lean on one another.

Conclusion

Taking care of yourself isn’t just about feeling better—it directly impacts the quality of care you provide. By making self-care and work-life balance a priority, we model healthy habits for our clients and create a career that is sustainable, fulfilling, and grounded in well-being.

Bottomline: therapy is a part of what you do, but it is not your entire identity. Be sure to dedicate time to things that you enjoy and bring you more balance.

Ready to dive in deeper? Listen to the whole podcast here.

Podcast Transcript:

Miranda: Welcome to the Therapist Thrival Guide! My name is Miranda. I’m a licensed clinical social worker, and I’m here with Shelby and Taylor. Today, we are talking all about self-care.

This might be a topic where you’re thinking, I’ve already learned about self-care, but we have so much great information for you—so many tips, so many warning signs—all the things. We’re going to jump right in, but first, I want Shelby and Taylor to introduce themselves. Shelby, do you want to go first?

Shelby: Sure! My name is Shelby Finley. I’m a licensed professional counselor in Missouri and a licensed clinical professional counselor in Kansas. I’m the clinic director for the Kansas City locations for Ellie. We have three locations in this area.

Part of the reason I joined Ellie was to take better care of therapists. I’m really excited to talk about self-care because, as a company, I kept wondering how we can truly pour into therapists. From there, it became about encouraging therapists to take care of themselves, which is why I brought Taylor on—to talk more about what self-care looks like for a therapist.

Taylor: My name is Taylor Magruder. I’m a provisionally licensed professional counselor in Missouri, and I’m a therapist at the Kansas City Stateline location. I work with adults (18 and up) on issues like anxiety, depression, ADHD, PTSD—all those kinds of things.

Miranda: Awesome. This topic is so important, especially this time of year. We just went through a lot of election stress with clients, and now we’re moving into seasonal affective disorder season.

As helpers, we go through our own struggles, but we’re also expected to show up for clients. Sometimes, we neglect ourselves and try to continually pour from a cup that isn’t being refilled. I’m so excited to talk about this because even if you’re listening and thinking, Don’t worry, I take bubble baths when I’m stressed or I go for a run after a hard day—great! But there’s always room for improvement when it comes to self-care, not just for ourselves, but for our families, our clients, and our employees. It’s absolutely crucial.

So, where do you want to start, Taylor? Do you want to dive into how to recognize when you need self-care? What are the warning signs of burnout?

Taylor: First off, I think it’s so funny that you mentioned self-care isn’t just bubble baths. That was literally one of the first things I wrote down when I was thinking about this! What self-care is not.

Bubble baths and face masks can be part of physical self-care, but it’s not limited to that. For me, when I’m approaching burnout or not taking care of myself as well as I should, my texts and emails start to pile up. I become a little avoidant. My to-do list gets longer, and I start feeling overwhelmed and resentful—kind of a woe is me mentality.

At some point, I have to stop and ask myself, What role am I playing in this feeling? Where am I not setting boundaries? Because even though I become avoidant, I’m also lacking boundaries and not being mindful about what I can realistically take on.

Miranda: When you say lacking boundaries, what do you mean?

Taylor: A lot of it is about saying no—to social invitations if I don’t have the energy, to clients who want to schedule more often than I have availability, or to requests that stretch me too thin.

I was telling Shelby that my own therapist has a pretty limited schedule, and in the past, it’s been tempting to schedule my clients during that time instead of prioritizing my own sessions. Eventually, I had to realize, This isn’t sustainable. If I keep making space for others but not for myself, something is off.

Miranda: That’s such a good point. When we talk about boundaries as therapists, I often think about how we tend to overextend ourselves for clients. I was talking to a supervisee recently, and he mentioned giving out his personal phone number to clients.

I get that he cares deeply and wants to be there for them, but I also want to make sure he’s protecting his own boundaries. One of the fastest ways to burn out is getting texts from clients at 10 or 11 p.m. saying they’re in crisis. Of course, we want to show up for our clients, but we also need to acknowledge that if we’re constantly on call, we’re going to end up exhausted, resentful, and unable to be effective.

Shelby: Exactly. There are two big reasons why holding that boundary is important. First, you’re taking care of yourself. Second, as therapists, we’re not supposed to create dependency in our clients.

If a client can only turn to you at 10 or 11 p.m., that’s a sign they need to build a stronger support system. Who else can they turn to? What natural resources do they have? They need to start growing their network, because as much as we care, we can’t be that one person forever. And like you said, Miranda, even on days off, if you get a text from a client, it suddenly feels like work is infringing on your personal time.

For me, not giving clients my personal number is a hard boundary. Everyone’s boundaries look different, but if someone is comfortable with that, I hope they have other boundaries in place to protect their well-being.

Miranda: Absolutely. When I think back to the most burnt out, unhappy, and anxious I’ve ever been in my career, it was right after undergrad when I worked as a case manager. We didn’t have work cell phones—we used Google Voice numbers that went straight to our personal phones.

To this day, I still have a visceral response when Thanksgiving rolls around because I remember three Thanksgivings in a row where I got crisis calls on my Google Voice number, which rang directly to my personal phone.

When I left that job, I promised myself I would never blur that boundary again. I need to be off the clock and unreachable sometimes. That’s why crisis care exists. As outpatient therapists, we’re not crisis responders, and we shouldn’t be expected to be.

Shelby, I love the point you made about making sure clients have a broader support system so they’re not always relying solely on their therapist.

Have either of you read Trauma Stewardship?

Shelby: Yes! I love it.

Taylor: Oh my gosh, me too! The author came to Kansas City a few years ago, and I got to meet her—she even signed my book. I was so excited.

I was just talking to a client about this book recently. I have a few clients in grad school training to become therapists, and I was telling them how Trauma Stewardship was life-changing for me. It breaks down secondary trauma, compassion fatigue, and burnout in such a powerful way.

Miranda: There’s one chapter I always recommend—even if you don’t read the rest of the book. It lists warning signs that you’re not being an effective therapist anymore because of secondary traumatic stress, compassion fatigue, or burnout.

The first time I read that chapter, I felt so called out. I recognized the avoidance you mentioned, Taylor. I also saw that sense of grandiosity—the belief that I’m the only one who can help these clients. That’s never true.

One of the biggest warning signs for me was a loss of creativity. When I stop painting, writing, or being creative in my personal life, it’s a red flag that I’m getting overwhelmed professionally. That book really helped me recognize my own warning signs and take action before I hit burnout.

I think it’s crucial to know your own warning signs and communicate them—to your partner, to your colleagues. I tell my coworkers, If you notice I’m buried in emails or staying late past the time I said I’d stop seeing clients, call me out. Because usually, that means I’m blurring boundaries or not prioritizing myself.

What other warning signs have you both noticed in yourselves?

Shelby: So I think something that I have to own is that some of my warning signs are embarrassing and disheartening to acknowledge. The fact that I don’t want to do things I normally enjoy, that I’m not seeing my friends as often, or even as a leader, when someone comes to me with a problem and my response is just “okay”—that’s minimizing. And I’m not proud of that. That’s a warning sign for me. When I don’t have as much empathy as I’d like or as much to give, I know I need to start pouring into myself. Because at that point, it’s not just impacting me—it’s impacting my team members, their clients, and it creates a trickle effect.

As a leader, it’s important to pour into yourself and also model self-care. Recently, I took a self-care day and told my team, “Hey guys, I’ve had a lot going on, so I’m taking a self-care day. Here’s who you can contact if you need anything while I step back.” I was grateful when my team responded with support, saying they were glad I was taking time for myself. That feedback meant a lot. I want my team to know I’m taking a step back for my well-being because modeling that is important. We all have crummy warning signs sometimes, and we have to own them. If someone brings a problem to me and I respond with “okay,” that’s a sign I need to check myself.

Miranda: Oh my gosh, that’s such a good example. I can think of times when I’ve done the same thing with my spouse. He comes home and says, “I had a bad day at work,” and I’m like, “Bet you didn’t have to make a CPS report today.” I’m so guilty of that.

Shelby: Same! When I worked in crisis, someone would say, “My boyfriend broke up with me,” and I’d think, “Yeah, but you’re not hospitalized, so keep going, sis.” That’s such a crummy response.

Miranda: Minimizing is a real warning sign that if you’re not taking care of yourself, you can’t have empathy for others. We need to be able to sit with someone struggling with a breakup and validate their pain just as much as we do for those in more immediate crisis.

Taylor: So what do you two do for self-care?

Taylor: Self-care is preventative, constant, and non-optional. It’s not just something to do when you’re burned out—it’s something to do all the time. For me, I have a ritual when I get home from work. I don’t do these things because I need them that day; I do them because I need them consistently. When I get home, I stretch for five to ten minutes. If I have more time, I’ll do a dance workout because I genuinely enjoy it. I danced growing up, and I realized I wasn’t feeling motivated by traditional workouts. But with dance workouts, I focus on the choreography, and it’s fun. At the least, I move my body in some way because we sit all day, and I need to reconnect with myself.

Miranda: Where do you find these dance workouts? Because I love this idea. Dancing is so good for mental health.

Taylor: I use Apple Fitness Plus. They have choreographed dance workouts, which I love because I get really into perfecting the moves. If I’m short on time, I’ll just put on my favorite pop songs, grab the TV remote, and dance around my living room.

Miranda: Full-on Lizzie McGuire moment.

Taylor: Exactly! My dog hates it, but I have fun.

Shelby: He’s getting a free concert—what’s his problem?

Taylor: Right?! I sing to him, and he just looks at me with his ears down.

Shelby: My after-work ritual is working out. If I sit on my couch, I’m not getting up again. So I take my dog for a walk as soon as I get home, then I change into gym clothes. If I put the effort into dressing for the gym, I’ll actually go. Another thing I do is check in with myself: Do I need people today, or do I need alone time? Some days, I’m all about socializing; other days, I just need quiet. I’ve even started doing diamond painting as a solo activity—it’s been fun making little gifts for my nieces and nephews.

Miranda: I get that. I’m an outgoing introvert. I like being around people, but I also need alone time to recharge. When I worked in child protection, I had a long drive home, and I didn’t realize how much that decompression time helped me until COVID hit. Suddenly, I was home all the time, surrounded by people, and I struggled. That’s actually why I got a dog—having a reason to take walks really helped. Even now, if I have a stressful day, I make sure to take a quick walk around the block. Just getting fresh air and sunlight can make a huge difference.

Shelby: That’s such a good point. We’ve talked a lot about self-care after work, but what about during the workday? Taylor, how do you handle those seven-session days?

Taylor: Sometimes we overcomplicate self-care. At its core, it’s about basic human needs—eating meals, sleeping, drinking water, moving your body. These things feel like givens, so we devalue them, but they’re essential. During my day, I make sure I have snacks, I drink water, and I pay attention to what I need between sessions. If I feel social, I chat with coworkers. If I need to decompress, I stretch or meditate. My physical therapist gave me shoulder exercises, and I make sure to do them because I carry so much tension there.

Shelby: Finding those little “work perks” is key. One of ours is having comfy couches in our offices. I went to a self-care CEU event recently, and they normalized things like turning off the lights and resting between sessions. At my first therapy job, I was scared to do that, but my supervisor told me, “You have 20 minutes before your next session—use it to reset.” That advice stuck with me, and now I encourage my team to do the same. If taking a quick break helps you show up fully for your next client, it’s worth it.

Miranda: Exactly. Self-care isn’t just about time off—it’s about what we do daily to sustain ourselves.

Taylor: So I’ve been like, okay, let’s turn this into something productive. Now when I get to this one stoplight, where I have service again, I can listen to music or call someone. I take those first few minutes to just decompress.

Miranda: Shelby, you made me think of a couple of different things, but that decompression time—yes, it’s so crucial. For me, in that job I was in, it was necessary. But also, let’s normalize not staying in jobs that require so much more self-care. Yes, we should be taking care of ourselves, but before I came to LA, I had so many jobs that took so much out of me.

And I think for those jobs, a long drive was really helpful because I needed that separation way more than I do now. Yes, self-care is crucial for any helping profession, but no amount of self-care is going to make a toxic job not suck. If you’re in a work environment where you’re not appreciated, underpaid, or just completely drained, self-care alone won’t fix that.

Also, let’s call out that changing jobs can be an act of self-care. You are a highly skilled, highly educated professional, and you deserve a job that prioritizes your mental health too. That’s crucial.

This is going to sound backwards, but I don’t need as much self-care as I used to in those really bad jobs—because being in a job that I love is also a form of self-care. That’s just super important, and it does exist for people.

Shelby: I think you bring up a good point. With clients, we give them all these coping skills, and they tell us they’re using them—but they’re still struggling. At some point, we have to ask: Okay, maybe it’s not you. Maybe it’s the relationship. Maybe it’s the job. Maybe it’s the city.

I remember my first job in community mental health. It was a 40-hour-a-week job, seeing clients back to back. And if you weren’t with a client, you were expected to jump into a group to hit your productivity. It was just constant. I was exhausted. It was the first job I had when I moved to Kansas City, and I wasn’t making any friends because I was so drained all weekend.

I realized, This is not sustainable. I didn’t know anyone in the city. I was lonely, but I didn’t have the energy to meet people. Eventually, I moved into a leadership role that gave me more capacity to pour into myself, but that initial experience really showed me the importance of environment.

Miranda: I think you’re right. At some point, you have to ask yourself: Is it that I’m not taking care of myself, or is my environment just not set up for me to thrive? And if it’s the latter, what needs to change?

So, Shelby, you mentioned the ProQOL—did I say that right?

Shelby: Yeah, that’s how I say it.

Miranda: Could you give a little background? You started talking about how this is a tool you use with the therapists who work for you. Can you tell me more about the ProQOL and how you actually use it?

Shelby: Yeah! So, it’s the Professional Quality of Life survey, and it measures three things: burnout, compassion fatigue, and secondary trauma.

I think it’s great—it’s somewhere between 20 and 40 questions. People can take it online quickly or print it out, score themselves, and see where they’re at in those three areas.

Something we’ve all been saying, but maybe not explicitly calling out, is that we have to keep assessing ourselves. Just like our clients need to check in on their mental health, we, as therapists, have to do it even more. If we’re not taking care of ourselves, it trickles down.

This survey is a great way for me, as a leader, to encourage my team to check in. I send it out once a quarter via email, with both a printable version and a link to take it online. I don’t ask them to share their scores, but I let them know: If you want to talk, I’m here.

Therapists often prioritize everyone else over themselves, and I see it as my responsibility to make sure they’re checking in on themselves. Honestly, I can’t even remember where I first learned about the ProQOL, but it’s stuck with me as a leader.

Some therapists have even shared with me, Hey, since coming to LA, my compassion fatigue score has dropped five points. That’s when I know the change in environment was what they really needed.

Miranda: We’ll share a link to the ProQOL in the description. I think everyone listening should take it—just as a self-inventory to check in with yourself.

Maybe you’re recognizing some warning signs in yourself. Maybe you’re realizing you’re more burned out than you thought. Having an assessment like this can be so valuable.

Are there any other tools you all use to encourage therapists to take care of themselves? Or things you’re doing for your clients—or even yourself?

Taylor: There’s this app that one of my clients told me about called How We Feel. The whole purpose is to track your emotions, practice identifying them, and become more aware of them overall.

You can set it to send reminders however often you want. I have mine set for twice a day—just a little check-in. It asks, How are you feeling? Then it gives you a list of emotions, complete with definitions, which I love.

I think we often overgeneralize—I feel stressed. I feel overwhelmed. But why do you feel that way? Breaking it down into more specific emotions helps you understand what you actually need.

The app also provides coping skills and emotion education videos, and it’s completely free—no subscription or anything.

A lot of my clients love data, so they like that the app has an analysis section where it tracks trends. You can journal a little when you check in, noting who you’re with, where you are, and what you’re doing. It even connects to a Fitbit or a cycle-tracking app.

Over time, it shows patterns—like, Why am I marking myself as anxious every morning? What’s going on then? That insight can be really helpful. Honestly, almost all of my clients who’ve tried it have loved it.

Miranda: That’s really cool. I’ll include a link to that as well. Anytime we find resources that work for clients, that’s great—but when they help us gain more insight into ourselves, that’s even better.

Any last thoughts before we wrap up?

Shelby: The biggest rule—it can’t be said enough—is that every good therapist should have a therapist.

It’s like personal training. You might know how to work out, but a personal trainer keeps you accountable. I always have a gym buddy—if I don’t, I’ll make excuses. But if someone’s waiting for me? I’ll show up.

It’s the same with therapy. Even if you’re just checking in biweekly or monthly, having someone to hold you accountable for your self-care is invaluable. I’ve had clients come in just for that—a check-in buddy to say, Hey, are you actually taking care of yourself?

What we do is really hard. It’s also really unique. I think about some of my days and realize, No one else had that kind of conversation at work today—but I had it twice.

We do such a challenging job. We pour into others all day long, so we have to double down on how we pour into ourselves.

Miranda: Thank you so much for joining. This has been such a great episode—I’ve gotten so many good ideas, and it’s been a great reminder of how I can better check in with my supervisees.

Thank you both for being here, and thanks to everyone for listening!

Shelby: Thanks for the invite—we appreciate it!

The post Self-Care for Therapists: Proven Strategies to Manage Work Stress and Prevent Burnout appeared first on Ellie Mental Health, PLLP.

Listen to our full podcast episode to learn more about this diagnosis.

What is Oppositional Defiant Disorder (ODD)?

ODD is a pattern of persistent defiance, irritability, and argumentative behavior that lasts at least six months and creates significant challenges at home, school, or with peers. It goes beyond typical childhood stubbornness (and beyond squabbles with their siblings). Kids with ODD often struggle with authority figures, frequently lose their temper, and may intentionally push boundaries in ways that feel extreme.

Some common symptoms of Oppositional Defiant Disorder in children include:

• Frequent temper outbursts
• Excessive arguing with adults
• Refusing to follow rules or comply with requests
• Blaming others for their mistakes
• Purposefully annoying or provoking people
• Acting spiteful or vindictive

These behaviors usually show up more with certain people or in specific settings, like with parents, teachers, or at school.

Learn more:

How Is ODD Diagnosed?

ODD is diagnosed in roughly 2 to 11 percent of children and is more commonly identified in boys than girls. Although, this may be just due to differences in how our society interprets certain behaviors. No matter the diagnosis, the goal is to understand what is driving your child’s behavior and how to support them effectively.

A therapist will meet with you and your child to complete different assessments together. They’ll ask you questions about their behavior, how long these issues have been present, if there have been any major changes or adjustments in recent months, how their general health is, school performance, strengths, and goals for the therapeutic work. All of this information helps them to understand the clinical picture and recognize how to best treat the presenting issues. If you would like to get a more in-depth assessment done, you could work with a psychologist for a psychological evaluation, although this isn’t necessary.

A diagnosis of ODD does not mean you are a bad parent, and it does not mean your child is “bad” either. Kids with ODD often have underlying struggles, like ADHD, anxiety, mood disorders, or past trauma that influence their behavior. What looks like defiance is often a sign of deeper frustration, difficulty regulating emotions, or unmet needs.

Is It Really ODD or Something Else?

Behavioral challenges do not happen in isolation. If your child struggles with behaviors associated with ODD, consider other factors that might be at play. Conditions like ADHD, anxiety, autism, and trauma-related responses can all lead to similar patterns of defiance. Sometimes, what looks like oppositional behavior is really a child trying to regain control in a world that feels overwhelming or unpredictable.

How to Manage ODD Behavior in Children

Helping a child with ODD is not about “fixing” them and it definitely does not just mean that they are bad kids. It is about understanding their needs and guiding them toward better coping skills. Here are some evidence-based strategies that can make a difference:

Use Positive Reinforcement

Catch them being good. Instead of focusing only on what is going wrong, reinforce positive behaviors with praise, rewards, and encouragement.

Set Clear Boundaries and Consistency

Kids with ODD thrive on structure, even when they push against it. Be clear about expectations, stay consistent with consequences, and follow through with what you say.

Engage in Collaborative Problem-Solving

Instead of power struggles, involve your child in finding solutions. Ask questions like, “What made that situation hard for you?” or “How can we handle it differently next time?”

Focus on Connection First

Many kids with ODD act out because they feel misunderstood or disconnected. Strengthening your relationship through one-on-one time, validating their feelings, and staying calm in tough moments can reduce defiance over time.

Seek Family Support and Therapy

Parenting a child with ODD can be exhausting. Parent management training (PMT) and family therapy can provide practical tools to navigate difficult behaviors while strengthening your bond.

Some books that I recommend for kids struggling with behavior issues are:

• “The Red Beast: Helping Children Understand and Manage Anger” by K.I. Al-Ghani
  • Age Range: 5-9 years
  • This book uses the metaphor of a red beast to represent anger, teaching children ways to calm the “beast” when it wakes up.
• “When I Feel Angry” by Cornelia Maude Spelman
  • Age Range: 3-6 years
  • This book explores what it feels like to be angry and offers young children simple ways to deal with their emotions.
• “Hands Are Not for Hitting” by Martine Agassi
  • Age Range: 3-6 years
  • This book teaches children alternatives to using their hands when they are angry, promoting positive ways to express their feelings.
• “That Rule Doesn’t Apply to Me” by Julia Cook
  • Age Range: 4-7 years
  • This book is all about learning rules and following them, and why rules are important.

When to Seek Professional Help

If your child’s behaviors are significantly impacting family life, school, or friendships, it may be time to seek support from a therapist, psychologist, or behavioral specialist. Therapists can help to see what’s happening beneath the surface and problem solve with you. Kids learn emotional regulation skills in therapy, while parents can learn tools to set limits in a way that fosters cooperation rather than conflict.

Frequently Asked Questions (FAQs) about ODD

What are the early signs of Oppositional Defiant Disorder?

Early signs of ODD include frequent temper tantrums, refusal to follow rules, and ongoing defiance toward authority figures.

Can ODD go away on its own?

While some kids or teens outgrow ODD behaviors, early intervention with therapy and consistent parenting strategies can help manage symptoms effectively. Addressing some of the underlying issues can be crucial to resolving symptoms.

What is the best treatment for a child with ODD?

Behavioral therapy, parent management training, and structured routines are named as the most effective treatment options for children with ODD.

Can adults have oppositional defiant disorder?

ODD is primarily diagnosed in kids, but it is often the precursor to Conduct Disorder or other mood disorders or personality disorder in adults.

What causes ODD?

There is no one cause for oppositional defiant disorder. As discussed on the podcast, ODD can often be masking for or coupled with autism, ADHD, trauma, or other mood disorders. For kids, behavior is how they communicate.

Is ODD real?

A diagnosis is a grouping of symptoms, and Oppositional Defiant Disorder is a real diagnosis in the Diagnostic Statistical Manual (DSM).

This diagnosis has stirred up controversy because:

1. It is often diagnosed in kids that are strong-willed, rebellious, or defiant, which can be considered developmentally appropriate or somewhat subjective.
2. Family discipline and expectations can vary so widely—it can just be pathologizing inconsistent parenting and family stressors.
3. There is a lot of overlap of children diagnosed with ODD and children that have experienced trauma, are diagnosed with ADHD, or other mood disorders. For this reason, people argue that therapists are not always looking at the full clinical picture when using this diagnosis.

Final Note for Parents

A diagnosis like ODD feels heavy, but it is only one piece of a much larger puzzle. Kids are so much more than their behaviors, and we don’t want them to see themselves as “bad” or “difficult.”

Biases in how children’s behaviors are perceived can also influence how often ODD is diagnosed, especially across different cultural and racial backgrounds. As a parent or caregiver, you are your child’s best advocate. Make sure they are seen as a whole person, not just a set of symptoms.

If you are feeling like your child’s therapist isn’t looking at the full picture, don’t feel bad about switching providers. It’s crucial for you to feel listened to and that the therapist is on your side and supporting your family. A psychological evaluation might also be a helpful step towards ruling out other diagnoses or seeing what’s could be happening underneath these behaviors. Several years ago, I worked with a kid that had been previously diagnosed with ODD. After building rapport, learning more about him and his family, we realized that this kid was struggling with sensory issues and depression. Getting to the root of the issue and making some key adjustments made a huge difference for this kid’s behaviors.

Parenting a child with ODD can feel like an uphill battle, but you are not alone. With the right strategies, support, and understanding, you can help your child learn new ways to manage frustration and build healthier relationships. It will not happen overnight, but small steps add up over time.

Podcast Transcript:

Miranda: Welcome to the Therapist Thrival Guide. My name is Miranda. I’m a licensed clinical social worker, and I’m here with Letisha and Gina, both are veterans of this podcast. They are like my two go to, hey, I want to talk about this topic. I want you to be on this podcast about it. And today we are talking about Oppositional Defiant Disorder. Gina, do you want to go ahead and introduce yourself before we get started?

Gina: Yeah, absolutely. I’m Gina Young. I’m an LICSW in the state of Minnesota and a director of community based programs in Minnesota.

I have been working with kids for the last 12 years and it has come across, my desk a few times, I’ve also supervised staff that have been working with kiddos that have been diagnosed with it.

Letisha: Letisha, do you want to introduce yourself? Certainly. I’m Letisha Harris, and I am a MA studying to get my license to be LPCC. I have been working with kids for a long time. I definitely am very curious about learning more about ODD. I don’t know a whole lot about it, but it’s always nice to learn something new. As well as, I’ve worked with kids for a long time, so I’ve seen it often and not really known exactly what it is or why,

Miranda: yeah, and this is one of those topics and one of these diagnoses that feels very taboo for a lot of reasons, and we’ll get into that.

But I wanted to talk through what does the DSM say? What are the symptoms of ODD? And then I want us to talk a little bit about the taboo nature of it, like why are so many clinicians like Gina very resistant to putting this diagnosis on someone’s chart? And then even just like maybe peeling back some of the layers, talking about some differential diagnosis and treatment.

So that’s what my hope is for today. Gina, do you want to just get us started by talking about what does the DSM say about What do you need to do to fit this diagnosis?

Gina: Yeah, and it starts off its own chapter of Disruptive Impulse Control and Conduct Disorders. And so the DSM 5 says that ODD is a pattern of angry, irritable mood, argumentative, defiant behavior, or vindictiveness lasting at least six months as evidenced by at least four symptoms from any of the following categories and exhibited during interaction with at least one individual who is not a sibling.

So the categories are angry, irritable, angry slash irritable mood, and there’s often loses temper, is often touchy or easily annoyed. is often angry and resentful. The next category is argumentative slash defiant behavior. Often argues with authority figures or for children and adolescents with adults.

Often actively defies or refuses to comply with requests from authority figures or with rules. Often deliberately annoys others. Often blames others for his or her mistakes or misbehavior. the last category is vindictiveness. has been spiteful. or vindictive at least twice within the past six months.

Unless otherwise noted for individuals five years or older, the behavior should occur at least once per week for at least six months, category B, the disturbance and behaviors associated with distress in the individual or others in his or her immediate social context. So family peer group work colleagues.

Or it impacts negatively on social, educational, occupational, or other important areas of functioning. category C, the behaviors do not occur exclusively during the course of a psychotic, substance use, depressive, or bipolar disorder. the criteria are not met for disruptive mood dysregulation disorder.

there are three levels of severity. Mild symptoms are confined to only one setting. Moderate symptoms are in at least two settings. And severe symptoms are present in three or more settings.

Miranda: Gosh it’s interesting because when you’re talking about different settings that raises some red flags around this diagnosis if you have a kid who is only being oppositional at school, or if you have a kid who is only being oppositional at home, it just gives me more questions than answers,

And I forget, and maybe you said this already, but is there an age range that has to meet ODD? No. Okay. I remember there being one for conduct disorder though, like you have to meet. Yeah, that one’s over 18. Okay. oftentimes, for conduct disorder, Part of the diagnosis is that they had ODD or it talks about the precursor.

So when we’re talking about oppositional defiance disorder, what’s your issue with this diagnosis?

Gina: So my main issue is throughout my career of working with children and I started off in an agency that was very much focused on the community and working with kiddos with trauma.

ODD is often given by hospitals and in acute settings because you’re getting a parent report and reports from other adults and the kiddo, but there’s usually a focus on the defiance behaviors. So that can happen. And then I think you see it more often in juvenile justice settings as wella kid that won’t listen, a kid that won’t follow the rules.

And in my time working with kiddos, I have never seen an ODD kid that doesn’t have something else going on. I’ve always found an underlying issue underneath the defiance, whether it be a mood disorder like anxiety or depression, or. In most cases, PTSD there’s always been another piece to it, right?

Children do not exist in a vacuum. They exist in environments and within systems that are heavily influencing their behaviors and their presentations. And ODD is saying. Often loses temper, touchy, angry, resentful, challenges authority, deliberately annoys others. That’s like a lot of children I know. It’s just so wide of a scope.

Miranda: And that’s even something with kids that have depression or kids that have anxiety or kids that have trauma. to me, it feels like ODD is almost a symptom instead of a diagnosis.

Do you know what I mean? It feels more like. This is a grouping of symptoms that leads to, of course, that’s what a diagnosis is, it’s a grouping of symptoms, but, to me, it feels like more of a symptom instead.

Gina: The defiance part of it was always Communicating that there was a greater need that we were addressingwhether it would be a family.

And when I was doing crisis work and going in the home, it was always a structural family issue. the kid had gotten an ODD diagnosis when they were. Six, seven, eight, and that had become the kid’s whole identity in the eyes of the parents, right? it was this grumpy, bad child and their parenting Changed once that diagnosis came through so their relationships changed with the child.

So I just have never met a kid that truly meets ODD criteria across a lot of settings without there being additional trauma and or mood issues. it’s the precursor to conduct disorder and then the precursor to juvenile justice and going to jail and prison, right?

To me, it’s more a lack of resources and a lack of skills and us meeting the needs of the kiddos in our community. And then we put them in jail, so that’s not great, and anybody who gives an ODD diagnosis for any child under the age of five, we will talk I’m not a fan of that.

Gina: And I’m going to name that I believe ODD is more often given to black boys. 100%. Yeah. I think we see that in the data that we know from kids that are getting suspended from school, like from kindergarten onward, is that It’s BIPOC kiddos that are getting sent home. And that are not being looked at with as much support and curiosity as we would give other cultures.

Letisha: Yeah. And that’s good reason because when you think about it, coming from my own perspective, just hearing you say that I’m thinking about my two year old, defiant, antagonizing his brother, like things that a two year old would normally do.

And as he gets older, that probably will continue. It might change and vary in different ways, but is that something that he would then be labeled as? more likely to be labeled as ODD as opposed to a normal two year old who has, obviously there are family structures that are different, right?

Obviously, He may have experienced some PTSD or some other things I’m a firm believer that everybody has experienced some PTSD at some time in their life. some people it affects more drastically than others, how will that impact him as he gets older?

And will this become something that would be more looked at when he’s in school as, more of a defiant behavior as. He resists to do something that maybe he’s not comfortable doing, or maybe doesn’t understand, or maybe doesn’t have a proper communication about what does that look like for him when he gets older, and speaking to it as a person of color, it’s more likely to be looked at as that as opposed to a child trying to figure out where his boundaries lie.

Miranda: Oh, yeah. I had a case a couple years ago where there was a kid who came to me with an ODD diagnosis. This was a kid who had gone through so many therapists, and either he fired them or they fired him.

I think he was only like 12. It was a really hard case because he met criteria for ODD. He met every single thing. And as a new therapist, I remember reading this and being like, he meets criteria, but I’m just really struggling with this diagnosis because I don’t want to put this on him.

I am just skeptical of this diagnosis and I think in that particular case, he ended up having psyche vows too because he, it was a long road coming to me up till that point, he had seen a lot of providers and he also met criteria for major depressive disorder.

And kid didn’t have any trauma that we were aware of in his background, but it was one of those cases where you’re like, I just feel like I’m missing something like you. Yes, we have these symptoms. Yes, he’s on his sixth school in the last two years. But I just feel like I’m missing something.

And I think that for some clinicians, ODD can just feel like a lazy diagnosis where you’re not wanting to go that much deeper.

Gina: It feels to me like sometimes when people give adjustment disorder, I’m like, What are you doing?

Miranda: Adjustment disorder for three years,

Gina: Yeah, exactly. I’d be like, did they adjust to anything? Or what’s going on? And I think this aligns, with people who get diagnosed with borderline personality disorder.

Therapists are like, no, thank you. I don’t want to work with ODD. I don’t know how to work with ODD. And then it becomes, they just cycle through people, which just further ingrains the problem and the lack of connection.

Miranda: Yeah. I don’t remember who it was.

It was probably you, Gina. Someone who told me in my early years of being a therapist, when I was first doing that big wave of diagnostic assessments. I remember thinking about how A diagnostic assessment is really meant to be a snapshot of what is happening and a roadmap of where to go from here.

Yeah. It doesn’t have to be a detailed history on everything that this kid has been through or everything that he, that’s happened. It doesn’t have to be a super detailed it doesn’t have to go through every single diagnose, like there’s just there, there are kids in your life that you’ll work with that will meet multiple diagnoses

I had a chart in grad school that talks about the overlapping characteristics of trauma ODD is one of those overlapping diagnoses And I could have given that kid ODD. I could have given him, major depressive disorder.

I’ve seen plenty of kids that meet both of those and anxiety and you can tack on a million diagnoses onto a person’s assessment But I think the question that you have to ask yourself is this giving me the best clinical picture and the best roadmap forward?

Yeah, so I think you just like rather than just Seeing oh this kid has ODD. Oh this kid has You know, they’ve been diagnosed with X, Y, and Z in the past. it’s up to you as the clinician to say, does this still fit this picture even or, maybe we’re doing like a adjustment disorder for the first diagnosis or something while you’re getting to know them.

And while you’re trying to figure out what is contributing to this clinical picture because I feel like I’m missing something.

Gina: When I think also coming to it with a fresh set of eyes, right? I think we have some providers who read that stuff and some who don’t, and I stopped reading it because I was like, I don’t know what’s been tried, what’s worked, what hasn’t worked, we don’t want to reinvent the wheel.

And we want to get some information about that, but every time you meet a kid, you’ve got to be open to giving them a fresh set of eyes and a fair start some providers read that stuff and some who don’t, and I stopped reading it because I was like, This has so much of its own bias from all of the providers that came before I want to come in clear eyed to this situation so that I can make my own decision,

Letisha: Yeah. And to that point, the child if they’ve gone through multiple providers, they’re expecting for you to have that same perspective of them, right? They’re expecting that label is who they are. And you coming in with a fresh set of eyes allows for them to not be seen under that label, but to be seen as who they are, and then you can make a proper diagnosis because you’re looking at them from a fresh set of eyes.

And it can be very intimidating to see certain diagnoses as a clinician, and be like, oh, what kind of crap am I going to get myself into? What kind of person are they going to be, right? But if you allow yourself to have fresh eyes on it, then you can say that may be what somebody’s perspective of, as Gina was saying, that may be their perspective of this person.

But I do have to do my due diligence and allow myself to really see who this person is and see who this child is or this adult, right? See who they are under. That lens as opposed to under the lens of somebody else’s previous experience with them. One ODD child may not be the same as the last ODD child, right?

And one ADHD child may not be the same as the last ADHD child. Being able to See each child differently each day, right? Each week that you come in to see them, you have to have a different set of eyes. That was one thing I learned when I was working in child care, is that I cannot say, you did all of these things to me yesterday, right?

First of all, that’s a two year old or a four year old. They don’t really care or remember what they did to you yesterday, I can’t come in with that bias because then I’m not going to be able to truly educate them help them get to the treatment plan and help them move along in their journey.

Miranda: I think that’s especially key with diagnoses like oppositional defiant disorder where you come in and you’re just like, going to look at this. In a new way I think there’s also a lot of diagnoses, even for adults I was working with a client who came in as an adult and had borderline, I’m not afraid of borderline.

I love my borderline clients. my very first question is usually do you agree with this diagnosis? Do you think that this is, Yeah. Let’s just talk about this. I think that talking about it is going to decrease some of the stigma and the scariness about it.

But You can also take the same principles and think about it when you’re working with kids, about how parents might approach a kid, or if a parent is exhausted and they’re like, this is why my kid’s in therapy, or this is what the issue is, and then you sit down and you talk to the kid and you’re like what do you think the issue is?

Or what’s behind it for you? Or what do you want to be working on? your buy in is going to be so much greater, but then also, you’re going to get so much more insight, again, into the issues below the behaviors, because the parents are sometimes only looking parents, teachers, insert.

But a lot of times they’re only looking at “Oh, he got expelled again” or “Oh, he’s suspended.” And so I think that it’s important to be able to take those cases and try to be as unbiased as you can, because those kids probably have a lot of grownups in their life that don’t believe in them that just only take their behaviors at face value and say he’s a bad kid or he’s this way.

And I think that as therapists, it’s our role to hold on to the hope for our clients, but also be able to look deeper.

Letisha: Eliminate some of those expectations. Because it can be that they don’t. See much value in them, and it can also be that they see way too much value in them,

they think, oh he would never do that, They think so highly of them, right? And the pressure that puts on a child Is overwhelming. Or the enabling that can happen. You have to be this way. You have to do these things. when I was in high school, I had a friend who was overwhelmed with having requirements to be getting A’s all the time.

Miranda: And so that pressure that was on her was overwhelming. I can’t imagine that a child that is considered to be labeled, a certain way or a certain behavior, how much that behavior and the expectation for them to be different is put on them and how much pressure that is for them and they’ll start to that diagnosis, We talked around this a little bit, but let’s talk about differential diagnosis and what are some diagnoses or things that if you have a kid that’s labeled as ODD or maybe you’re considering this diagnosis yourself as a clinician, what are some kind of alternatives or even just what could we be looking at?

Yeah. A DHD. That is a big one. I work with a lot of kids with ADHD and I adore them and they can be really annoying. And there’s nothing wrong with that, right? They have big feelings. They have a hard time expressing them and they want them to get met and they feel like they’re the most important.

Gina: So I absolutely think they can lose their temper. They can be very touchy sometimes. They can have trouble following rules.

Miranda: I think they check a lot of these boxes as well. so it’s important to either make that referral for testing, if appropriate for ADHD.

Gina: Like Miranda said about a snapshot in time, this is a Polaroid of just this moment and we really need to get a view of the child’s functioning across their lifetime and in the various settings that they’re in too. I think there’s quite a bit of crossover with ADHD, I think there’s quite a bit of crossover with trauma.

Miranda: I think the difference with ADHD and ODD is it’s coming from a place of hyperactivity ODD. would look more like deliberate defiance, where an ADHD kid would maybe believe me, it’s they’re not looking at you in the face, in your face and being like, I’m not doing that.

It’s more of it might look different where they’re constantly forgetting they’re supposed to be doing something you were saying it also looks like trauma.

Gina: Trauma and autism. Those are the two things. Especially with trauma. And I think a lot of times from my past experience with kiddos with trauma that end up with an ODD diagnosis, it’s because they can’t trust adults because of things that have happened.

Yeah. We’re talking about complex trauma over a lifetime, a child’s lifetime. We’re not talking about a car accident or one moment. We’re talking about repeated losses and repeated letdowns by systems and by adults. And so by the time you get to them, when they’re 15, they’re over it, like they’re not going to trust another adult.

They’re not going to talk to another therapist that hasn’t been helpful. And so instead the systems have judged and tried to control versus tried to understand and be curious. trauma looks like a lot of different things for different kiddos. a lot of the situations that I’ve come across underneath ODB has been a lot of experiences of trauma.

But other people maybe have not identified it as trauma.

Miranda: And think about it too, it is not a coincidence that when I worked in the foster care system, every kid, I, Worked with as a case manager had been diagnosed with ODD at some point whether it be attachment loss, real traumatic events, like whatever it is, there are things underneath it that are leading to exactly what you’re talking about, Gina.

And this is especially key when we’re thinking about kids who had pre verbal trauma who Can’t say what is bothering them. they feel it differently. They’re experiencing their trauma in their bodies rather than being able to like,

Gina: Nobody named that for them, right? It wasn’t okay to be scared. They had to just not cry and keep moving on with whatever they needed to do. So I agree. So many foster care kids end up with that diagnosis and that is, I think, really harmful to them.

Miranda: Oh, absolutely. when I worked as a home study worker, I would write home studies for families we thought they might be a good family for, then they would go through a period of what was called full disclosure, documentation on this kid so that they could get a full picture of who they might be adopting for so many of those families they would see ODD and they’d be like “ooh, I don’t know if I can do that. I don’t know if I can deal with being a super defiant kid all the time.”

And then, naturally my next thought would be like, “why are you doing this?” but also, I think that diagnosis was very harmful when it came to whether or not a child was quote unquote adoptable.

Gina: And so that was absolutely harmful for a lot of those kids.

Letisha: It’s very harmful when you think about the aspect of the child being accepted, right? If like you were just talking about with adoption, with foster care as well That child, my perception of defiance is different than another person’s perception,

I’m only going off of what I perceive to be defiant. if I’m saying defiant, I’m thinking like, this kid’s gonna be running away, this kid’s gonna be Cursing me out, this kid is going to be doing all of these things, right? Whereas this kid may just be a kid that says no, and it’s very deliberate about their no, if they don’t feel that safe space, they’re more likely to be like, I’m not doing that.

I’m not going there. that defiance is different than it. varies in that expectation of who that child is. you set the child up for failure when the person doesn’t really know the child except for on paper and what somebody else is perceiving to be their behavior.

Gina: What about mood disorders? how might this, what’s the Venn diagram of ODD? Irritability, especially in any kiddo under the age of 18 is definitely one of the criteria for MDD, right? And if we’ve met any teenagers, they’re challenging authority often. like everything’s on a continuum, like we’re talking about, right?

you are absolutely dipping into the mood disorder. Pop when you’re looking at ODD and the other one I was thinking about was autism too. Because let me tell you, they want it a certain way and it’s the only way their brain will accept it to be.

Letisha: Yeah.

Gina: And so here comes a grown up who wants it to be their way for whatever reason they have, especially in a school setting or anything like that.

Especially if they have sensory sensitivities or kids who have trouble communicating, like that are on the autism spectrum, kids use behavior as language.

Miranda: if they don’t want to do something and you’re trying to get them to, but they can’t verbalize that, it can look differently.

Gina: I’ve been learning more about persistent demand avoidance. And how big of an impact that can have on kids with autism and kids with ADHD with a nervous system that’s so dysregulated that it’s always going to look like defiance to other people when in reality it’s them needing it to be offered a different way or at a different time when they’re calmer and when their body is feeling safer.

It’s like your fight, flight, freeze response where if you are sensing that, you’re under attack or something, if your nervous system is sensing that something is wrong,

Miranda: Your amygdala is going to be like, okay, These are your options. for a lot of kids, that’s fight, for me, it’s fight. I’m not going to punch you, but I’m going to fight back, and so defiant.

I think this is just a key part of the conversation there are so many things that can look like this but the part that I think is very unique with ODD that you don’t see in these other diagnoses is the idea of vindictiveness.

Gina: it’s that idea of revenge. Yes.

Needing to get back at the person. when we started working together, you had a kiddo with ODD who could not let go of like, When they had been slighted, they kept a track in their brain of this person has, bumped me in the hallway, they took my lunch, they slid my locker, all of these little things that could be let go.

But for this kiddo, we’re so magnified that you don’t see necessarily in autism or in a mood disorder, but it’s very specific to ODD.

Miranda: it is like an obsession, though.

Gina: Agreed. To me, when we’re talking about a kid who cannot let go of something and it’s like they’re fixated on being slighted it doesn’t necessarily veer into OCD, but it reminds me of the obsessions, like I’m fixated on this and I feel like I have to do something about this, which again falls under anxiety, It’s this idea of injustice which is if the adults are not going to take care of it, then I’m going to get revenge for what I think was a very serious injustice to me, even if it was small And it gets not just obsessive, but magnified in their mind and becomes a much, much bigger deal than what is really going on.

Miranda: But everybody does that on some small level, too, though. I could have an argument with my partner, and then I’m gonna think about it, and it’s gonna get so much bigger in my mind. By the time I see him, we’re gonna have an argument about it.

Letisha: Your part gets smaller. But that’s what I’m saying, is it’s like, there are some parts of this that are common to all people.

Gina: there are shades of it, that are normalized to some extent.

Letisha: I get bitter and mad at some people sometimes and I can’t let it go.

But with a kid with maybe an overwhelmed nervous system and trauma and a lot of adults and systems that are like, you’re the problem. I can imagine. It’s no wonder this gets so big for him. And kids have so little control over so many aspects of their life.

And then you put this diagnosis on top of them. I can only imagine how invalidating that is.

Miranda: To piggyback off of that for a second though, like, how often are kids being told their diagnoses or are they seeing them on a piece of paper and being like, what does that mean?

I think that they’re adults alike where, you might be diagnosed with something and then it’s, I remember I wrote a home study for a family years ago when you’re going through the adoption process, you have to have a letter from a therapist if you are seeing a therapist, you have to have a letter from them that says this is the diagnosis and we approve them or whatever, which is, don’t get me started on that.

As an adoptive parent, it kept me from going to see a therapist during the adoption process because it was another cumbersome step. there’s a letter you need from a therapist if you’re seeing one.

I was writing a home study for this guy and he got a letter from his therapist or he, it like got sent to us and then we included it in the home study. then he was reviewing the home study and he was like, What? I’m diagnosed with Borderline Personality Disorder?

But it was a major diagnosis where he had no idea that he had been diagnosed with this. And I think that happens with kids too. I don’t know how I feel about it’s not like every kid needs to know exactly what their diagnosis is either, but it is just a weird thing.

we are labeling you and then Not talking to you about what this means

Gina: I could do a whole episode about the need to keep them informed at a developmentally appropriate space. I’m not going to be using the words that we’re finding in the DSM, but they’re going to know that they have worries that are affecting a lot of areas of their life.

Yes. as a kid who was in therapy themselves, like I didn’t know what I had into later on. And I was like, Oh, I should have known like that would have been really helpful. Like my parents maybe would have known somebody should talk to me. That would have been really helpful.

And therapy is so scary for kids anyway, because it’s parents making them go. Unless you’re over, like 10 and up and you’re requesting to go, it’s really parents are bringing their littles in and are like, fix these kids. And so I’m not participating in that. it’s going to be a way more inclusive environment.

they’re going to know when I list and I ask all these questions, I want them to know what we’re going to be working on. And I want them to. De stigmatize whatever disorder we’re giving, right? And by not talking about it, we’re keeping it in secret.

Letisha: Aeah, I’m not a fan of that . I was just gonna say, also not weaponizing it against the child, because sometimes you have that parent who’s overwhelmed or frustrated, and it’s a weapon against that child, as opposed to You have this disorder, that is affecting and impacting your everyday life.

And these are the steps that we’re taking to help you manage that. That’s a different conversation than screaming at them because you’re overwhelmed about their diagnoses. And now they’re looking at that as a negative thing on top of all the other negative things that they may be experiencing.

So not using it as a weapon, but allowing them to understand what this does, how this impacts you, what things we’re doing to help manage that, and how we’re helping you to treat that diagnosis so that it helps them to better understand it and be able to work with it and process through it as opposed to it becoming something negative.

So how do you treat ODD?

Miranda: Gina.

Gina: I was doing a little bit of research before and I was looking at the prevalence rate and it’s 2 to 11%, which is really small. it is definitely seen more often in boys than it is girls. I honestly have never met a girl with ODD.

I don’t think I’ve ever encountered a kiddo. With ODD. in my encounters with it, it’s been family interventions that have worked with parents on how to support the kiddo and help them build the skills that they need, at home and then at school as well. And I want to get back to Leticia’s did something really great about weaponizing. ODD can be very much weaponized in schools. And so if you get a kiddo in special education that has an ODD diagnosis, I’ve never seen them in the mainstream setting.

I see them in level three and level four. Because it’s the teachers who are like, I’m not taking an ODD kid. They get shuffled along, and is this helping them having this diagnosis, or is it hurting them?

In fact, are the adults changing their behavior based on the diagnosis that this kid is coming in with? And they spend six hours a day in school, sometimes eight. That’s half their day. And if their teachers are feeling ill equipped and stigmatizing the child, it’s just going to make it worse.

Letisha: That’s true.

Miranda: Yeah. the kids that I’ve had that have been diagnosed with ODD, I have found the most success. With working with them when we come up with goals together When we are heavy with partnership and figuring out, like what are you getting out of this?

Can we come up with different reward systems? Can we do different things that will? Like I had one kid who I had a ticket system where he got a ticket every time he came to session and another ticket if he did something I wanted to do,

And so usually it’s going to be like, do you want to, read a book about it? What do you want to read a book about? and then he got two tickets if he brought something to talk to me about. this kid was obsessed with Pokemon cards, and so I went through a lot of Pokemon cards with this kid, but I want to be clear that when I started seeing this kid in therapy, I had a hard time at first because I was like, I don’t know what to do.

I don’t know if I’m making any progress. It feels like we’re taking forever to build rapport. And it feels as one of those clients where I’m like, oh, I don’t dread seeing you, but I’m also just I don’t know thrilled to see them either. But I think it’s because I was feeling ineffective. It was more about how I was feeling when I was with him. And then I realized that. I think I worked with him for a year or something like that.

By the end of the time that we worked together I’d love to be able to say he made some progress, which was great. but it was just a super hard case where I still think back on that case. I still think that I was missing something in there, whether it be some trauma or something. I was probably still missing something that, he wasn’t communicating to me, and I wasn’t getting from parents. there’s a lot of beauty in the hard cases and a lot of room for improvement. if you are a therapist listening to this being like I have an ODD case that I’ve, that I just am having so much hard, such a hard time with.

It’s I just want to say that, yeah, like they can be hard cases any diagnosis can be a hard case. not just ODD kids, there’s a lot of improvement that can happen. I would encourage you to look at the. individual symptoms and the things leading to this diagnosis,

Gina: You’re going to treat the different things causing distress around autism. I looked up some evidence based practice and one of them was parent management training, which involves teaching parents effective strategies to manage their child’s behavior through consistent positive reinforcement. It’s considered the gold standard of treatment.

Miranda: Makes sense that it’s positive reinforcement that works and not just like I’m taking away everything from you.

Gina: Which is, I think when I was working at Holmes, Parents were removing doors off the hinges and taking everything from the room.

And I was like, they look like a prisoner. This isn’t going to work. it’s not going to work. You can’t take everything from somebody and then still expect them to behave. You know what I mean?

Miranda: Especially if they’re a kid that has been in foster care or has had trauma because they’ll be like, I’ve had everything taken away from me before.

Gina: it just fine.

Miranda: Okay. That’s so interesting. And that kind of tracks with what you were just saying, where it’s so much of, involving the parents.

Letisha: They also listed cognitive behavioral therapy. It can help children with ODD learn to identify and manage their emotions, develop problem solving skills, and challenge negative thoughts, contributing to defiant behavior.

I try to talk about with the people that I supervise is I need you to get an idea of how the child views the world, right? If we can get a snapshot into their brain and understand what negative cognitions they might have that have shaped their identity and their behaviors.

That’s the thing that we can work on to change. And once you change the negative thoughts, you can then change the behaviors. and I think you can do that at a young age too, but somewhere along the line with kids with ODD, it was instead of do what everyone else is doing, I’m going to defy and act out.

And what messages did you get around that, right? And so exploring that more, I think CBT is a cornerstone for a lot of the therapy that we do. And so I’m happy to hear that it’s in here too, as a tool for kids with ODD.

Miranda: This has been awesome. Thank you so much to both of you for joining. This has been a really good discussion and hopefully this has been helpful for people listening just to hear some clinicians talk through how they’ve struggled with this diagnosis and where to go from here because it’s something that’s being diagnosed we need to know how to navigate it and also just how to See what’s underlying too.

I think it’s important. I agree. I don’t think kids are inherently bad. And I think that’s maybe why I struggle with this one. Thank you both so much.

Letisha: Thanks, Miranda

The post Oppositional Defiant Disorder (ODD) in Kids: Symptoms, Causes, and How to Help appeared first on Ellie Mental Health, PLLP.

In this interview-turned-blog-post, Miranda Barker, LICSW talks Jordan Mealey, a licensed professional counselor and clinic director from Ellie Mental Health – Central New Jersey location. Jordan is a Grief Recovery Specialist and trained in the Grief Recovery Method. Together, they delve into the nuances of grief recovery, offering invaluable insights into effective methods for helping individuals navigate the deeply personal and often challenging journey of grieving.

Listen to the podcast here:

Introduction to the Grief Recovery Method

“Grievers grieve at 100 percent and every griever grieves differently,” shares Jordan. She emphasizes the uniqueness of each person’s grief, shaped by their personal relationship and experiences with the loss. The Grief Recovery Method, a structured program designed to help individuals process and manage their grief, has proven to be an effective approach for many. It’s grounded in the belief that “grievers are not broken” and focuses on delivering tools for personal healing.

Key Components of the Grief Recovery Method

Understanding Emotional Communications

One of the central tenets of the Grief Recovery Method is addressing “incomplete emotional communications.” These are the unexpressed feelings and thoughts about the deceased or lost relationship that still linger and cause pain. Jordan explains that these can include “unmet expectations, unfulfilled wishes, and unresolved grief.” Addressing these can significantly aid in the healing process.

Searching for counseling while grieving? Find your nearest Ellie Mental Health here.

The Loss History Graph

A crucial assignment in the method is creating a Loss History Graph. This visual tool helps individuals document significant losses and changes throughout their lives. Jordan describes it as starting with the “dawn of conscious memory” and plotting key losses across a timeline. This exercise not only helps in visualizing one’s grief journey but also assists in identifying patterns and unresolved feelings.

Practical Steps for Therapists

Active Listening and Empathy

Jordan stress the importance of being a “heart with ears” for grieving clients, a concept that embodies deep empathy and active listening without judgment or unsolicited advice. “Listen with your heart, not with your head,” Jordan advises, highlighting the emotional nature of grief over intellectualizing or problem-solving.

Creating a Safe Space

Ensuring a safe, private, and comfortable environment for clients to express and work through their grief is paramount. Jordan recommends that therapists encourage clients to “sit for themselves and just feel and be in it,” taking necessary breaks without pressure.

Looking for tips for supporting kids that are grieving? Discover how you can help children navigate grief and loss today.

Balancing Structure and Flexibility

While the Grief Recovery Method typically takes eight to ten weeks to complete, Jordan notes that it often extends to 12-14 weeks in practice. This flexibility allows clients to process at their own pace without feeling rushed.

Educate that Grief is not Linear

Elizabeth Kubler Ross’s “Five Stages of Grief” was actually created when she was researching dying. It was not meant to be applied to the typical person that is walking through loss.

Reinforce to your clients that grieving is not linear: You might not experience each of the famous “stages” and the grieving journey looks different.

Grief also does not have a time frame. Learn more about prolonged grief disorder and the steps you can take to begin the healing process today.

Dealing with Immediate Grief in Therapy Sessions

When a client unexpectedly brings up a recent loss, it’s essential to provide immediate support. Instead of diving into the details of what happened, Jordan suggests focusing on emotional support: “How can I support you right now while you grieve?” This question can offer comfort and set the stage for a more involved exploration as the client is ready.

Common Missteps to Avoid

Jordan also discusses the many well-meaning but ultimately unhelpful phrases people often hear. Statements like “God only gives you as much as you can handle” or “There are other fish in the sea” can unintentionally invalidate the person’s grief. As therapists, being mindful of our language and ensuring it fosters validation rather than minimization is crucial.

Closing Thoughts

Grief is an inevitable part of life, but it doesn’t have to be navigated alone. As therapists, our role is to provide a compassionate, understanding presence and the right tools to help individuals find their path through grief. Jordan’s insights and the principles of the Grief Recovery Method serve as a valuable guide in this critical work.

“I just learned so many beautiful morals and values of what it is to be a selfless person and, loyal and loving,” Jordan reflects on his personal experiences, further emphasizing that the journey through grief, while challenging, can also lead to profound personal growth and understanding.

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By understanding and implementing these techniques and perspectives, therapists can better support their clients through the often-painful journey of grief. For more detailed information and resources on the Grief Recovery Method, therapists can visit their official site and consider specialized training to enhance their practice.

Check out the full Youtube episode below.

The post Understanding Grief Recovery: Interview with Jordan Mealey appeared first on Ellie Mental Health, PLLP.

Meet the Experts

We interviewed three experts that are diagnosed with ADHD themselves, and specialize in working with clients with ADHD:

• Davin Cobb: A licensed associate marriage and family therapist at an Ellie Buckhead location in Georgia.

• Christina Gonzalez: A licensed clinical social worker at Ellie Mental Health of Central Jersey.

• Joey Lisvardi: A physician assistant based in Minnesota, specializing in remote sessions.

Watch the Full Interview:

Read the full transcript of the interview here.

The Initial Steps for Therapists

When suspecting a client has ADHD, therapists often face the challenge of how to proceed. Miranda set the stage by asking, “What is our first step? You think you have ADHD—Now what?”

Christina recommends therapists do an initial inventory with clients: “I kind of like run it down with my clients of ‘What does that look like?’ and ‘How are you associating with it?’ Ok, you are having these symptoms, but is it isolated or is it kind of a constant thing?”

There’s not a simple internet “do I have ADHD quiz” you can take—but there is official testing that can give the diagnosis, tools, and suggestions. If they seem to be hitting a lot of the check boxes, you’ll want to recommend diagnostic confirmation testing.

Common Symptoms and ADHD Evaluation

Remember that ADHD looks different from person to person. Some common symptoms of ADHD include:

• Fidgeting and restlessness
• Being easily distracted
• Difficulty focusing
• Impatience or impulsivity
• Time management issues
• Forgetfulness and disorganization

The Role of Medication

Medication can be a helpful tool in dealing with the symptoms of ADHD, and there are a lot of different options! Joey discussed the importance of considering individual symptoms and comorbidities when prescribing: “For someone has a history of substance use problems, it’s important to prescribe something that’s not going to carry as much potential for being misused.”

Read our deep-dive blog post about ADHD medication here.

Joey highlights the importance of a collaborative approach, involving both therapists and prescribers: “I try and encourage patients to talk with a therapist to set themselves up for success with their environment or lifestyle.”

Tools for ADHD

The experts emphasized the importance of personalized strategies to manage ADHD. Davin shared her approach to creating a “toolbox of routines”: “I let them like create a story of their life, of what their experience is like, like through their lens. I often like to do that to understand what they’re actually experiencing.”

Christina highlighted the importance of parent education and self-regulation for kids: “Creating a toolbox for them of self-regulation…and for some, there is that stigma on medication. So a lot of parents don’t want to put the kids on medication.” She emphasized being able to teach tools and skills if they’re not ready for medications.

Here are some other ADHD tools that they recommended:

• Breaking down tasks into smaller actions: Here’s a “Focus Plan” worksheet we recommend!
• Calendar: Having an updated calendar to help with forgetfulness. Additionally, using a daily calendar that breaks down tasks by the hour (or at least in smaller increments) can be helpful for time blocking.
• Fidgets: If you’re feeling fidgety, have something to do keep your hands or body occupied can be helpful! Consider using an under-desk elliptical, kinetic sand to play with, taking physical notes, or having a coloring book on hand (here’s a funny ADHD-themed one).
• Body doubling: This is when you ask someone to work alongside with you… you’re not working together, but rather just working on different things in the same room. Having someone else that is focused can help you stay on task too.
• Set timers for how long you want to work on tasks for. For example, set a timer for ten minutes and get as many notes done as you can in that time (my personal favorite is to play “All Too Well (Ten Minute Version)” and try to get as much done during that song as possible. There are several other apps for this too.
• Visual aids like lists, whiteboards, or dry erase markers on glass doors can serve as good reminders: “I am a big proponent of lists and being able to physically cross things off.” – Christina

ADHD Tools for Therapists

The interview concluded with valuable tips for therapists who themselves have ADHD. Davin acknowledged the ongoing adjustment required: “It’s a forever evolving thing…I have to create a system that works for me and the way my brain operates.”

Optimizing your environment is key. Joey found great success working from home and avoiding office distractions: “I do so much better from home. I am less likely to wander around the office and talk to everyone.” He emphasized the importance of setting up a conducive environment by having a designated workspace to minimize distractions and using an under-the-desk elliptical to manage his energy and stay focused.

Christina added her long-standing strategy of writing things down on a physical piece of paper: “If it’s on a virtual calendar, nine times out of 10, it’s not gonna be remembered, even though I get 12 notifications on my phone.” There are all sorts of paper calendars out there that can help you stay organized and on top of your everyday tasks.

You Can Thrive with ADHD

ADHD can be a challenging at times to manage, but with the right strategies and support, it is possible to thrive. Whether you are a therapist helping clients cope with ADHD or managing your own ADHD symptoms, we wish you luck!

Listen to the podcast here:

Spotify

YouTube

Apple Podcasts

The post ADHD Tools and Tips: Insights From Our Experts appeared first on Ellie Mental Health, PLLP.

Meet the Experts

Miranda:  “Welcome to the Therapist Thrival Guide. My name is Miranda Barker and I am here with Marissa and Madeline, who are both Ellie employees. Can you both introduce yourselves and explain what you do at Ellie?”

Marissa:  “Yeah, sure. We work with the outreach department for the Ellie franchise side, supporting franchise owners and clinic directors with tips and resources for effective community outreach.”

Madeline:  “I’m Madeline, and outreach is more about the interpersonal side of marketing. We target audiences and establish long-term relationships that translate into referrals and partnerships.”

The Importance of Relationships in Outreach

Miranda:  “Outreach is all about relationships. It’s not about appearances. It’s about nurturing genuine connections. Time spent on building these relationships pays off.”

Marissa:  “People often see outreach as gimmicky or salesy, but it’s more about genuinely interacting with the community and offering value. You might feel uncomfortable initially, but genuine interactions lead to real connections.”

Strategies for Effective Mental Health Outreach

Understanding Outreach:

Miranda:  “Could you describe what outreach in this context means?”

Madeline:  “Outreach involves human interaction to build long-term relationships that can lead to referrals and partnerships, benefiting clinics over time.”

Initial Steps:

Miranda:  “What’s the first step in outreach?”

Madeline:  “Start with some research and planning. Utilize tools like Google to identify nearby target areas and create an organized planner. Know who you’re speaking with and why.”

Marissa:  “Effective outreach involves detailed pre-planning and research to identify the right stakeholders and set up meetings.”

Customizing Your Outreach Plans

• Know Your Audience: Tailor your outreach efforts based on the services you provide and the specialties of your therapists. Don’t go to schools if you don’t have therapists who specialize in treating children.

Marissa: “You want to match your outreach focus to what your clinic specializes in.”

• Outreach Goals: Define clear objectives for your outreach, whether it’s building brand awareness, forming partnerships, or directly attracting clients.

Marissa: “Set clear objectives and goals for what you’re trying to focus on.”

Targeting the Right Partners

Miranda:  “Should we look for referral partners, clients, or both?”

Marissa:  “Both! Set clear objectives. For new clinics, focus on getting both referrals and letting people know about your services.”

Madeline:  “Sometimes, client conversations happen spontaneously during outreach. Be ready to address immediate needs as they arise.”

Healthcare Professionals and Therapists:

Reach out to local medical offices, therapists, and even schools. They can be wonderful referral sources, especially if they are aware of your services and feel confident in referring their clients to you.

Marissa:  “Don’t just focus on medical offices. Contact other therapists who might have long waitlists or don’t accept insurance. Establishing a mutual referral network can be incredibly beneficial.”

Madeline:  “Schools can be more challenging due to varying district policies. However, contacting school counselors or mental health coordinators can open doors.”

Engaging Community Events and Conferences

Conferences:

Miranda:  “Are conferences worthwhile for outreach?”

Marissa:  “Absolutely. Conferences are great for brand awareness, client referrals, and potential recruitment. However, not all conferences are the same. Research them thoroughly before participating.”

Madeline:  “Partnering with other clinics to split costs and responsibilities can make it more feasible and effective.”

Ways to Engage at Events

• Walk Around: Take advantage of lulls at events to network with other exhibitors and potential partners.

Miranda: “Walking around during lulls at conferences can help you make valuable connections.”

• Fun Giveaways: Use quirky or context-appropriate giveaways to attract attention and make your booth memorable.

Madeline: “Quirky T-shirts, mugs, or practical items like sunscreen can draw people in.”

• Be Approachable: Stand up, smile, and engage visitors with simple, open-ended questions.

Marissa: “Standing and smiling makes a big difference. Ask engaging questions like, ‘Have you heard of Ellie?'”

Community Events:

Events like Pride parades or local fairs are excellent for more relaxed and engaging outreach opportunities.

Marissa:  “Community events are fun and relaxed. Engage with attendees through interactive activities, music, or attractive giveaways to draw them to your table.”

Nurturing Relationships

After meeting potential partners, follow up is crucial.

Marissa:  “Stay in touch. Send personalized follow-ups, holiday greetings, or updates about your clinic. Keep the relationship active and genuine.”

Madeline:  “Ask people about their needs and how your clinic can support them. Personalized and relevant communication makes all the difference.”

Tips for Long-Term Relationship Building:

• Follow-Up Personalization: Remember personal details and send thoughtful follow-ups to show genuine interest and care.

Marissa: “Send personalized follow-ups that reflect your conversations and understanding.”

• Use Tech Smartly: Supplement personal contacts with useful newsletters or informational emails but watch the frequency.

Madeline: “Offer opt-ins for newsletters without overwhelming contacts with automated emails.”

TLDR: Tips for Effective Outreach

1.  Be Authentic:  Your genuine passion for mental health will resonate more than a rehearsed elevator pitch.

2.  Do Your Homework:  Research potential partners and understand their needs.

3.  Engage Genuinely:  Successful outreach is not just about handing out cards but about establishing real connections.

4.  Follow Up:  Always follow up with contacts to nurture and strengthen the relationship.

5.  Be Open:  Feel free to ask questions and admit when you’re not sure about something. This authenticity can lead to deeper and more meaningful conversations.

In summary, staying genuine, being well-prepared, and maintaining personalized and ongoing communication are key elements in building effective and lasting outreach relationships.

Links to Podcast Episodes:

Spotify

Apple

Amazon

YouTube

The post Thriving in Outreach: A Guide for Therapy Professionals appeared first on Ellie Mental Health, PLLP.

The discussion covers their backgrounds, the education required to become an art therapist, and various techniques and benefits of art therapy. The guests share

• Insights on using art in therapy sessions for both children and adults
• The role of art therapy in treating trauma and anxiety
• Provide practical prompts and methods for therapists looking to incorporate art into their practice.

This episode is a valuable resource for therapists and anyone interested in the power of art therapy. Listen here:

Read the transcript:

Miranda: Welcome to the Therapist Thrival Guide. My name is Miranda Barker. I’m a licensed clinical social worker here at Ellie, and today we’re talking about art therapy. So we have two amazing art therapists on the podcast with us today. Do you two want to go ahead and introduce yourselves? Chelsea, you can go first.

Chelsea: Yes, my name is Chelsea Wire. I’m a licensed professional counselor in Missouri. I’m working out of the new Ellie Wentzville offices just outside of St. Louis.

Kailah: My name is Kailah Tuttle and I am a licensed professional counselor and also a co-clinic director at the Ellie in Ann Arbor, Michigan.

Miranda: Awesome. So how long have you two been practicing as therapists and specifically art therapists?

Chelsea: Hi, Chelsea speaking. I graduated in 2011. Since then, I’ve received a graduate degree art therapy counseling.

Kailah: I’ve been practicing counseling for seven years now, and art therapy specifically for about four years.

Miranda: What’s your graduate degree in?

Kailah: Clinical mental health counseling.

Pathways to Becoming an Art Therapist

The American Art Therapy Association website clearly defines and explains that to be an art therapist, one MUST attend a master’s level program in the field of art therapy, but it’s important to realize that any therapist can incorporate art into their practice.

Kailah:  I know there are kind of some different pathways of how to get there of like we have an intern starting with us who is dual doing both mental health counseling and art therapy.

So you can kind of do them in tandem through graduate work. But I actually did a continuing education program. It was a two year program all online, all different sorts of courses, and it was very trauma informed. So, expressive art therapy is kind of the umbrella that we operate under.

Miranda: That sounds great. So, theoretically, I mean, I’m a social worker, so I could do a could do like a [training] and then and then it sounds like you would receive supervision to and then you could have those additional letters behind your name.

What about if I’m just a regular therapist? Can I do art therapy skills in sessions without being full trained or certified.

Kailah: Absolutely.

Miranda: I mean, that was kind of like a leading question because I mean, yes, I, I do art therapy skills with the kids that I work with and like the college students, but it’s one of those, it’s one of those funny things where it’s like, yes, I like, maybe I’m not a play therapist, but you can do play therapy. Without the additional training, you can’t call yourself an art therapist, but you can use art in therapy.

Kailah: Yes.

Understanding Art Therapy

Miranda: So what is art therapy?

Kailah: Yeah, art therapy is kind of like an extension of therapy and expression to me. So, there’s something about art and expression that gets to somewhere that language can’t. A lot of trauma is pre verbal, so it can be helpful to use other types of therapy modalities for that.

Art just gets to some of those areas that we can’t always through general speaking.

Chelsea: I agree with Kailah. It’s experiential. This helps with problem solving, understanding something that, especially if you don’t have the words for yet that can be creative that you can see, feel.

Miranda: No, that makes sense. I think that when I initially think of art therapy, I think of that one assessment – the house, tree and person assessment. I don’t even know what this assessment is for.

 If you’re not familiar with this assessment, it’s, it’s essentially like you have your client draw a house, a tree, and a, a person, and this assessment says that you can psychoanalyze different things about it. So they might be like, wow, you drew yourself the size of the house. Maybe that means you have a big ego. That’s not really what one of the assessment things is, but that’s kind of the spirit of the assessment that I understand.

So I imagine art therapy is that you sit with your client and you’re like, okay, draw me a picture. And then you kind of psychoanalyze a bunch of it and you’re like, okay, this means you have a bunch of trauma or this means that you don’t have a good relationship with your mom or something.

But, I know there’s more to it, but is, is that a part of art therapy that you do or is that, am I like way off?

Kailah: I don’t really use it as like diagnostic criteria. I think that’s actually pretty discouraged. I think of it as like an extension of like what we’re already doing in therapy of like, it kind of builds concepts or kind of brings things home that we’re already talking about or working on.

I do think that there can be some insight glint. So like, for example, if someone’s like, I really hate this person, and I don’t want them in my life anymore, but then maybe we are doing, a common technique like a safety island where it’s like, bring all your safe people, and then they put this person on the island, then I might say “well before that you said you hate this person,” and just kind of point that out. It just kind of like builds that bridge between that internal world and that external world that they’re expressing.

Art Therapy Techniques and Tools

Miranda: Okay, what is a safety island? It might be something worth talking about but, what is that?

Kailah: Yes, so you can do this in any number of ways I really like it but I have people make this island and it’s like all the things that would bring you safety, so, like if you think of like a calm safe space, like typically I have people go through their senses and say, you know, I see these things and they bring safety or calm.

Miranda: Are you having them draw it, or like paint it?

Kailah: Yeah, you can draw it, you can paint it, you can do it with mix media or however you want. But then, and the waters around it are like those things that are dangerous that they’re trying to like get away from. So like in the waters might be like depression, anxiety, like self harm, like whatever the thing is that they’re trying to create safety from.

Miranda: Oh, I love that. Chelsea, what do you think about kind of the art therapy as a diagnostic thing versus like just kind of a tool that you’re using in therapy? How, how do, how do you use it?

Chelsea: Sure. So really it’s more about what comes up for the client, but what something means. And we can infer some things, you know, like you mentioned the, like the person is as large as the house.

Like, what’s this person like in comparison to this other person that was drawn in the image, or if you were to draw another person, what size might they be, you know, or how might you place them in the space that keeps them more open to how they might interpret.

In regard to diagnostics one that’s good that that I remember learning about in graduate studies with art therapy was it’s called the Levick Emotional and Cognitive Art Therapy Assessment, aka LACATA, and it’s a series of several different drawings that can help give kind of an idea about what themes keep popping up and did something shift between like this drawing or that utilize more so with, with kiddos.

So that one has been good because it’s been reliable and valid within sessions, but in regard to diagnostics to like that can come between session to session and what comes up in that space, you know, any themes, patterns.

Miranda: So do you just kind of leave it super open ended or do you have it more as like directed? In play therapy terms you’ve got like non-directive and directive play. Is it similar with art therapy?

Chelsea: I think so. It kind of depends on the kiddo and your relationship with them thus far. Like, is it their first session? Is it their seventh session?

Have they expressed, “I’m willing to try this” or “I can’t draw,” (and I’m using air quotes in that). That’s something that comes up a lot, especially with adults that I’ve worked with, and so that’s something more to explore, “where did that come from for you, and has that shown up in other areas?”

I might introduce it kind of like, well, “let’s just play,” or “if you’re willing, you know, let’s try this.”

I might say, “this can be, you know, if it’s a canvas or whatever is there, this can be that container,” or you can say, “what does that drawing or that creation look like for you?”

Miranda: I love that. I’m sure you both have clients that come to you that are like, I don’t do art. So what do you do with people who are like “I don’t know. I’m not very creative.”

Kailah: Yeah, I, I think that’s such a, a myth and or misconception in art therapy of like I have to be creative to do art therapy and that’s not true. That’s why I like kind of calling it more like expressive therapy sometimes or talking about expressive interventions because you do not need to be artistic at all.

In fact, I usually find that the more “artistic” people will sometimes be a lot more perfectionistic. They’re like overanalyzing their work or they’re tearing it up or they’re like, this didn’t come out how I wanted when that’s done. It’s kind of the opposite of what you’re supposed to be doing is more like that in the moment expression.

I’m like, I’ve done art therapy with grown men and kiddos. Like, there’s like a wide spectrum who can benefit from this.

If they’re saying this but are for a loss at words, then sometimes I might pull out a piece of paper or a canvas or something, like, “do you think you could kind of like, at least do some like symbols or shapes or colors that it would be?” And they’re like, “Yeah, actually.” So then it’s a little more informal, just based on like whatever’s in the moment.

But sometimes, like if someone’s like, “I’m really struggling with this thing.” We have all these interventions and kind of approaches in mind, but it’s more just finding like what’s that fit in the moment based on the client experience.

Miranda: Maybe it’s our second session. We’ve done the diagnostic assessment and we’re just like, I want to get to know you.

This is going to sound silly, but I do the wordle every single day and it’s like, I have a couple of go-to first wordle words, right? Like audio, pearl, you know, whatever. But but so do you, so in, in therapy or in art therapy, do you have a couple of like, here are my initial like prompts that I like to start out with?

Chelsea: One thing that I’ve done before is I will take a piece of paper. It could be eight and a half by 11 is fine. And I’ll say, you know what I’d like you to share a little bit about you. And I’m going to share with you a little bit about myself too. And I’m going to start on one end of the page.

And you’re going to start on that end of the page. We’re just going to make some, some marks together. You’re going to make marks down there and I’m going to make marks over here in all different colors. That’ll let them pick, you know, markers or oil pastels, they can choose material. And so. They’ll make some marks and I’ll make marks and eventually we’re somewhere in the middle, we’re going to figure out what we’re going to do with that space.

And so to me, that’s like, okay, like that could be like, you know, what might their boundaries be like in that space? Are they having, are they playful? Are they cautious? You know, how do I want to support them on the page in that space? So to me, I’ve found that that’s helpful with meeting clients kind of where they are and they can get to know me a bit too.

And I invite also like, if they want to share more during that time. Or if they want to, if they have any questions about me, you know, I might share about that. So just again, depending on the client about what’s planned for them and what they’re ready for, because we might not talk, we might share a little bit, we might talk a lot.

Kailah: One of my favorite getting to know you activities is creating a name tag – about how you would introduce yourself. And that’s like more than your name, right? So they can like write their name, however they want. And then here are some things about me and I make one as well.

I think that’s another piece of art therapy that’s very important– the co-regulation of doing it with them is very important. You’re not just sitting and staring at them with a clipboard, and making these notes or observing. But when you’re doing it with them, like, you’re being vulnerable with them, and you’re sharing the process of “this is what I’m feeling or noticing,” or “this is what I want to include.”

Miranda: I love that.

Art Therapy for Different Age Groups

Miranda: So, I forget, do both of you work with like kind of all ages or, or do either of you like specialize in kids or adults?

Kailah: Yeah, I work with all ages. I mostly see adults now just because I have my own little one at home. So, I work pretty daytime hours and that tends to be when mostly adults and college students are working and more so needing services. I do see a few kiddos. I started working with kids primarily when I first started therapy, but mostly adults and typically adults with trauma is my thing.

Chelsea: Same answer on my side.

Miranda: Like exactly the same. Oh, that’s so interesting. I can relate. I became a parent for the first time two years ago. I also started initially seeing kids and then I have shifted more to college students and teenagers so I can be home more in the evenings with my kids.

 How does it vary, or like, what are some of the differences between seeing kids in art therapy and seeing adults in art therapy?

Kailah: Kids are naturally a lot more expressive and willing to do playful, kind of like in the moment things.

I’ve never really had to convince a kid to do art therapy. They’re just like, cool, like, here’s some markers, here’s some paper, whatever. They’re a lot more playful. We’ll just kind of go with it. I mean, they’re like very, the kids that I’ve seen are very, like, you can give them any sort of prompt and they’ll just kind of like take it as their own.

I find that adults are a lot more like, wait, “what was I supposed to be doing?” Or like, “what did you want me to do here?” And kids are just like, “Okay, yeah, you give me a general concept, and I’ll just have fun with it.” It’s the imagination potential.

Chelsea: I like how you said that imagination potential. It’s not that adults are not imaginative per se. It’s just that it seems like they’re not as used to doing that on a day-to-day basis, possibly. Like, if it’s not something that they bring into whether it’s like their workplace or at home. And so it’s like they’re going back to, you know, Kind of like, well, what do I know about these materials or what do I know about this?

So yeah, I like using that phrase and shifting it to like, “well, let’s play with these materials” because it kind of helps break that if there’s a perceived barrier. There seems to be less of a sense of like inner critic that comes up with kiddos.

Miranda: That’s a good way to put it. Yeah. I mean, I think that I’m a very creative person.

I like creating things, but as soon as you put me in a room with another adult and the adult is like, “Hey, create this.” I’ll be like, “Ooh, okay. Are you going to psychoanalyze this?” I don’t know, are you going to tell me I, I drew this wrong or something?

What are some of your other, like, favorite go to prompts when you are working with adults or kids? Thanks.

Kailah: Yeah, I really like doing emotion wheels. That’s a good example of how there are really easy ones to implement are going to be things that already there’s kind of like a template for.

Like, these are things that you don’t have to be an art therapist for. You can find these things on Pinterest, Teachers Pay Teachers. There’s all sorts of different resources out there. But anyways, the emotions wheel helps to talk about like how you can feel more than one emotion at once.

So, you draw a general circle and kind of section that off into four pieces or eight pieces or however many feelings that you wanted to include and then just kind of jot down like here are all the emotions that I’m noticing and then how would I represent those in the pieces and you can use that for adults too but it’s just kind of gets at how I can feel insecure and anxious, and I can also be really excited about something, but we have all these different complexities to our emotions and expression gets at that.

Chelsea: Yeah, it’s hard to choose just one to share. One that comes up for me is I call it like a resiliency rock tool. And so you have like river rocks, around the size of you palm.

And then I bring in, pre-cut words from magazines. And I have them hold the rock. It’s like a mindfulness exercise and just noticing the texture, the temperature, maybe the color. And they’re noticing any significant features about the rock. And a lot of times the rock like starts off feeling kind of cool and it warms up in their hand as they’re holding it.

And they’re like starting to feel that weight in their hand. And then I invite them to go through these pre-cut words. And because I found that if I give them a magazine, a lot of people just like end up looking at the magazine versus if there’s pre-cut words and it’s like, okay, it’s all there.

And they can choose what jumps out to them about what has helped them through those (pun intended) rocky, harder, or heavy times. And they might pick out, for example, like maybe recognizing that it was a transition to something different.

And then these are the different things that have helped them keep going, even though it’s been difficult, or a challenge, so to speak. And so then we use Mod Podge and place those on the rock and then it’ll dry clear. And so they have this rock, you know, you can’t dismiss that this has happened.

Yes, this, you had this experience and what helped you through that process. And so they have that reminder there.

Miranda: I love that. Oh my gosh. So actually just keeping on that same kind of, or that same topic.

Art Therapy for Trauma and Anxiety

Miranda: Kailah, you talk about doing. a lot of trauma work within art therapy. I’m assuming you’re not just going, “Hey, paint a picture of the worst thing that’s ever happened to you.”

So what does art therapy look like when you are kind of doing some trauma interventions?

Kailah: So a lot of trauma and how art therapy can get at that at a very basic level is really getting in touch with the body because there’s so much disconnect between internal experience and then so many people are in like a freeze or dissociated or numb state after trauma.

So getting in touch with those bodily emotions is a really common starter. One starter intervention I would do is, body scans. I’m also an EMDR therapist (Link to EMDR blog), so I kind of, like, use both of those about, like, like, how would you represent this in your body?

That’s a really good one where you can just pull up a template of a body and just kind of notice how they’re feeling. If people are having trouble with that, sometimes music can also be a really good cue into that of like, if they have a certain artist that makes them feel some type of way, like putting that artist on and just kind of like, we’re just going to sit here and just kind of jot down what comes up with colors and symbols and just kind of thinking through that internal experience. It’s like we’re trying to proactively get in touch with what’s already there and then make meaning and wisdom out of what we have in our internal landscape.

Chelsea: Yeah, trauma is so much in the body with, you know, muscle tension or just those bodily sensations.

Again, like, it’s nonverbal. It’s what that sensation is. And you brought up EMDR earlier. Another intervention, too, is a bilateral drawing. You can use a larger paper, but like using both hands, you know, right and left together, use different colors or multiple and moving them together in tandem.

You have them create that back and forth. I’ve seen this done standing up or sitting or I’ve seen people lay down on their bellies, even a lot of adults, it seems like they get a lot from that too. It’s not just kids.

Miranda: Very cool. Are there other diagnoses that you feel like are helpful with art therapy?

Kailah: Yeah, I mean, there’s so much, like, I don’t think there’s necessarily a bad place to start, but it’s, if you think about anything where people are, like, struggling with something internally and they’re looking to get it outside of them, like, that’s kind of what I think of with expression.

I mean even like general life stressors, or anxiety is a really good one because there’s just so much floating around in our head, we ruminate and we just like go over and over and over. But sometimes it just takes that, it’s the same thing with therapy, right? Like people will say, Oh, I didn’t even realize that until I just said it out loud.

And you’re like, okay, yeah, like it’s a similar thing of like drawing it out or expressing it through movement or whatever it is. It’s just one another layer to understanding.

Favorite Art Therapy Prompts and Tips

Miranda: Do either of you have a prompt or like something that you’ll do with someone if they’re feeling anxious or if they are needing to process any anxieties.

Chelsea: I’ve asked people to consider if they could create that anxiety through something tangible. I brought up inner critics earlier. It seems like that can be one source of anxiety too. Whenever they make that, whether it’s on paper or you have like random materials, like aluminum foil or yarn, like they’ll create that.

And then if they’re into writing, like I might ask them too, “okay, how could you create that?” It could be like floating in the ocean together side by side. Or it could be like, okay, well, the light shining on this anxiety and maybe the shadows not as big as I thought that it was, you know? You’re creating that that experience outside of ourselves.

So it’s something that is a part of me and isn’t who I am. And then by that, having that tangible creation, okay, now what? What do we want to do with that? And how do you want to navigate that moving forward? It becomes like a, kind of, Holding that space with them.

Kailah: I like doing safe spaces a lot. That’s a good one. I’m just like building your safe space and those elements. Kind of like the safety island idea. I also really like monster making. Like, especially with kiddos. That’s fun.

Like if your anxiety was a monster or a bully, or if the clients likes video games– like a final boss. Like, what would it look like? Like, what kind of details would it have? And then you can kind of get a sense of, it usually gives some insight into what it is that they’re really anxious about. Like, does this monster look like someone?

Or I’ll ask, “does it remind you of an experience from your past?” Because so much of that anxiety is rooted in past experiences of whether it was like, rejection or different types of fears that have happened over time. But just kind of getting in touch with, okay.

I think of like the scene in, there’s a scene in Harry Potter where they like make their fears into something funny, but it’s like, you can draw it out and then you start to look at it and you’re like, actually, like, why does this thing have so much power over me? It’s pretty ridiculous when you think of it.

Miranda: Absolutely. Oh, I love that. Any other things that we feel like we’re missing? I mean, you, you both have given so much good information. What are some of your other like favorite parts about art therapy or things that you think we missed?

Kailah: If you’re looking for a good place to start, like templates, like there’s so many workbooks and art therapy techniques, I love, Pinterest is a really good resource too, I go on there and scroll for techniques all the time. People think “I have to be an art therapist or I have to be creative or have to be this or that.”

And no, it’s just kind of like meeting your client where they’re at. If you already have a client that’s creative, like, or that wants to utilize some art, like that’s, that can be a really good place to start.

And art when I say art, that’s like art and expression is such a broad term. So this is not just drawing and painting. It can be sound making and movement and expression of all different kinds. It can really be anything that’s. Like expression as an extension of the body.

But just, you know, kind of find your element. Like expression can be so large and art therapy makes such a good intersection to other therapeutic techniques, like finding your thing.

And like, if you love CBT or ACT, like there’s so many intersections between these worlds. So just kind of finding like your own rhythm and your own style and just kind of see like, how could I incorporate more expression or how could I help this client really bring this.

Chelsea: Mm hmm. Yeah, I found too especially in my internships and I’ve started to get back into it just recently is that I’m so glad is starting to make some art on my own whether it’s like just a little bit in between sessions or during a break or at the end of the day, just to kind of have my own container, put this in of like, you know, “where have I started?” and “where am I now?” Just to help get it out of, of my own head.

In regard to materials, I’ve seen so many people create so many neat things from various objects too. And then they get to choose what to do with that. One thing that I did learn over time, is that the art and the process belongs to the client, just like, you know, any of their expressive therapy, or even like someone’s experience overall. We can provide that space and it’s you know, but what they create and take with them. That’s for them.

Miranda: I’m curious, do you ever have clients that like create art and then they want to destroy it?

Chelsea: Yeah, and you said the right word “being curious” about it. Depending on what was created, it could be pretty, pretty glaring of like, “okay, I can see why they did destroy it,” whether it represented something I’ve noticed that could bring closure, or it could bring a sense of control over what was created or what they want to do next with that process or insights that were made. Yet really it’s what’s helpful for the client in that space.

Kailah: Yeah, I think it’s all about the intention of destroying it, of like, this is something that I’ve come to terms with, so I want to burn it, burn it, or rip it, or shred it, but, like, that’s very different than, “Oh, this isn’t good enough” and then that, but that creates its own line of conversation of like, “why do you think this isn’t?”

Because no matter what they express, we can do something with it. But yeah, if it’s from like a perfectionism mindset and they’re trying to destroy it, that’s, that kind of leads you into another level of insight too.

Chelsea: Definitely. And depending on too, like where that comes from and what you find out when you’re like being curious and wondering perhaps that could invite maybe transforming it to something new if they would like to.

Final Thoughts and Takeaways

Miranda: Any other last thoughts before we, before we go? This has been such a good introduction to art therapy.

Kailah: I feel like when I think of art, I always think of Miss Frizzle from the Magic School Bus. She is one of my heroines, but she always says, “Take chances, make mistakes and get messy.” And I feel like when we’re talking about art therapy—like what better wisdom to leave you with?

Chelsea: I agree a hundred percent. I would say too, stay curious and you won’t be disappointed. Whether it be a client or therapist.

Miranda: I love that. Awesome. Well, thank you both so much for joining!

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The post Exploring Art Therapy: Techniques, Benefits, and Real-Life Application appeared first on Ellie Mental Health, PLLP.

They discuss the basics of the EMDR process, including the importance of creating a safe space and the various methods of bilateral stimulation used in therapy. They also talk about their personal experiences with EMDR, the different types of traumas it can address, and its application for both children and adults.

Whether you’re a therapist interested in training or someone curious about how EMDR can help, this episode offers valuable insights and practical information.

Read the Transcript:

Miranda (Host): Welcome to the Therapist Thrival Guide. My name is Miranda Barker. I’m a licensed clinical social worker and I’m here with Amber and Gina. Amber, do you want to go ahead and introduce yourself first?

Amber: Yeah, absolutely. My name is Amber. I’m a co clinical director at Ellie Mental Health Ann Arbor in Michigan. I am an LLMSW.

Miranda: What does that mean? LLMSW?

Amber: Limited License Masters of Social Work.

Miranda: Got it. Okay. So in our state, is that the same as like an LGSW?

(Amber nods)

Gina: Gina, take it away. Okay. Hi, I’m Gina. I’m at Ellie, Minnesota at the Mendota Heights location.

I’ve been with Ellie for four years. and I am the director of the Embedded and In Home Therapy team.

Miranda: Awesome. Gina has been on our podcast so many times because she was my clinical supervisor and so she feels like she has to say yes to me whenever I ask her to do things.

What is EMDR?

Miranda: But today we are talking about EMDR and I knew that this was a topic that Gina would want to talk about. This is probably the most requested topic –I mean, people are always messaging me with topic ideas or like putting it in reviews, which if you’re listening to this, please rate and review on your, on your podcast platform.

EMDR just keeps coming up because I think people are so fascinated by it. And I personally don’t know a ton about it. I have had several clients that I have referred over to Gina for EMDR, and so I’m excited to have this episode and talk a little bit more. So yeah, where do we want to get started?

Why don’t we, why don’t we just talk about like, you know, really basics. What does EMDR stand for? What is EMDR?

Gina: EMDR stands for Eye Movement Desensitization Reprocessing. It was developed by Francine Shapiro in the 1980s when she realized that there was a connection between bilateral stimulation, and I’ll go on to explain that, and processing difficult thoughts and memories.

And bilateral stimulation is just sensory experiences on one side of the body and then the other side of the body. that’s simply, very simply put.

Bilateral Stimulation Techniques

Gina: And then EMDR allows a lot of different options. for, bilateral stimulation depending on the client’s preference. The most traditional one that we see, I think in media is the going back and forth, like this with your fingers.

And you’re like, how am I going to do this for like 10 clients all day long without my arm hurting?

Amber: We also did like the butterfly hug, so also like crossing your arms and tapping left and right on your shoulders, which is a great alternative for, again, when you’re on the video screen, sometimes you’re not getting the full bilateral.

So doing the tapping, you’re getting the left, like left, right, left, right, on, virtual sessions.

Gina: Yeah. And I think there’s even like tapping your knees too, like my therapist and I see each other over telehealth. And she can’t tap for me, so I tap my own knees while I’m doing my own processing, right?

And then there’s also, I call them buzzies. Amber, I don’t know what you call them. But they’re little handheld plastic devices that vibrate and you hold one in each hand and it plugs in.

Amber: I have the ones where you can do it from your phone. So you can just be sitting there and your client can hold on to them.

Miranda: So for those of you that are listening or reading and not watching the video, it looks like kind of a remote control or like a guitar pedal or something.

Gina: This is the box that controls everything. These are the devices that you hold in your hands.

Miranda: Oh, they look like something that you’d put on your chest to like, and do “clear!” Yeah, they’re like little, they’re small discs.

Gina: Yeah. And they vibrate. And with this box that Miranda talked about, it’s like a remote, I can control how fast the vibration is and then how intense the vibration is, and then you could also plug in headphones to this and there could be sound.

That’s the other way we do bilateral simulation is sound. and I can control the volume of the sound. So if I have somebody that needs two ways of bilateral stimulation, like that works best for them, we might do the buzzies as these are called. And then we also might do sound and they would wear headphones and the sound would go back and forth.

Miranda: I’ve also seen that there are ways that you can do it with lights. Is there like a, how does it, are light bars?

Gina: (Nods) Some people in Ellie, Minnesota, have light bars and they’re really large. they’re like, Sometimes a foot to two feet to three feet long, and they have little tiny Christmas lights in them, and they, the light will flash quickly from one side to the other.

So then nobody has to move their hands. The client can just stare at the lights going back and forth. And again, you can control those. Like from a remote control with the light bar. The light bar is expensive. It’s probably the most expensive option. We’re talking like 600 to 1, 000 depending on the light bar.

So that’s certainly an option too for somebody who has a heavy caseload of EMDR. A light bar would make a lot of sense.

Miranda: So there are so many different tools to kind of mimic that bilateral stimulation, but could you explain a little bit more about what the bilateral stimulation is or like what is going on with our bodies when that’s, when you’re kind of going from left to right?

Gina: Yes, absolutely.

Understanding Trauma and Memory Processing

Gina: And Amber, please feel free to like interrupt me, if I’m getting anything wrong or if you want to add anything from my understanding of it is when our brain experiences a trauma that overwhelms our brain. Go into fight, flight, or freeze, right, or fawn, and the memory will break up and get stuck in different parts of our brain, right?

So the part of it that wants to tell the story, it’s stuck in that part of the brain. The part of it that is about the senses, as far as like what we saw, what we smelled, what we felt, those are stored in different parts of the brain. and that’s an adaptive way for us to continue to move forward, right?

It’s a little bit of like compartmentalizing is your body’s like, well, I can’t think about this all at once. It’s, it’s going to stay stored in these different parts of the brain. And eventually your brain, like any other structure in your body wants to heal, right? And wants to process and bring those things together.

So EMDR is the idea of briefly thinking about the difficult thing that you experienced or went through while also experiencing the bilateral. stimulation that we just talked about in its various forms. This allows you to integrate all of the different parts of the memory and the experience into one experience and allows you also to create a personal narrative about your own function in the memory or the trauma that happened.

So what I always like to talk about when I talk about EMDR is I cannot change what happened, right? I, I am not going in there and adjusting or changing any memories. What’s most important to me is what you believe about yourself related to this trauma. We call that the negative cognition and the positive cognition, right?

So that’s the language we use to talk about what’s the negative belief that developed after this trauma happened to you. And Amber, I don’t, I don’t, Most commonly actually a client who I just saw yesterday was like, well, this is all I’m helpless. I’m powerless and she was like, that’s all it is. We’re just going to end up doing that one eight times.

And I was like, you know what? I want to tell you that’s probably the most common negative cognition.

Amber: Yes, I agree.

Gina: Everyone is powerless. “I’m helpless.” Or “I don’t have control.” And I’m here to process all 18 versions of that, right? Because in life that happened so much. and so I said, my, like my top three are probably “I’m powerless,” “I should have done something” and “I wasn’t in control” or “I’m not in control.”

 Everybody has versions of those traumas that they get stuck in. and so that’s really the piece that I want to talk to people about is that EMDR can change the way you think about yourself through that trauma that you lived through.

Amber: Yeah. And just speaking off of what Gina said, a way that I also explain it, cause it’s a lot of fancy-dancy terms is, you know, in REM sleep, when we’re sleeping really heavily, our eyes are darting back and forth in our, in our, when we have our eyes closed and stuff.

And oftentimes in REM sleep, we’re processing things like trauma and stuff like that. A way that I prep clients is sometimes when we do talk about heavy things, I’m just like, Hey, just so you know, you might have nightmares about this. You might have dreams about this. You might beat the crap of a person in your dream.

You might get something really clarifying and stuff like that too. And I think that’s important in describing EMDR is again, REM sleep, your eyes are darting back and forth. So your brain is processing that and using the bilateral of your eyes. And so it might help you again, brains are weird when you’re sleeping, The whole thing is weird.

So again, as you’re processing, it might not make complete sense, but you’re still processing as you’re sleeping. So I think of that as a way of like explaining EMDR of while you’re sleeping, your eyes are turning back and forth, you’re processing things. And, you know, like if you beat the crap out of somebody, I’ve had that dream before with my trauma.

What does that mean? I’m trying to get control of this person. I’m trying to, feel like I can communicate my needs and my wants and feel powerful. And I think that’s also a great way to explain that of like, okay, back to what Gina was saying is I feel so hopeless. I feel so powerless. I feel lack of control.

Okay. So what did your nightmare or your dream say about all that? so I think that’s a kind of like a smaller version of explaining all the things

Miranda: It’s kind of like how your brain is already doing this naturally while you’re sleeping and so you are mimicking that and almost forcing it to start to process some of those things by thinking about it.

Gina: Yeah, yeah, yeah. Amber brought up such a good point about the dreaming thing because, when we’re sleeping and we’re downloading our day, right? We’re processing through everything that happens. Some of it’s important. Some of it’s not so much, but the stuff that gets stuck, we end up having those dreams over and over and over again about it until we can work through it.

And that is so much. mimicking the EMDR experience. Not exactly the same, but very, very similar.

Amber: Yes. I think sometimes too, like, of course we have like the cliche of like, maybe go for a walk just to get your mind off of stuff. But actually when you’re taking a walk, the left, right, left, right of your legs also stimulates the bilateral.

So that’s why sometimes too, people find taking a walk really healing in addition to all the nature stuff, stuff like that. But yeah,

Gina: Such a good point. Yeah. The walk and talk. You know when you go for a walk with your friend around the lake and you’re like, Oh my gosh, I feel so much better. Well, that’s because you just talked through all these difficult issues and these things, and you’re moving your body and doing the bilateral. It is an informal version of EMDR, just like running, you know, running would also do that. Hiking would also do that. Like, I always feel like I, you know, went through a therapy session when I go for a walk with my girlfriend.

Miranda: That’s fascinating. Oh my gosh. I’ve never connected that before.

EMDR with Children and Informal Techniques

Amber: Yeah. So, kind of again with informal stuff too. If I have a lot of kiddos on my caseload and they don’t sit with this tapping all that stuff.

They say: “Nope. Absolutely not.” So I’ve used like a drum again, left, right, left, right. Even passing a ball is great for kids, because again, you’re getting the stimulation of left, right, left, right, and stuff like that. So there’s a lot of informal ways that you can actually imitate that, especially with kiddos who can’t sit very still.

Gina: I’m so excited, Amber, that you do EMDR with kids because it’s so needed and there’s not enough people doing it. And I would say I have tucked those little buzzies in their pockets. And they play. Or I tuck those little buzzies in their shoes when we are like running around and they’re playing, you know, house with something like there are ways to build it in so that they can still be mobile and you know, kids are busy, like they’re not going to sit for this.

Anyways, I love that you brought that up that this is not someplace where you just have to sit on a couch and do this. This is something that can move with you too. And now they have wireless buzzies. A lot of people here, even at our office in Mendota have wireless ones. With some you can control it from your phone and they can like be in their pockets or be behind their knees or like wherever they feel good for the person, for the client.That’s really what matters.

Miranda: Absolutely. This is fascinating. Ok, so I know enough about EMDR to know that you don’t just like dive right into EMDR either. There’s somewhat of like a process where you talk about like a safe space so walk me through that.

Starting EMDR Therapy: Safe Spaces and Containers

Gina: Amber, you just went, you’re going to be fresh on all this.

Amber: Okay, ready? Let’s go do all these things. You have to get a background of course, of like, what are we working on? Let’s go through your history. The initial intake session, is typical. Then after that when you’re preparing to actually do EMDR, you have to find that safe space.

There is this idea of a container and a safe space. So the container is, I like to think of something that you can put something away and then you don’t have to visit it until the next time you’re in therapy. I’ve seen people use, Mason jars, pirate chest, mine was Spongebob’s pineapple house.

It should be something that you can lock away and, like, have, like, a physical, like, again, a lock. It can be physical or it can be imaginary. With kids, again, I like to do the, physical thing because they can keep it and we can write little notes of like, what did we talk about today and stuff it in there.

As for adults, for the most part, they can do imaginary containers, but hey, for all means, you can do a physical one too. Like, you could do a physical mason jar, something that you can close and maybe you can keep it with your therapist for a time being. But it can be imaginary too of like, a pirate chest or whatever– something that can close and that you can put away.

So that’s a container part. So as you’re going through your trauma and stuff, it can be hard to leave therapy and leave the stuff at the door. So having that imaginary locking key or whatever it is helps you focus on, okay, I’ve said what I said, this is in therapy. It’s safe. safe. It’s closed. I don’t need to worry about it anymore in my day to day life.

As for the safe place, again, remember that your body is going through the fight or flight thing, even as we’re introducing our trauma to our therapist. So having a safe space, I think in general with EMDR and all, all therapy of having a safe place is very smart. So, that can be somewhere that you’ve experienced before, that can be an imaginary thing, some people find that it’s, in nature and stuff like that, again, somewhere that they visited before, like maybe with Gina, that’d be like a place that she hiked.

That’s a way for you to revisit when you’re feeling a little bit escalated and stuff like that. Okay. My safe place was like a little cabin in the woods with lots and lots of animals and with waterfalls in the back. That’s an imaginary place that’s calming for me. So I know that when I need to visit my safe space, I can visualize there, put myself there.

I feel myself petting all the animals and hearing the waterfall and stuff like that. It calms down my nervous system. So as again, as you’re having to revisit trauma and stuff like that, you have these spaces that you can end the session session in, that you can put stuff away, feel calm, relax.

Miranda: So as a therapist, when you start doing EMDR with a client, you’ll do some like informed consent, you’ll explain that this is what this process is going to look like before we actually start processing. We’re going to talk about a container and safe place or safe space.

And is that like a visualization that you’re guiding them through or something that, or is it just something that you’re kind of introducing and then maybe like the next session you’ll start doing EMDR? Like what is the time frame even look like for this?

Gina: So there’s eight phases of EMDR. The first session is like pre phase one.

It’s really important to realize that. I’ve had a lot of clients come to me who are like, my therapist and I just jumped in to EMDR right away, and I go, what? What?

Informed Consent and Client Autonomy in EMDR

Gina: Miranda, you brought up informed consent. I really want to speak to that for a moment because something that I always, always say in my first EMDR, like meeting the client session is it will get worse before it gets better.

You’re not going to walk out of here and your depression is going to be gone, or you’re going to feel like a million bucks. We’re going to have to trudge through some mud sometimes. I’m going to do my very best to help you to contain it when you leave so that it doesn’t affect other areas of your life, but you will, you can often see a flare up of symptoms, right?

And keep in mind that after an EMDR session, people are tired. Their brain just ran a marathon in 45 minutes, right? So they’re running through all these traumas and thinking about all this stuff, and then we’ve got to wrap it up, and they’ve got to go back to their life. So it’s really important to talk about this.

You’re not going to feel amazing the second session, the third session. This will take time. and that is a really important of informed consent that I really wanted to make sure that we talked about.

Miranda: So what happens if a client is starting the EMDR process, they’ve done some reprocessing and then they’re like, this is too much. Like can they just end? What happens?

Amber: Well, everyone’s entitled to their own type of modality. It might be that, like once we start doing all the tapping and all that stuff, the bilateral, and they might realize too, like it’s too much or feel a little bit cringy doing this.

Everyone’s entitled to find their modality and find a therapist that they enjoy and that they relate to. So it’s totally okay if they get through some stuff and they’re like, yeah, I don’t really like this.

Okay. We can stop. If you need someone else, like if you’re specifically EMDR only again, transferring is totally fine. A client has every right to change whatever they’re doing.

Gina: And we have a consult group here in Mendota Heights just because we have so many providers in Ellie Minnesota that are EMDR trained.

I think we have 24 or 25. So sometimes we all meet together and a common theme is, “We started EMDR and we stopped because the client wants to talk about something else right now.” That’s really, really, really normal because we are touching on hard things, right? That have existed for a very long time. And we’re trying to switch up the homeostasis that this client has been living in.

And that can be very uncomfortable. And so we have lots of clients who are like, “this is too much. This isn’t the right time. I’d like to take a step back.” And I want to honor that. We’re never going to make somebody do EMDR, right?

EMDR is not just EMDR therapy, it’s talk therapy and other things all mixed up into that. because, you know, healing is not a straight line.

Using EMDR for PTSD and Trauma

Miranda: One thing that’s really interesting to me is, and Gina, you’re the one that told me this, but EMDR does not require a complete retelling of your trauma.

Like they don’t need to say it out loud. And I think that some clients really struggle with certain types of therapies that require a complete retelling of their trauma. Why is EMDR different and what can they do instead of talking about their trauma?

Gina: So some people with trauma want to talk and process it out loud and I’m here for that, right? And sometimes they want to talk and process too much, and they want to switch into their intellectual prefrontal cortex brain. And I go, “Ooh, you’re talking too much. Can you just say a sentence about what you experienced and then we can go back in, right?”

And that’s because it makes us more comfortable—to intellectualize it and I explain what’s happening. I can use words. There’s some distance with words from the trauma, but I’m way more interested in how you feel and what’s living in your body.

Miranda: So like going back to a different podcast episode that we’ve did where we talked about the whole brain child, does that mean that when you are doing EMDR, you’re almost like trying to live within the right side of the brain– the emotional side and kind of like not necessarily.

Gina: Yes, exactly.

EMDR Techniques and Phases

Gina: So when you’re in the phase that you’re about to start reprocessing and I have this like worksheet that I have in front of me and I go, “okay, so we’re going to think about the image that is the, the most distressing part of the memory.”

We’re going to think about the negative cognition, which in this example we’ll say is “I’m helpless.” And then we’re going to remember the feeling that you have. Chest pressure is honestly probably the most common one that I hear. Either that or racing hard or sweaty palms or tight muscles. So you’re looking to highlight those three things as you go back into the memory: the cognition, the feeling, and distressing part of the memory.

You need to light up those three parts of the brain. When people get stuck in EMDR and don’t know what to say or don’t know what to do, I go back to how are you feeling and how does your body feel? Because those are the things we’re most separated from. And we feel more comfortable just talking, right?

Miranda: But when you ask those questions, are you asking about how they felt in that trauma or how they’re feeling in this moment in your office?

Gina: In this moment, thinking about that trauma. That’s what I’m asking.

Amber: Yeah. Got it. Yeah. And just to add a little bit onto that too, there are different types of EMDR.

We’re working from the present to the past. and then we’re also dealing with the present right now. So another thing that people are weary of again, is like, I don’t want to talk about my childhood. I don’t want to talk about my mom. I don’t want to talk about my dad. I don’t want to talk about my caregiver.

Nope. Nothing about that. So there’s other ways in EMDR that you can ignore that. So one kind of EMDR—restricted–  doesn’t go into the childhood.

Gina: She’s talking about the AIP, which is the adaptive information processing. It’s the foundation of EMDR. It’s the idea that the memory systems incorporate new memories into old ones as we experience them. And so that’s just a part of the framework of, of EMDR. Yeah.

Miranda: Stop it– So if I’m like thinking about the movie Inside Out and how, like, they have the, the memory world, you guys have both watched this movie, right? Of course.

Amber: We’re therapists. Of course we watch Inside Out.

Miranda: Yes. Exactly. But it’s like in that movie, they have the memory bank where they have all of the rows of like the, the memories that are stored. And then every once in a while they will like have that big hose where they’re sucking up the memories to be recycled.

It’s almost like what you’re talking about where those memories just get recycled into new ones.

Gina: Yes, exactly. Yes, yes, And traumatic memories are processed differently. Right? Because of the overwhelming effects and the overwhelming trauma that we’re experiencing. Our brain is not calm when a trauma happens, right?

So, it’s stored differently and that AIP model helps us to understand that.

Miranda: Okay. I just thought of another question when you said that. Can you do EMDR for, like, pre-verbal traumas?

Gina: Yes. Yeah, there is pre-verbal EMDR.

Miranda: How would that, how would that even work?

Gina: It’s much more, it can be much more based on feelings and body sensations. And there’s a whole, pre-verbal, protocol that you need to use and have to go through before you would offer that to anybody.

Miranda: Okay, so is EMDR only good for trauma?

Gina: Nope.

Miranda: What are some other diagnoses that you would use EMDR for?

Amber: All.

Miranda: Ok, say more, Amber.

Amber: Anything honestly, because I’m thinking about generalized anxiety disorder, everything like I’m scared to do ____. I’m nervous about ____. Are people judging me? Why are you worried about people judging me? You can break down that thought of where that thought came from.

For example– Where did that judgment come from? Is it because somebody judged you for how you drank your coffee in a coffee shop or you believe that they were judging you. That’s a small or minimal example, but you’re having this assumption about yourself, and with EMDR you can explore where did that come from and how we can dive into that.

Borderline is another good one. Why are you having these attachments? Where did that come from? What are the thoughts about these things? anything, anything EMDR.

Gina: Yeah, there’s attachment focused EMDR, with the idea of early childhood neglect and not getting what you needed from your parents and being able to reparent yourself through EMDR.

I’ve used EMDR with a lovely seven year old who struggles with being around people who are sick and a strong fear of vomiting. And she’s doing such great work, at being able to build that tolerance and understand that just because somebody’s sick, that doesn’t mean that I’m going to get sick, or that they’re going to throw up.

So yes, anything with a belief that isn’t serving you can probably be worked on with EMDR.

Miranda: Other parts of EMDR that you like or that you are like, “Oh, we haven’t talked about this aspect of EMDR yet.”

Gina: I think it’s important to talk about the eight phases. The main ones that often get talked about are the prep, right?

The resourcing, which is the, the container and the safe place. and then the reprocessing part, which is really like the meat of what we’re doing. Then there’s also, we do a body check after that. Like, where is this stuff living in you? All of these things, what we’re talking about as far as the memory, the feeling, and the body sensation, they’re all tied together.

And then after we do the reprocessing, after we get to a place where you believe the positive cognition, then we move forward. And in the future you can always go back if you need to reprocess something.

Miranda: How long does EMDR typically take?

Gina: That’s a good question. I mean, it’s really, I don’t know, Amber, I’m curious what you would say.

Amber: Honestly, the answer to all these things is depends on the person. but typically, typically I would say at least, like, maybe, you 12 to 15 sessions, and that’s maybe even being generous again.

And let’s imagine you’re working with this client and you want to make sure that they have enough time to change the negative cognition to a positive cognition. Validity of cognition. So at the end of EMDR a person should be likely to believe that positive cognition about themselves. So let’s say if you’re working with the negative cognition of “I am not in control” then the positive cognition would be “I am in control when I can be.” You don’t want it to be “I am in control” because there is some instances where you’re not in control and that’s okay.

So by the end of EMDR, we want that to be true, which would be a score of seven. So that person should be ending EMDR. It might not get to a seven and that’s okay too, but we want it to increase over time. Bottomline is that we  want our clients to associate with the more positive cognition of “I believe that I can be in control when I can be.”

Gina: And we have Protector Overwatch in Minnesota, where we serve, those that are police officers, firefighters, EMT, first responders, military personnel. And I’ve worked with a few of them on single incident traumas. I’d say with a well resourced person, they can be done in five sessions. But if there’s a bunch of other childhood trauma or a lifetime on a very stressful job where they see trauma after trauma after trauma, then that’s going to take more time.

I think the longer you haven’t talked about the trauma or the longer you’ve experienced it, prolonged chronic trauma, it can take longer to then process it through EMDR. It just depends on the person and the readiness of the person as well.

Training and Certification Process for EMDR

Miranda: If you’re a therapist listening to or reading this, they might be asking, how do I get trained in this? Is it something that I need to do like years of work towards being certified before I can start practicing this? What does this look like?

Gina: Amber just went through it. So I’d love to hear.

Amber: Yeah. So I did my training through EMDR consulting.com. and from there you can do it in the middle of the week or on the weekend.

I did mine on the weekend with George Tab and a hundred percent recommend. It was a three day course I did completely virtual. I believe you get the option to do it in person as well. There are so many of options, but EMDR consulting is the one that I’ve heard the most. If you just google EMDR certification and make sure that you get your CEUs and stuff like that.

You can be certified, and it does not take years. Right now, being that I just finished my trainings, I have a year to get some consultation and after that, I would just have to revisit and talk to the coaches there.

Miranda: But you’re practicing EMDR now, so it’s like you go through the training, you start practicing it,      you’re kind of doing something similar to supervision is what it sounds like, and then, and then at the end of a year, you’re like, all right, I can now call myself certified or what, at what point?

Amber: You have to do a bunch of, courses, which again, I finished all that. I unfortunately have to wait until I’m fully licensed to, to get my certification.

There’s supervision that you need to complete. There’s so many hours that you have to also do EMDR too. Then after that, and again, you have to be fully licensed. to get your full certification. I might be missing some things, Gina.

Gina: No, I think the, Amber’s got it. there’s, they usually, it usually happens in two parts.

Yeah. So sometimes I haven’t ever seen it done all at one time because that would be a ton of information, but usually it’s one long weekend of like 24 to 30 CEUs. And then part two is 24. We don’t want them to be super separated, because otherwise you’ll forget the material. mine, I was working at a lovely non-profit where they offered EMDR at about half the price. I wouldn’t have been able to afford it otherwise, right?

Miranda: Because how much is it to do all of this? How much is the training?

Gina: I think Amber and I are going to say a range. Yes. Anywhere between fourteen and seventeen hundred dollars usually. Split between the two weekends and hopefully paid in a payment plan.

Miranda: Yeah, I mean, that’s really cheaper than somatic experiencing, cheaper than a lot of like cheaper than a lot of modalities out there.

Gina: It is more affordable than some of the trainings out there.

Miranda: Well and gosh, if you’re ending it with so many CEU hours, it’s probably worth it.

Gina: Right, and like Amber was talking about, after you finished part one, part two, they want you to be practicing and working with clients after part one, and they want to see you again for part two, and they want you to be doing the work after that, you need 10 hours of group consultation.

And they’ll set you up with that or advise you or give you options of who you could do the 10 hours with. Once that’s done, you can submit that and become certified. Got it. So you can be called “EMDR trained” if you completed it. If you want to do certification, you have to go through MDREA and send all those materials in and then pay like a yearly fee to continue to be certified.

And then from there, you can become a consultant in training, a consultant, and then a trainer. And there are steps for that along the way that include even getting like letters of recommendation. And then I think to actually work to being a consultant in training, you have to have like 200 clients and at least a certain amount of hours, that you’ve done EMDR.

I think it’s important to have those gatekeeping measures because it needs to be done in a certain way to be effective. In their own practice though, therapists have flexibility. And I think, clinicians who have been doing it for a long time, they have their own ways, right?

Like it all comes back to the bilateral, but they develop their own interesting ways of doing it too that are, can be very effective.

Miranda: okay. I have a question. So, for my personal situation, like, I don’t see, I don’t see a full time caseload of clients. So I don’t know if it would be worth it to, to actually become certified and pay the extra cost and supervision.

Could I just do EMDR training and then, like, start practicing at that point and not ever get fully certified?

Gina: I’ve been doing it for 12 years and I’m EMDR trained. I am not certified.

Because I don’t necessarily see the cost benefit for becoming certified and paying the fee to be an MDREA member and then doing all of that work. I’d like to be a consultant someday though, so I’m probably going to do like the steps for that because I want to train eventually, but no, I’m still trained in the EMDR.

For some people that certification is super important and you do get put onto like Emdrea’s list of certified therapists, which I think is, there’s a lot of benefit in that too.

Regardless, you don’t have to figure that out right away. And it wasn’t within my budget to do that right after I’d gotten trained anyway.

Final Thoughts on EMDR

Miranda: Well, this has been super helpful. Any other last thoughts or things that we feel like we’re missing about EMDR?

Amber: I have been seeing a lot of people inquiring about EMDR. So I think it is one of the up and coming kind of modalities, kind of the buzzword kind of thing.

I think it’s a good investment to get this training. Because are people going to be wanting it too and we’re getting a lot of inquiries for EMDR. So I think it is worth it, especially as that becomes more well known in society today.

Miranda: That’s fascinating to see how clients have become more aware of these modalities. The book, “The Body Keeps the Score” has gotten so popular, even just like non clinicians with people who are just trying to understand themselves, and that book talks about EMDR. I’ve had probably two or three different clients who have read that book and then come to me and been like, I think EMDR would be really helpful.

Gina: Yeah. My first session is always, how did you hear about EMDR? Yeah. Tell me what you know about EMDR. Like give me an idea. And it’s, “my sister did it” or “My best friend did it”–  very, very much word of mouth. They found it super helpful. It changed their life.

And then they get to tell them about their experience and what they saw change in their life. And they want, they want that for themselves as well.

When I was a fresh newbie and was working with people with lots of trauma, I was like, “OMG, how am I going to help them?” Like I had CBT and I had the foundational knowledge of what I learned out of school, but I was like, “I’m going to need something else to be effective here.” And you know, I was considering TF-CBT and brain spotting and ART. There’s so many options now and all of them are worthwhile.

And EMDR was the one that I was drawn to because I felt like it could help the largest group of people and it could be used with adults and kids.

Miranda: Awesome. Well, thank you both so much for joining and we’ll have to have you back again sometime.

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The post Understanding EMDR Therapy: Basics, Process, and Benefits appeared first on Ellie Mental Health, PLLP.

• Diagnosing ADHD in Therapy
• Strategies for managing ADHD
• Common medications used for managing ADHD
• How to deal with ADHD as a therapist

Check out the full podcast episode and the transcript below.

Read the Transcript:

Miranda (Host): Welcome to the Therapist Thrival Guide. My name is Miranda Barker. I’m a licensed clinical social worker. Today we are talking about ADHD and we have some awesome experts with us today. I’m going to let you guys introduce yourselves. Davin, do you want to go first?

Davin: Sure. My name is Davin Cobb. I am a licensed associate marriage and family therapist.

I work at an Ellie Buckhead location in Georgia.

Christina: I am Christina Gonzalez. I am a licensed clinical social worker at of Elemental Health of Central Jersey, located in the Flemington office.

Joey: I’m Joey Lusvardi. I am a physician assistant and I work remotely, but I’m based in Minnesota.

Miranda: Awesome. I love having episodes like this where we can pull, number one, clinicians in from all over the country.

Number two, when we can have a prescriber here to talk about these specific diagnoses. So Joey, you’re kind of like our guest of honor because it’s important to be able to talk about how prescribers and therapists can be talking, can be working together, especially when it comes to ADHD and like some of these diagnoses where medication is super helpful and effective and all those things.

So wanted to just kind of get started by talking about if you are a therapist working with a client. And you kind of suspect that they have ADHD or perhaps they’ve said, you know, I’ve been wondering, I saw a TikTok the other day and I had a lot of the symptoms that this person was talking about. I think I might have ADHD.

What is our like first step? What are, what do you do?

Christina: I mean, for me, I kind of like run it down with my clients of what does that look like? How are you associating with it? It can be very real of like, yeah, you are having these symptoms, but is it isolated or is it kind of a constant thing and kind of doing an inventory with them of how long do you feel like this has been going on and what does that look like for you?

Miranda: Kind of starting there with them. What some of the common symptoms that you do see for people who, Who actually have ADHD then?

Christina: So the fidgeting, inability to kind of stay focused impulse control. I see a lot of kids in adolescence. So it’s like that impulsivity of going from like, Being completely fine to like, I’m going to have an anger outburst and do something that I’m not going to be able to come back from and I’m like, okay, that, that you see, but I guess for like the adults, it’s more of like the executive functioning piece of it, of time management and.

Kind of creating routines and structures for themselves, which can be helpful.

Miranda: awesome. What about you Davin? What when a client says like hey, I think I might have ADHD What’s your first step? What do you normally do with them?

Davin: Yeah, very similar to Christina. I try to one I like to normalize I’m really big on normalizing and like sitting with someone for a moment just to, okay, this is what you’re feeling.

What are these symptoms? What are, how are you equating to these things? And then I kind of like to, cause I work primarily more with like young adults and, and couples. So I see a lot of times, That I will point it out a little bit more before they will particularly my couples, like if one of the, of the parties is having some executive functioning, the partners may be complaining about, she’s forgetting things all the time.

And I don’t understand why she can’t remember this. And it’s that it’s not that hard. Do this. Then I’m normally like, okay, well, maybe let’s look at some other options particularly that could be going on. Because I think that a lot of times people with ADHD, there’s a stigma of just being lazy. So I do look for that as well.

Like, have you been told so often you’re lazy? Do you have like negative self talk about yourself, about what you should be doing, what am I not accomplishing? And how is that showing up in your life? A lot of executive functioning is usually where I like to lean into. I like to start with normalizing, particularly pointing out things that I’m noticing and then potentially looking at how do we need to move forward?

What are you looking for to help you with? Some of the symptoms you’re experiencing, whether that’s getting with a psychiatrist, I mean, working with them or working on some routine and normalizing. This is how your brain works. There’s no need of trying to become the it girl that you see on TikTok, particularly this may not work for you, but we can find something that does work for you.

Miranda: That’s super helpful. Do you, do either of you like recommend your, clients go seek out a Psyche eval right away? Or like, what is, is that, is that something that is typically needed for an ADHD medic, ADHD diagnosis? Or do you feel like you are comfortable enough being like, this is what we’re diagnosing.

Like, what’s the role of a Psyche eval with this?

Christina: So I mostly see kids in adolescence. So a lot of the times I will get either kids that are just diagnosed or they school speculating an ADHD diagnosis. So I will always, Refer to for like a psych or a neuro eval just for The kind of posterity of like knowing that they’ve done everything and if it isn’t this like kind of figuring out Where we are and providing all the support that they can actually like get because once school is like Oh, there might be ADHD involved if there isn’t an md attached to like the diagnosis.

They’re like, oh no We can’t give support. So I will always refer like for that as a You Just as, like, an extra layer.

Miranda: Yeah, yeah. Well, and I was always told, too, that we really shouldn’t be doing, like, our own, like, we should be kind of referring for that additional diagnosis anyways. I don’t know, Joey, do you have other thoughts on that, too?

Joey: Yeah, I mean, I obviously, like, I, I trust, like, that y’all know what you’re doing and that, like, if you have suspicions about it, like, you’re not just gonna randomly be like, Oh, yeah, like, you have ADHD, that, you know, you’re gonna do a thorough evaluation. You know, and I also think, too, sometimes, like, I’ve had people who’ve come to me and they’ve been a little bit like, I don’t know and then their therapist, they’ll talk to their therapist about it, and their therapist will be like, oh, yeah, yeah, you’ve got ADHD and it’s really helpful to, like, you know, have that additional perspective because there is still a stigma attached to it where people sometimes are like, you know, I’m not sure if I want to, you know, Get that extra label.

I, I think it’s worth, you know, like bringing it up and, you know, even if you’re not comfortable, like being like, okay, this is definitely ADHD you know, getting someone else involved who does feel comfortable doing that is like a really good idea and I definitely think that, you know, like most therapists are going to be able to recognize that like, Hey, this is something that requires a little bit more evaluation.

I think that’s, that’s a good thing. Okay.

Miranda: I guess most of the time when I have had clients who have said, Hey, I mean, I mean, let’s be honest. It has usually been like I saw a tick tock the other day and it made me think that I probably have ADHD and I see a lot of college students. And so then I usually will say.

Exactly what you were just saying, Christina. Okay, what makes you think that? Let’s talk about symptoms. How long has this been going on? And then, you know, referring for a more thorough evaluation. Because even though I am someone who that, who can be like, Oh yeah, you totally, you know, you fit the criteria in these ways.

I usually want them to, you know, have a more thorough diagnosis or a more thorough evaluation. So that makes a lot of sense. What about like role of medication and like what sort of conversations, and anybody can take this, Joey, anyone. What sort of conversations do you all have about ADHD medications and, and I guess like Ooh, you’re really struggling.

Have you thought about medication? Or, I don’t know, what does that conversation usually look like?

Joey: One of the big things to keep in mind with like medications is that they do have a straight value to them. And it’s something that like you need to be very careful because they are sought out. I I used to work at a college and so I saw college students and around finals time, like, the number of ADHD evaluations suddenly spiked and so you always want to be very careful about, you know, like, promising medications to anyone or promising a specific medication because when they get to the prescriber, we might like, as we’re doing our evaluation, they might be like, by the way, you know, like, I’ve got, you know, bulimia or something, and I’m not about to give something, you know, Like Welbutrin, for example, which we sometimes use off label for ADHD to someone who has bulimia because They might have a seizure and die and that’s, you know, kind of a bummer.

If they that were to happen I again like, you know, I’m usually trying not to kill my patients. So it’s something that there’s a lot to think about, and we have to spend a lot of time, like, ruling out that there’s other things, or that there’s, like, contra contraindications to the medications, too, where, you know, if someone has an eating disorder, then I’m going to be pretty cautious about it.

If someone has a history of substance use problems, I might, you know, go for something that’s not going to carry as much potential for you know, being misused. If someone has really bad anxiety, I might pick a different medication than I would if they don’t have those issues. And there’s a lot of things to kind of think about it.

And it really depends on what the. specific cluster of symptoms they’re getting are. And one thing that I really try and emphasize too with my patients I’m working with that have ADHD is that they aren’t magic pills and they’re not going to solve everything. And I really try and encourage them like whether it’s talking with me about like some things that they can do to try and make sure that they’re not, The they’re setting themselves up for success with like their environment or their lifestyle, or they’re talking about it with their therapist, like that they’re also, that we’re coming at it from multiple angles.

So it really is an area that like, I pretty quickly try and get like therapist involved again, if they’re not already, if they haven’t already had that conversation, because it’s so critical that like they address it from both angles. Both sides.

Miranda: That’s super helpful just to even know. I mean, I don’t know.

I didn’t know you could use Wellbutrin off label like some stuff like that. I mean, I’m curious beyond so like what are the major, what are the major prescription drugs that are used for ADHD?

Joey: Yeah. So I, we’d like to kind of divide them into two separate categories, which would be the stimulants and the non stimulants.

So stimulants are the ones that people are going to be most familiar with, more likely than not, that’s Adderall or Ritalin or Vyvanse or Concerta or Mideas or There’s a lot, there’s a lot of them, like there’s a lot of different weird release Formulations that like you can go down a rabbit hole of like all of the different like stimulants out there but They’re typically either going to be a methylphenidate product, which would be like Ritalin or Concerta, or they’d be an amphetamine, which would be Adderall or Vyvanse or Mideas. And the big difference between them is gonna be some people get different side effects from like one group versus the other and then how they’re released, so how long they last. And then the other group, the non stimulants, those are going to be medications like clonidine or guanfacine or stratera.

And then there’s a bunch that we use off label, like we will sometimes use, like Welbutrin mentioned earlier. Another one that we’ll sometimes use off label would be modafinil, which is a wakefulness promoting medication which to me, I always was like, that sounds like a stimulant, but we don’t technically call it a stimulant.

So it’s a non stimulant. And then even sometimes we’ll like, depending on what they’re presenting with there’s a newer antidepressant called Trintellix that like originally they had been looking into it as being a stimulant. being like, is this an ADHD medication? And then they were like, Oh, it works really well for depression.

And so it got approved for depression. And it’s one that like, we’ll sometimes use it for people who have like, really bad cognitive symptoms of depression. But I’ve had a few people that like, we’re not like for whatever reason, the other meds didn’t work. And we’re like, okay, we’re desperate. Like and they also have like depressive symptoms or they’ve got really bad anxiety.

And I will. Try them on Trintellix as like a, you know, like a, an out there option if it really comes down to it. But there, there’s a lot of different choices out there. There are

Miranda: so many. What are some common like side effects that you’re seeing with some of these different drugs? Maybe this is like a two part question where it’s like, what do you want therapists to know, I guess, about some of these drugs?

And like, how can we be working together? So maybe that’s a three part question, but you know what I mean? Like, how do we come together to like watch out for our clients and also like be in communication?

Joey: Totally. So let’s start with side effects. So gonna vary between individual medications, but typically, like, most of the ADHD medications, even some of the non stimulant medications, are gonna be very, like, energizing.

So, like, if you think about things that you would associate with, like, caffeine, like, a lot of them are gonna be side effects that you see with, like, Adderall or Ritalin or Wellbutrin. Big things are going to be increase in anxiety, insomnia, appetite suppression I can, we’ll also see tremors sometimes if they have a history of psychosis, it can activate psychosis, so like you want to be really careful with that or if like, you know, a patient who previously like Didn’t like, have, you know, any, like, hallucinations and they come in and they’re like, there’s gnomes running around the room, like, I don’t know and you’re like, huh, I think that they were just started on an ADHD medication.

That would be a good, like, we want you to, like, communicate that to us and, like, also encourage them to communicate that to us as well. So, like that’s, that’s a big one. Yeah. There are a few medications that like Clonidine or Guanfacine, which are blood pressure medications but they also can help with ADHD.

Those ones tend to be a little bit more sedating and calming and they’re really good for people who get a bit too agitated or wild or anxious from like a stimulant medication or we’ll sometimes use them in conjunction with them. I, I’m a really big fan of clonidine. We actually kind of joke that like I’m a clonidine influencer.

Because like I, I love clonidine. Like I think it’s really underutilized. And it can really help people who have, like, trouble sleeping because they’re like, I want to keep doing everything because ADHD does not let you slow down sometimes. And so there’s a lot of, like, different, like, choices, or there’s a lot of different, like Things that you can run into with that particular set of medications.

Miranda: Okay, you just made me think of something where, like, in the DSM IV, we had different diagnoses, right? We had ADD, ADHD, but now in the DSM V, they’re combined into your ADHD. So, do you prescribe differently based I mean, I guess you just said you prescribe differently based on symptoms that But, kind of, so it would make me think that like someone that perhaps had like the hyperactivity, you would be more apt to prescribe them like a guanfazine, something that’s more calming or is that just not necessarily the case still?

Joey: Yeah, I would, I would be a little bit more likely to be like, okay, maybe we go with like something like Clonidine or Guanfacine where like, again, it’s going to calm them down a little bit. Stimulants can work in any of like the, the subtypes of ADHD where It’s not like they’re limited to the inattentive subtype, they do tend to be a little bit better than like clonidine or guanfacine would be, but both of those can also work for the inattentive subtypes or the combined subtype where it’s, it really is like you have to, like, individualize it to the person and also think of like their comorbidities as well too because that sometimes will Push me in one direction or the other, where if they’re coming in and they’re like, I’ve got really bad insomnia, I’ve gotten eating disorder.

Like I’m, I’m anxious. Like I’m, they’re just sitting there like vibrating. Cause they’re so like nervous. Like I’m, I’m probably going to hesitate to be like, you know, let’s throw something in that’s known to suppress appetite, cause you to have insomnia and also potentially make you really anxious. Like that just doesn’t seem like a great idea.

I would still lean, I would probably lean towards being like, okay, maybe we go with clonidine or we go with like stratera or we pick another medication that would not have those risks associated with them.

Miranda: Okay. Yeah. I mean, I think that makes a ton of sense. Switching gears a little bit, then you talked a lot about how, when you’re initially seeing clients In medication management and they’re not seeing a therapist, you encourage them to because you feel like it works really well hand in hand.

So, kind of like transitioning over to Christina and Davin, curious about what are some common interventions and things that you’re, that you’re doing with your clients with ADHD?

Davin: So. A lot of the things Joey was just talking about, they really resonated with me because I am someone who has ADHD. So a lot of the times I like to have my clients create a story of like their experience because I think each person’s experience with ADHD is different.

Like we said, there’s many subtypes. So there’s the inattentive and then there’s the hyperactive and there’s a combined. So I let them like create a story of their life, of what their experience is like, like through their lens. I often like to do that to understand what they’re actually experiencing, because I think if we just take, Oh, I’m having a hard time paying attention at school.

And then I think that this is what works for that. Oftentimes that doesn’t work because as we know as people with ADHD, routines do not work for a long time. So I’m really big on creating like I call it like a toolbox of routines. So like this routine may work for you this week and it’s going really well, but next week it may not work.

So we need another routine that’s there because we want to reduce the amount of thought you have to have and how much you have to pull at all these different things. So I like to Oftentimes when someone like even hints that they particularly may have ADHD or they’re having trouble with focusing or impulsivity, I’m like, okay, well, let’s, let’s create a story of your life.

Like give me a scenario in your life, write it out through your lens so I can understand what your experience is like. And then we work on normalizing that for them. Because I think because TikTok university has become so influential, a lot of people are trying to figure out how to not have these symptoms.

And I don’t like to really go in that direction particularly because I think it then also brings in this identity issue and self esteem and the way I view myself so I really like to curate what works for them in this place in their life and also focus on what else is going on around you because that can be influential like there could be some comorbid things going on there could be you’re just highly stressed and it’s really making it really difficult for you to focus at work, so.

Rationalizing, creating a story and then a toolbox of routines just to help reduce because one’s going to stop. So having one right behind it may be helpful.

Christina: Definitely do kind of similar things to in that aspect. I have ADHD as well. So like sometimes it’s like, Oh, everything’s perfect. Great. I’m focused and can work.

And then it’s like, Ooh, there’s a squirrel and I’m looking outside. But I think too, with like the kids, it’s also creating a toolbox for them of self regulation. And like when they do start to compare, cause. I see a lot of it where it’s like, Oh, well, Johnny can do it. Why can’t I do it? And it’s usually like within the sibling sets too.

If there’s one sibling that has ADHD and then all the other ones don’t, it’s like, Oh, they’re the problem quote unquote problem. But in reality, it’s just, Hey, we just need a little bit more to self regulate and kind of. Get back to a baseline. And it’s doing also a lot of like the parent education too, of like, what are we doing at home to promote that of like letting them get out and creating systems that work for them?

And some, there is that stigma on medication. So a lot of parents don’t want to put the kids on medication. So it’s like, okay, what are we going to do to release those outputs? And they’re just going to have more energy and you’re going to have to let them run a little longer. Okay. if that’s what they need.

Miranda: I love that. I haven’t been working with this population for a super long time, but I feel like all of a sudden in the last, like, I don’t know, six months, I think I have like eight different people with ADHD on my caseload. And so it’s been really cool to learn from them and learn about what works for them.

Because like what you said, Davin, I mean, every, it works, stuff works differently for other people. So I was going to say a couple of like key interventions or things that I will use and maybe I should back up a little bit and say like, oftentimes I say, okay, your ADHD isn’t necessarily the problem. It’s like, what are the symptoms that are, that you want to be attacking?

 You can be a very hyperactive person and maybe you’re in the right career field for that. And that doesn’t really matter. But like, you know, I mean, but maybe you’re someone who cannot, like you, you have, you know, these different goals or you have these different, like work things that you need to get done and you’re having a really hard time getting through it.

And so maybe in, in that area, I pull out my worksheet where it’s like, literally, I can put a link to it in the description of this podcast episode, because people From Therapist Aid, all it does is it talks about let’s break down that thing that you need to do. You have this task, let’s break it down into like seven subtasks because I think that that can be super helpful for a lot of like the college students that I work with that have ADHD.

I also often if I’m working with an adult with ADHD, I often recommend the book Scattered Minds. I don’t know if you all have read this. Such a good book. The author of it has ADHD and so I think that’s super key when you’re looking for books that are about Neurodivergence you have to be it has to be written by someone that has that But I can’t even begin to tell you how many times I’ve read like how much I’m underlining in this book how much I’m Reading and laughing to myself There was a portion in this book that talked about and I had to read this to my husband later because I was like, Oh my word, this is me.

And this is has been me for my entire life, but it talks about like the absence of mind and distractibility and this is this particular part of the book is something that I hear a lot of clients complain about themselves and they’ll say I decided to clean my room, looks like a tornado just passed through, I pick up a book off the floor to replace it on the shelf, and as I did so, I realized that there are these other books on there that I haven’t looked at in a while.

And then I picked up those books, and then you begin to read a poem. And then you realize that the poem has a classical reference in it, which prompts you to consult your guide on Greek mythology. And now you’re lost because one reference leads to another. An hour later, you’re interested in classical mythology, exhausted for one minute.

You return to your intended task. And then it’s realizing that, oh no, a pair of socks has gone on furlough. And then you’re trying to find it on the floor. And then you realize that you haven’t done laundry. And so it’s like you’re going back, you’re going from thing to thing. And then at the end of it, you realize that you never cleaned your room.

And I laughed out loud at this part because There are so many like little tiny interventions that you can kind of pick up from clients or just pick up from different podcasts or places over time and, and in particular, that issue of distractibility can be helpful of like having one thing I often recommend clients do is like have a laundry basket at the threshold of your room.

And so you’re not allowed to like leave your room because we all know that you can, you know, grab a book and then you. You know, go to different rooms and whatever. But to, if you have a laundry basket at the threshold of your room and you’re like, okay, I’m going to put everything in this laundry basket that needs to leave my room, then at least you’re not leaving your room.

You’re still like focused in on your task and you’re just kind of putting things in a pile of like, okay, I’ll deal with this in a little while. But all that to say, there are so many cool interventions. There’s so many little things that we can be doing. And Curious about other ideas that you all have had or, or things that you do with clients that have ADHD.

Christina: A big proponent of lists and like being able to like physically cross things off. Like I will recommend like whiteboards or like if they have like a glass door, like writing it with a dry erase marker and then like being able to erase it and be like, okay, I accomplished that. But it’s like also right in your face.

Of like, hey, it’s right here. Like you see it like if you have to walk to the bathroom It’s right there and you see the list you have to do. So it’s like that constant reminder

Davin: Yeah, I was gonna say kind of similarly to what you were saying Miranda I often tell my clients I get you one of those like little rolling things that rolls and Have a designated space for where everything that doesn’t supposed to be in this room or here just goes there And then at one point you can put all of those away also something That I wanted to kind of highlight is sometimes these things just don’t work because that’s just not how your brain works.

So I have a client who has really severe executive functioning issues and at times I kept trying to throw all these different interventions and I realized she wasn’t responding to them because They just weren’t working for her. There was also another layer to this. She was dealing with like severe depression.

So I think at times as clinicians, we have to be really flexible to understand it. It could be many different things just because I have ADHD And I’m having issues which focusing that may not be the only reason why I’m having difficulty in this area. That client particularly was In a graduate program and we talked about environment and she was like, when I go into work, I feel horrible.

The environment, the people there, no one wants to help. So we were so focused on like this ADHD and executive functioning that when I like widened the scope and talked about like the systems at which she was operating in, she was able to identify that there were things outside of herself. Again, I think it’s important to not solely always point at ourself when you have ADHD because it’s very easy.

The stigma is you’re lazy. If it’s a shoe on the floor, just pick the shoe up. I’m having a really difficult time picking the shoe up, so it must be me that’s the problem. So focusing on like some identity work as well as like what else is going on in your life. Sometimes switching from that, the main focus of this thing gives another area of opportunity to maybe Work on switching your focus potentially.

Joey: I love what Davin just said there where like people should like try and remind your clients that like ADHD isn’t like the entirety of their like world like there are other things that can really affect it where I get a lot of people who like around finals time they come in and they’re like, Joey, turn, turn up the dial on my ADHD medication.

And I’m like, have you considered you might be stressed out because finals are a terribly designed system. And it’s, it’s one of those things that like, I could, I mean, I could turn up the at their Adderall and then they’re going to be really anxious and it’s going to just create more problems. Or, you know, you could work on talking about like, how do you reduce their stress or like, how do you, like figuring out some of those other things that can play a big role in like their functionality from like a medication standpoint, one of the big ones I hear is like.

People who are on a stimulant and they don’t get like really hungry at all. Like during the middle of the day, like they’ll be like, yeah, it’s weird. My medication doesn’t seem like it’s working as well in the afternoon. And I’m always like, well, did you eat lunch? And they’re like, well, no, I don’t get hungry.

And I’m like, okay, like, so we need to like purposefully like add in eating because Weirdly enough, like, as soon as they start eating during the middle of the day, their medication’s working really well because they’re no longer hungry. And it’s something that, like, It’s a very, very simple, like, intervention.

We’re just reminding them that, like, anything you eat is going to help. I tell people, like, I’m not here to be, like, you know, the diet police. Like, if you want to eat, like, a slice of pizza and some ice cream, cool. Like if that’s what you can eat, go for it. Like It’s something that is going to help.

And like taking some of those things into account too, can really, really help people like end up being more successful.

Christina: I totally agree with that too. Cause like, I see a lot of like the nutrition piece and sleep with my clients where it’s like. They forget that basic ADL need of food and sleep are vital when it comes to kind of creating systems for an individual that has ADHD, like those are needed regardless.

So, like, just a reminder of having a snack on a list or having it in your pocket, it might be important. helpful strategy to

Miranda: What about for clients that are struggling? I mean, that’s something that’s super common. I see a lot of clients struggle with sleep as a result of their ADHD meds. What do you all recommend for those clients?

Like, do you recommend a med change or like what sort of changes do you typically see? That’s helpful.

Davin: My first question is usually, when are you taking your medication? Because even for myself, if you take it in. 12, it’s probably going to be a little harder to go to, especially if it’s an extended release to go to bed at night.

So like there’s some clients where I was like, you need to set your alarm at 6:30 to take it. Even if you’re not getting up at 6:30 to take it because you’re having trouble sleeping. Cause you’re not taking it till after you eat. You don’t eat until 12. That’s going to make it really difficult. This is going to releasing your body for a long time.

And now you’re trying to go to sleep and you’re looking at. The ceiling saying I have insomnia now. So now that’s a side effect, but also there is a way to be proactive potentially about that. Asking when are you taking your medication? Are you drinking water? That was a huge thing with my college clients.

They were on it and they would forget to take drink water. The most common thing, just drink some water. As soon as she would drink some water, she’s like, I feel so much better. You have dry mouth, all of these symptoms that are happening. There is a level of proactivity that needs to be there. to help with that if you actually want the medication to work for you and not to be up all night.

Christina: After the medication question, I usually go on a wider scope of it too, of is there other external factors? Is there, are there new stressors? Are there new things that are kind of going on? Because it’s sometimes if it’s not the medication, there’s New things going on, work, school, just family life, like so many different things could be impacting it too.

So not just being so isolated about it.

Miranda: Okay, I know that we are coming kind of to a close and so I’m watching the time but before we leave I want I know at least a couple of you have been diagnosed with ADHD and have like figured out how to thrive as a therapist with that diagnosis. And I’m curious, Davin, do you want to start?

Like how, how have you gotten into a rhythm? How do you, how do you like thrive as a clinician?

Davin: To be completely honest, it’s a forever evolving thing. So I want to normalize it. Like, there’s some weeks and some days where I’m not killing it. And there’s some weeks where I’ll go into that routine box and I’m like, this is what you really need to crack down on for this week.

For me, I think the same thing that I do to my clients I do to myself. I work really, Heavily on like my own identity because at times, because I got diagnosed later in life, which happens with a lot of adults, especially women. So I look back at my life and I’m like, dang, you were always killing it in school.

You always had good grades, but you always waited till the night before to do your assignment. So I also contributed that to, Oh, I just, I work well under pressure. So kind of going back and re narrating some of my experiences has been really important for me to be a thriving clinician because it’s not easy.

And that’s something I’m still working on being on go for one hour straight. And then particularly maybe having to do some notes after I’m not doing the notes. So I have to create a system that works for me and the way my brain operates. So I think for me is creating a system and then being okay. When that system’s not working, like being able to notice that’s not working for you right now.

Like you were doing good for a month with that system. It’s not working. And also just being kind to myself. There are some days. where my tank is zero and I have to be honest with myself and I have to rationalize that tell my my clinic director I didn’t get those notes done today. I apologize but I’m really having some executive functioning being aware of myself has helped me to be better as a clinician and to thrive just with the business aspect of it all.

Joey: I try and make sure that like I set up my environment so then I’m like most likely to be successful where like I as soon as like COVID hit and we were like all working from home I was like I do so much better from home. I am so much less likely to wander around the office and talk to everyone.

And I am just like way more productive. I can focus more on my patients. Like I’m better able to do things like working from home. I don’t do well in a clinic setting. Like and I recognize that about myself and thankfully Ellie is awesome. And like, they’re really flexible about that, where like they allow me to set up the environment for me to thrive.

I also know some of the things that I tend to get really like, like I will struggle with that it’s like, okay I can’t necessarily do this Well, I’m like, you know, like talking with a patient because I do need to put on my professional disguise like I try and find ways to get those out either before or after or in some cases during none of you would know this right now, but I’m actually exercising currently.

I have an under the desk elliptical that like you can’t tell that I’m doing it So when I’m feeling really like oh, I’ve got a lot of like, you know energy. I can’t sit still I can just you know well, I have to make sure that none of my cats are sleeping behind it because they have been known to go and be like this is the coziest place And that I want to go and sleep right now, obviously.

But like, as long as they’re not there, because they do get priority. I I can just, you know, put my feet on it and then I do a little bit of like movement and it really helps. And kind of recognizing some of those things or trying to incorporate some of like the things that you struggle with into your day.

And your routine and find a way. To. Work with them as opposed to against them can really, really be helpful.

Christina: I know for me, too. Like, I got fortunate, I was fortunate enough where my mom saw through my masking as a kid. So, she’s a teacher, so she was able to see kind of, oh, no, something’s off. Like, you’re overcompensating for something here.

So, I’ve had systems and routines in place since fourth grade. And a lot of those systems and routines are still things I do to this day. Writing things down on a physical piece of paper, if it’s on a virtual calendar, nine times out of 10, it’s not gonna be remembered, even though I get 12 notifications on my phone.

And I think just also like in my practice, being honest with like my younger clients of like, you know what, sometimes I’m gonna be like a squirrely brain and it connects with them and being able to kind of slow down with them of like, what do you see in me that you do? And kind of being able to connect on that level.

It allows that normalcy of not letting it be the whole story because there’s other parts of everything and everyone so kind of giving that connectiveness of Kind of just slowing down and being like who you are and authentic in yourself.

Miranda: Awesome. These are such good suggestions. Thank you all so much for joining.

I feel like we could talk and talk and talk about interventions and maybe what we need to do next is y’all need to get this book and we can have like a book club about it and have like a follow up podcast where we talk about how much we love or hate this book.

But thank you so much. I know we all have clients to get to. And so, so good to talk with you all. And yeah, thank you all for listening and we’ll see you next week.

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