Types of Mental Health Workers

Because so many people are confused about it.

Psychologist: has a PhD, EdD or PsyD (doctoral level); may specialize in terms of patient age or condition and theoretical approach; uniquely does psychological evaluations including intellectual, achievement, personality, and projective testing; may prescribe psychotropic medications in some states with appropriate licensure and education (not Utah)

Psychiatrist: has an MD or DO with specialized training in recognizing and treating mental illnesses; prescribes psychotropic medications

Social Worker: Masters degree in social work (LCSW)

Marriage and Family Therapist: Masters degree in Marriage and Family Therapy (LMFT), trained in systems theory

Clinical Mental Health Counselor: Masters degree (CCMHC, formerly LPC)

Psychiatric Nurse: RN with specialization in psychiatry (LPRN)

All must be state licensed to practice.  Unfortunately, in the past and as far as I know even today, anyone else can hang up a shingle as a therapist, or counselor, or life coach, or energy healer, or whatever, with no oversight or protection for the public.

There are many nuances in terms of theoretical orientation and specific techniques used.  Most professions have national and state associations (and web sites) which can provide more information.  The state Division of Occupational and Professional Licensing can also be of help.

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The Ineffable Cheerfulness of Acknowledging Suffering and Impermanence

Some friends and family members have decided to read selected Buddhist teachings and talk about them together, all with our own reasons for doing it.  My main reason is that it makes me cheerful.  Roshi’s famous quote – “Life is like stepping into a boat that is about to sail out to sea and sink” – makes me laugh every time, which may be perverse, but explicable given my innate pessimistic temperament.  If I always keep in mind suffering and change – and believe me, I do – then any lovely little pleasure or beauty stands out even brighter against the darkness.  Or something.  Anything good that happens is an unexpected pleasant surprise.

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Economic Resilience

This article from the APA Help Center  was first published in the depth of the Great Recession.  But with the stock market losses in the past few days, we may need the reminder again on handling economic stress:

“As job losses soar and the media continues to report on falling stock prices and rising foreclosures, many people may react to the economic climate with a flood of strong emotions and a sense of uncertainty. Yet, people generally adapt well over time to life-changing situations and stressful conditions.

“What helps some people ‘bounce back’ while others continue to feel overwhelmed? Resilience, the process of adapting well in the face of adversity, which is vital in these high-stress times. Resilience is a learned skill that can help carry you through the current crisis as well as future relationship, family, or work problems you may encounter.

“The current economic situation is a major stressor for eight out of ten Americans, according to a 2008 survey by the American Psychological Association (APA). With constant reminders from newspapers, television and the internet, it’s hard to avoid the doom and gloom narrative about the economy. It’s normal to feel overwhelmed when you seem to be surrounded by bad news that impacts your family situation or that you fear may do so in the future. However, you can handle stress in positive ways and implement tactics to help you better manage and develop your resilience. Seeing this difficult situation in a positive light can help you build and utilize your resilience.

“Accept that change is a part of life – You may have to adjust your goals, or make changes to your lifestyle as a result of the economic crisis. Accepting circumstances that cannot be changed can help you focus on circumstances that you can alter.

“Make connections – Good relationships with close family members, friends, or others are important. Accepting help and support from those who care about you and will listen to you strengthens resilience. Some people find that being active in civic groups, faith-based organizations, or other local groups provides social support and can help with reclaiming hope.

“Keep things in perspective – Try to avoid the Chicken Little attitude that the sky is falling. Remember the good things you have in your life and realize that this situation will pass. Visualizing what you want, rather than worrying about what you fear, will help you craft a hopeful outlook and reduce your everyday stressors.

“Look for the opportunities – People often learn something about themselves when going through a difficult situation such as the current economic downturn. Use crisis as a chance to grow professionally or personally. Look into groups in your community or on the Internet that can help foster your interests and expand your opportunities to put your top skills to good use.

“Be mindful of the good things in your life – Resilient people count their blessings. You might let the people in your life know what they mean to you by writing them a gratitude letter. Or, you might spend just five or ten minutes a day reflecting on one aspect of your life that you are grateful for. Such simple techniques can be powerful in their impact.

“Maintain a hopeful outlook – No one can reverse what has happened. But by being resilient, you can change how you interpret and respond to events. Try looking beyond the bad news and into the future, where circumstances may be a little better and where you can take steps toward improving the situation.

“Talk to a psychologist – Sometimes dealing with stress by yourself can be overwhelming and frightening. If you continue to feel overwhelmed, you may want to talk with a psychologist who can assist you in managing your stressors and addressing the emotions behind your concerns.”

Posted in Finances, Health and Wellness, Psychologists and Psychotherapists, Self-help | Tagged , , , | Leave a comment

Getting Insured

This is a public service announcement.  :-)

Most of our children are self-employed, and the Affordable Care Act (Obamacare) has been a blessing for them.  But choosing the best of the many health insurance options on-line, on your own, is a nearly impossible task.

Our kids have been able to get the best coverage available for them by going through an insurance broker.  Shalise & Chad Day, at 801-404-5330, (office on State Street in Orem) have been incredibly helpful to our children.  I’ve been referring uninsured patients to them as well, and all have been happy with their help.  Their service is paid for by the insurance company, so it doesn’t cost the person buying the insurance, and they help sort through the many plans and options to find the best coverage for the least amount of money.

You’re welcome.

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Mindful Eating

I started eating vegan about 9 months ago.  I’ve lost a fair amount of weight but even more importantly, I’ve brought my blood glucose levels down to normal.

Here is an article on Jean Kristeller‘s MB-EAT, or Mindfulness Based Eating Awareness Training.  Excerpts:

“[Her training] blends ‘mindful eating’ exercises, such as being aware of hunger, chewing food slowly, tuning in to taste and noticing fullness, with mindfulness meditation practice to cultivate more general moment-to-moment awareness of self. Psychologists around the country are using it to help binge and compulsive eaters, diabetics, and people who are mildly and moderately obese to regulate their eating and avoid weight gain.

“”Traditional techniques for tackling the obesity epidemic often don’t take into account the strong drivers of eating: negative emotions, cravings and impulsivity, particularly in the face of highly palatable food,” says… Elissa Epel, PhD, who has collaborated with Kristeller on several research studies using MB-EAT. ‘Mindfulness training gives us more control over these strong drives and makes us more aware of the triggers of overeating that come from outside of us.’

“Kristeller advocates no particular diet — and no foods are off-limits. She teaches students to savor their food while eating, rather than mindlessly eating while watching television, surfing the Internet or reading the paper….

“Kristeller’s MB-EAT 10-week course teaches people that, once they pay attention to their body’s signals, brownies and chocolate cake are best experienced and savored in just a few bites.

“’Our taste buds are chemical sensors that tire quickly,’ she says. “The first few bites of a food taste better than the next few bites, and after a large amount, we may have very little taste experience left at all.’

“Participants in her training programs — those who struggle with food and weight issues and health-care professionals interested in helping them — focus on three mindfulness practices: awareness of hunger and what it feels like in the body, awareness of what it feels like to be full, and the practice of savoring — slowing down to truly taste food and be mindful of the various flavors and sensory experiences associated with each bite. A variety of foods — including chocolate — are used in the program, and Kristeller even assigns participants increasingly challenging homework assignments, such as going to a buffet. She teaches them that by attending to how much they are enjoying the food and recognizing the point at which it stops being as enjoyable, they can eat much smaller amounts, leave food on their plates and return for seconds if they still want more.

“’It’s about finding satisfaction in quality, not quantity,’ Kristeller says. She also teaches people not to beat themselves up if they overeat, but to see this as a learning experience….

“[E]ffects [of her program] are proportional to the amount of mindfulness meditation practice that is reported….

“[T]he more mindfulness the women practiced, the more their anxiety, chronic stress and deep belly fat decreased. Obese participants in the mindfulness program also maintained their body weight while those in the control group increased their weight over the same period of time….

“’One lesson we’ve learned is that with the effort and attention to eating taught in the MB-EAT program, people can change their relationship with food very quickly, and within a few sessions, they’re often starting to eat differently,’ [one researcher] says.”

Posted in Behavior Change, Health and Wellness, Self-help | 1 Comment

Sexual Incompatibility

Content note: Links in this post from 2012 discuss sexual abuse, among other sensitive subjects.

Every couple I know* – in a therapy setting or not – has experienced sexual incompatibility at one point or another in their relationship.

“Sexual incompatibility is a normal and natural part of marriage given the different sexual wiring of men and women, and the unique differences and desires of every individual.” source

So, let’s try a couple of brief thought experiments.

Scenario One

Imagine yourself as a woman, say a 35 year old mother of three children.  You were a virgin at your wedding, but that doesn’t mean you were not sexual.  You couldn’t wait for marriage.  You were shy in talking about sex with your husband, however, and he didn’t know that much to begin with either.  So there was a learning curve, but you were getting along OK and hoping things would get better.

Then you got pregnant.  And nauseous.  Everything made you sick, including the sights, smells, and the up-close bodily contact of sex.  To say nothing of what was happening to your formerly trim, sexy body.  You felt like a cow – a cow that threw up all the time.  Sex was the furthest thing from your mind.  And then the birth.  Do we even need to describe it?  There was nothing pretty or comfortable or “feminine” about that experience – in fact, if there wasn’t a baby involved, you could accurately describe it as brutally traumatizing.  Afterwards, you didn’t want anybody to touch anything down there, for a very long time. 

Three times you went through this.  You love your kids, you love your husband, you’re glad you did it, but sometimes you feel like sex is something you can leave or take.  Your body has changed and softened and aged, and the threshold for sexual arousal is higher.  Sometimes.  Sometimes not, but it isn’t exactly predictable.

Scenario Two

Imagine yourself as a man, say the 35 year old husband of the woman above.  You love your wife, you’ve always loved her, you’ve always found her sexy, and you’ve learned to be extremely careful about making comments on her appearance or fitness level because of her reaction.  You get it – the societal pressure on women about their appearance.  You’re patient when she’s pregnant, when she’s nursing, when it’s her period.  But then there are also the random famine times, which are so difficult to endure without getting resentful.  She’s in your house, in your bed – and she doesn’t want sex.  She just doesn’t want it, she doesn’t even have a reason why.

Sometimes you feel desperate.  You love her, and you don’t want anybody else.  You need sex with her to know that she loves you. 

This is only the most stereotypical of the endless permutations of sexual desire that can occur between partners over the course of a relationship.  Imagine the complications created by a history of sexual abuse, chronic illness, pornography exposure, infidelity, etc. etc.

Some things to remember:

  • Some sexual incompatibility is inevitable, if your relationship lasts long enough.
  • Don’t take it personally.
  • Try to understand your partner’s perspective.  Resentment makes everything worse.
  • Practice talking to each other about sexual issues in a loving, open way.  You may need couples therapy in order to do this.
  • Don’t give up.
  • Remember that even in a marriage, no means no.

No person in a sexual partnership should ever feel they should or must have sex whenever the other partner wants to: we have sex with a partner when both of us feel a mutual, shared desire to do so. For partners who really do want to be sexual with one another, and who want similar things — a similar frequency of sex, a handful of sexual activities they both mutually enjoy, a general sexual dynamic of that works and feels authentic for both — even though there will be times when one partner wants to be sexual and another doesn’t, often those times will overlap and intersect enough to leave everyone satisfied with the relationship. When people in sexual relationship aren’t similar in those ways, it’s going to be really tough to have a sexual relationship that works well for everyone involved.

I want to make sure this is clear: consent is not a no or a maybe. Nor is it someone caving into another person nagging, whining, pressuring, goading or pushing for sex. Consent is a big, fat, sure, clear YES. If either one of you are continuing or trying to continue sex with the other with anything but that sure yes, what you’re doing is NOT consensual, and is potentially abuse or rape. This is not a minor thing… this is very serious business. To give real consent, someone needs to be able to make decisions about sex without any feelings of pressure. No always needs to be just as okay an answer as yes, even if someone has to manage feelings of disappointment. source

A brief overview of sexual incompatibility here.

The negative effects of earlier sexual abuse on a marriage are discussed in this essay by Mormon writer Tessa Santiago.

Feminist Mormon Housewives always has interesting posts on this topic with input in comments from every perspective: here is a recent, and here is an earlier post.


*that is, every couple with whom I am familiar enough to have discussed their sexual experiences (including gay couples) – so not really a large sample – but 100% of the sample that exists.

Posted in Health and Wellness, Relationships, Sexuality | Leave a comment

Karla’s Anxiety Management Plan, Or How to Stop Dithering and Actually Get the Work Done

I’ve been blogging on and off for years.  Some versions of my blog have disappeared – some have become inaccessible for inexplicable (to me) tech reasons – one long series of posts I can still read but not modify.  Those posts from 4-5 years ago I will maybe look at and pick the best to republish here.  This is the first.

Mindfulness Check

Several times throughout the day, take a moment to stop.  What am I feeling?  Thinking?  Doing?  Use a brief relaxation technique to calm and quiet self.  Breathe.  Listen to the body.  Listen to the universe.

Priority Review

Do I know my priority*?  Am I working on my priority, taking a planned break, or doing routine self-care**?  Or am I dithering, by:

  • Not doing anything
  • Mindless avoidance—eating junk food, wasting time online, etc.
  • Doing something good but other than the priority

Do I want a break before I attend to my priority?  If so, take a break.

Then DO IT

*Priority Planning

Review goals weekly for each of the working areas of my life:

  • Family and home
  • Personal health
  • Psychology practice
  • Writing

Plan daily tasks with the following in mind.  Focus on 1 and 2, minimizing 3 and 4 [this idea stolen from Stephen Covey]:

  1. Urgent and important
  2. Important but not urgent
  3. Urgent but not important
  4. Neither important nor urgent

Review daily tasks for the areas each morning and/or evening.

**Routine Self-Care

Morning exercise (stationary bike, weights, stretches)
Meal planning/prep
Mindfulness checks
Breaks during the day:

  • Meditation
  • Nap
  • Gardening
  • Music
  • Reading
  • Hot tub
  • Journaling
  • Talking
  • Online

Evening exercise (walking, swimming, dancing)

Update: An enormous caveat for this type of plan is that it doesn’t work while caring for small children.  In that case (as I know by experience), everything is interruptable.   One gets in the mental habit of being always available, of one’s tasks and goals always taking second place to others’ needs.  The alternative (as I also know by experience) is to be constantly grumpy and resentful of interruptions.  I do not know the solution, except to share childcare responsibilities with a trustworthy partner who respects one’s work time, and/or to work outside the home.

The other difficulty, and one which I am attempting to overcome with this plan, is that the mental habit of being constantly available remains even after the children are old enough not to need hovering supervision.  It isn’t just laziness, flightiness, or an inability to focus; it is the after-effect of a formerly functional way of being.  But the result is the same – dithering.

Plan created during a quarterly Professional Women’s Alliance retreat several years ago.  Thanks to Amy and Betsy for helping me with it.

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