"Somewhere we read, “The unexamined life is not worth living… for a human.” How are we supposed to live, to examine, to be, to become, to be fully human when we are so busy?

This disease of being “busy” (and let’s call it what it is, the dis-ease of being busy, when we are never at ease) is spiritually destructive to our health and wellbeing. It saps our ability to be fully present with those we love the most in our families, and keeps us from forming the kind of community that we all so desperately crave."

Check out this article: The Disease of Being Busy.

We see and hear a lot about depression. Actually, as I write I see a anti-depressant medication commercial on television. Everyone has ups and downs in mood, but, how do you know that it is depression? Here are some signs of depression:

1. Hopelessness. It's more than the problem at hand. With depression, it's about having a feeling that nothing will get better and there is nothing you can do about it. 

2. Loss of Interest in Daily Activities. Maybe there are activities and/or hobbies that you used to enjoy. Do you still find enjoyment from those activities? Or, have you lost the ability to find enjoyment from those things? If you have a hard time finding enjoyment in activities you once enjoyed, you might be suffering from depression. 

3. Anger and/or Irritability. Feeling angry or irritable is often a symptom of another problem. With depression, your temper could be short and things can easily get on your nerves. Anger and irritability is a symptom of being unhappy.

4. Fatigue. Do you find yourself to be tired and/or physically drained? With depression - normal everyday tasks can be tiring and draining. 

5. Low Self Esteem. If you experience strong feelings of guilt or worthlessness, you may be suffering from depression. If you harshly criticize yourself for a fault or mistake, it could be a sign that something else is going on. 

6. Concentration Problems. Trouble focusing, making decisions or remembering things are all signs of depression. 

7. Appetite Changes. If you notice a significant weight loss or weight gain - it may be due to a change in appetite. 

8. Suicidal Thoughts. If you are thinking about suicide, you likely have depression. 

There's help for depression. I would be happy to see you in my office and help you get the help you need, call and make an appointment: 651.646.8985. If you are reading this and you are not in the Minneapolis-St. Paul Metro Area, you can find a therapist in your area by going to www.psychologytoday.com, click on "Find a Therapist." If you need to talk with someone right now, call 1.800.273.TALK.

Psychcentral had a great idea when they started the monthly column, "Clinicians on the Couch." So, with their inspiration, I answer these 10 questions.

What's surprised you the most about being a therapist?
It's a business. All of my job experiences up until this point contributes to my practice. I've been an office manager, administrative assistant, marketing assistant, copyeditor, writer, waitress. Every one of these jobs prepared me for the business side of being a therapist. When it comes to the business side of therapy - I am unsure if there is anything that could have prepared me 100% for handling insurance, getting credentialed with insurance companies, reviewing contracts, etc. 

What's the latest and greatest book you've read related to mental health, psychology or psychotherapy?
I really enjoyed these books:
Raw Art Journaling by Quinn McDonald (Editor: Tonia Davenport)
True Vision: Authentic Art Journaling by L.K. Ludwig
Art Journals & Creative Healing: Restoring the Spirit Through Self-Expression by Sharon Soneff

Art is already a venture in self-expression, and, the idea of art journaling is cathartic and self expressive. I learn so much when I engage in the process.

What's the biggest myth about therapy?
The biggest myth about therapy is that something is wrong if you go to therapy. Something does not have to be blatantly "wrong" for a client to engage in therapy. I like to think about therapy as if it is an opportunity for growth. 

What seems to be the biggest obstacle for clients in therapy?
The biggest obstacle for clients in therapy is the idea that the therapist has all the answers. That isn't the case. Clients have to do their own work and the therapist is there is facilitate the process. 

What's the most challenging part about being a therapist?
The cost of therapy is often prohibitive. Many insurance plans have high deductibles and/or high co-payments. This makes my work challenging. I would like therapy to be available to everyone. This means transportation would be available, deductibles and co payments would be affordable, (the list goes on and on...).

What do you love about being a therapist?
I enjoy hearing people's stories. I feel humbled by being a part of the story. 

What's the best advice you can offer to readers on leading a meaningful life?
Enjoy the moment. Think about how you experience your day with all of your senses. What are you seeing, touching, hearing, tasting and smelling? 

If you had your schooling and career choice to do all over again, would you choose the same professional path? If not, what would you do differently and why?
 In 7th grade I took a career inventory assessment. It was a really long test and the final results arrive months later (this was old school - before everyone had computers). The career inventory said that I would be best suited to be a social worker. If I could go back and make a different choice -- I would have gone into this career sooner. 

If there's one thing you wished your clients knew about treatment or mental illness, what would it be?
Most of the time, what you are going through is unique in some ways. Yet in other ways - it is part of the human experience that we all share. In our individualistic society, we need support in this human experience. So, in some ways, you're normal. 

What personally do you do to cope with stress?
I cope with stress by being close to my husband and my dog. My service dog, Cupido, does more than save me from my allergies - he helps me cope with stress. He is a happy go lucky dog that brings a smile to me everyday. 

Therapy is seems to be a mysterious thing. We may imagine something like this:

Or, a cute cartoon like this: 

Therapy has become a joke to many. Actually, it is a really effective tool to help ourselves when there is a problem or during a big life change. 

When you come to therapy - here's what you might encounter:

1. You enter the therapy office. Many times you will have your first interaction with a receptionist or front desk staff. They will ask you to complete a set of forms. The forms often include:       
        Registration Form: You write down your name, address, date of birth, insurance information.
        Intake Form: It could ask for information about your family history, the reason(s) you are 
        seeking therapy, medical conditions, your occupation/education, relationships, drug/alcohol 
        history, legal history.
        Consent Forms: You look over the Patient Rights and Responsibilities, Health Information 
        Privacy Accountability Act, Financial Policy of the provider or clinic.
        Scales and Questionnaires: You may be asked to complete some questionnaires that 
        appear to be more like tests or quizzes. It is important to be as truthful as possible as
         you complete these forms. They are the PHQ-9, CAGE-AID, GAD-7, etc. These 
        questionnaires look at your level of depression, anxiety and/or your substance use.

2. When you have completed all of these forms (are your hands tired from writing yet?!?), the therapist will meet you in the lobby, introduce themselves and invite you to come back to their office. 

3. You are in the office and the therapist will ask you some general questions, like: What brings you in today? How long has this problem been going on? The clinician may ask you some clarifying questions. 

4. During the appointment, the clinician will review the consent forms and explain them. One of the most important things that the clinician will review is regarding privacy. Almost everything is confidential. What isn't confidential? If there is abuse/neglect of a minor (under the age of 18), if you are going kill yourself and plan to complete suicide, if you are planning on killing someone else and have a plan to complete the homicide. 

5. Toward the end of the appointment, the therapist will talk with you about how often you would like to attend therapy. Sometimes people come to therapy once a week and when the problem starts to resolve, the client may want to come in less often. 

At the next session the therapist may talk with you about your diagnosis and talk about what might help you. 

Everything can change in an instant. I've been watching ABC's show, In An Instant. The first show was about a plane crash in Alaska, this episode showed amazing resilience. But, I thought that the pace was slow so I did not want to watch the show again. 

When they previewed the next show, In An Instant: Rush Hour Disaster, it was about the Minneapolis 35W Bridge Collapse. I felt like I had to watch, then, it showed my former co-worker, Lindsay Walz, and I felt even more compelled to watch. I would guess that the majority of Minnesotans were watching and reliving this. Most of us know where we were on that day and how the collapse affected us. 

Therapists talk a lot about exposure therapy and I feel that this blog describes it well. Check out Lindsay Walz's blog. She is a change maker and survivor of the bridge collapse. She has a non-profit called Courageous HeARTS, an arts-based nonprofit youth center which helps young people use creativity to build courage. 

Health insurance can be confusing. When it comes to therapy,  you might need to call you insurance company and find out what is covered. Make sure  you get the answers you need by following this example: (Download this Worksheet)

"My name is ____. I'm interested in going to River City Clinic for help with my mental health and I am calling to verify my benefits. First, I would like some general information."

Policy Effective Date: _______
Office Visit Co Pay: ____
Deductible: ____
Out of Pocket Max: ____
Do my deductibles, co-pays and co-insurance apply toward my out of pocket max? ____
How much of my deductible have I spent this year? ____
Do I need a referral to see a mental health/behavioral health therapist? ____
If yes, who needs to refer me? ____
Is River City Clinic (Clinic Director: Mark Hansen) and/or Heather Holt in-network? ____
If not, how does my insurance work if River City Clinic and Heather Holt is out of network? ____

Individual Therapy
River City Clinic usually uses CPT codes 90834 and 90837 for these services. 
What's my co-pay/co-insurance? ____
Is there a limit on the number of sessions per year? ____
If so, how many individual therapy sessions per year? ____
Is authorization required for individual therapy? ____

Lastly, ask for the representative's name: ____

When you come to my office for a visit, you will see that I have a service dog. His name is Cupido, he's hypoallergenic. He will be in a kennel for your first visit to the office. Most of the time - you won't even know he's there. 

A lot of individuals are not familiar with service dogs. I decided to put some information together. 

What is a service animal?
As defined by the Americans with Disabilities Act (ADA), a service dog (or miniature horse) is one that performs a task for the benefit of a person with a disability.

What is a disability?
It is any physical or mental condition that substantially limits major life activity. Some disabilities are not visible, such as deafness, epilepsy, diabetes, and psychological conditions.

What are some tasks that service animals can perform for someone with a disability? 
-Guide people who are visually impaired
-Alert epileptics to an impending seizure or protect them during a seizure
-Retrieve dropped items
-Help a person rise after a fall

How can I be sure a dog is a service animal and not just a pet?
 If a person wants to bring their dog into a public place, the only questions allowable are, “Is that a service animal?” and, “What task does s/he perform?” Asking about the person’s disability or requiring that you watch the animal perform the task are in violation of the person’s rights.


Service Dog Manners
When you meet a person with a service animals, please remember that the dog is working. Don’t do anything to interrupt the service animal while it is performing its tasks.

Some guidelines for interacting with people who use service animals:  
·     Speak to the person first. Do not aim distracting or rude noises at the animal.
·     Do not touch the service animals without asking for, and receiving, permission.
·     Do not offer food to the service animal.
·     Do not ask personal questions about the handler’s disability.
·     Don’t be offended if the handler does not wish to chat about the service animal. 
·     Do not ask for a demonstration. 

About Heather's Service Dog:
My service dog is named Cupido, he is a Lagotto Romagnolo, a rare breed from Italy. Cupido is a gluten-detecting service dog. He is one of just a few gluten detecting dogs in the world. Cupido does not need to taste my food or touch my food to know if there is gluten in it - he simply smells it and lets me know. 

For more information about Cupido, go to: www.gofundme.com/celiacservicedog, www.facebook.com/celiacservicedog, www.celiacservicedog.org.

A gluten-detecting service dog can be obtained by contacting Maja Golob, K9 Services in Slovenia. You can reach her at: www.hydrargium.si, [email protected].

Thank you to Pet Partners for some of this content. (875 124th Ave NE, Bellevue, WA 98005, 425.679.5500, www.petpartners.org)

According to Bessel A. Van der Kolk (2003), “it is virtually impossible to discuss trauma in children without addressing the quality of the parental attachment bond." Attachment is “an inborn system in the brain that evolves in ways that influence and organize motivational, emotional, and memory processes with respect to significant care giving figures” (Siegel, 1999). Attachment provides a sense of security, helps with regulation of affect and arousal, facilitates expression of feelings and communication and provides a base for exploration (Davies, 1999). 
            
John Bowlby (1988) in Developmental Psychiatry Comes of Age describes the patterns of attachment. Secure attachment is consistent with a healthy development where the person is confident in their caregiver’s responsiveness (Bowlby, 1988). The child is confident that the caregiver will be available and helpful in adverse situations (Bowlby, 1988). The second pattern of attachment is the anxious resistant attachment where the child is uncertain whether or not the caregiver will be available when needed (Bowlby, 1988). Last is the anxious avoidant attachment pattern where the child has no confidence in their caregiver’s responsiveness, which can often lead to the development of a personality disorder (Bowlby, 1988).

Another type of attachment pattern has been identified by Mary Main (Davies, 1999). This attachment pattern is disorganized/disoriented attachment (Davies, 1999). The children who relate with this attachment pattern are often contradictory in their behavior and were more likely to have experienced trauma (Davies, 1999). It is important to note that 80% of traumatized children have disorganized attachment patterns (Van der Kolk, 2003).

Abuse demonstrates a sense of helplessness in the attachment relationship. It is important to note that “Disorganized/disoriented behavior is expectable whenever an infant is markedly frightened by its primary haven(s) of safety, i.e. the attachment figure(s)” (Hesse & Main, 2000). There is a push and pull relationship demonstrated when the child feels obligated to be with their primary caregiver while being afraid of them.  

Victims of abuse may demonstrate dissociative symptomatology and social difficulties if they have a disorganized/disoriented attachment pattern (Siegel, 1999). Chronically traumatized children lack capacity for emotional self-regulation (Van der Kolk, 2003; Siegel, 1999). Children who have experienced trauma tend to react in a fight-or-flight or freeze reaction (Van der Kolk, 2003). These are totalistic reactions that keep them from being able to learn from their experience (Van der Kolk, 2003).

Attachment theory aids in understanding childhood trauma. This is the lens that many trauma informed clinicians will refer to when considering treatment. I have extensive training in attachment theory and the implications the theory when considering trauma. I feel honored to share the journey of recovery with clients. 

Please email me to get a listing of references for this post.