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. 

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: ____

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.