If you’ve ever typed “types of therapy” into a search tool and felt more confused after reading the results, you’re not alone. Terms like cognitive behavioral therapy, dialectical behavior therapy, and EMDR can sound clinical and intimidating, but this guide helps you understand these approaches with definitions written for real people like you.

Whether you’re considering therapy for the first time, exploring options for a loved one, or simply trying to ask better questions when working with a therapist, we can help you through it all.

Why Knowing Your Therapy Options Matters

The beauty of therapy is that there is no one approach: it looks different for everyone, depending on their needs. The right treatment for someone navigating grief may look very different from what works for someone managing borderline personality disorder or processing childhood trauma. You may have heard of cognitive-behavioral therapy (CBT), which is very effective for many people, but it’s just one of many therapy approaches that trained professionals can use.

Knowing what’s available and which modalities address different needs empowers you to have informed, meaningful conversations with potential therapists or current therapists. It also helps you trust the process once you begin the healing journey.

The Most Common Types of Therapy, Explained

How Do You Know Which Type of Therapy Is Right for You?

The truth is: You don’t always know in advance, and that’s okay. Most skilled therapists are trained in multiple modalities and will tailor their approach to your specific needs, history, and goals. The most skilled therapists have a diverse toolkit of methods they can draw from, adapting their approach to match each person’s unique needs, interests, and developmental stage.

That said, going in with some knowledge gives you the ability to ask meaningful questions. When looking for the right therapist, or during your next session, try asking your therapist these questions:

Asking these questions will help you find the right fit for your healing journey, and a good therapist will welcome them.

A Quick Reference: Therapy Types and What They Address

There are so many therapeutic approaches out there, and we’ve only covered a few. Still, here’s a breakdown of the theories we discussed and what they can help support:

Taking the Next Step

Understanding these approaches is the first step in building a better you. Finding the right therapist is a significant part of improving your mental health, but you don’t have to do it alone. GoodTherapy’s therapist directory allows you to filter by therapy type, specialization, location, and more, so you can find someone who truly fits your needs.

If you’re still exploring whether therapy is right for you, our blog on what to expect in your first therapy session can help you get started.

Remember, reaching out is not a sign that something is irreparably wrong with you. It’s a sign that you know your well-being is worth investing in.

There is an abundance of information about how anxiety impacts our health—mentally, emotionally, and physically.  Anxiety can cause periods of panic, feelings of fear or overwhelm, and a general sense of unease and tension. It can take over your thoughts and bleed into many areas of your life. Have you considered how anxiety destroys relationships with those closest to you?

If you are feeling a strain on your relationship, anxiety may be playing a role. Could your anxiety (or your partner’s) be putting your relationship at risk?

Here’s how and why anxiety destroys relationships, and what you can do to stop it.

1. Anxiety breaks down trust and connection …

Anxiety causes fear or worry that can make you less aware of your true needs in a given moment. It can also make you less attuned to the needs of your partner. If you’re worried about what could be happening, it’s difficult to pay attention to what is happening. When you feel overwhelmed, your partner may feel as though you aren’t present.

… so train your brain to live in the moment. If you notice a fear or concern that causes your thoughts to stray from the facts or the present moment, pause and think about what you know (as opposed to what you don’t know). Calm down before you act. You can make purposeful steps to build trust in your partner. Share openly when you’re feeling worried, and consciously reach out to your partner (physically or verbally) when you might normally withdraw or attack in fear.

Reach out to one of our therapists in Minneapolis, MN or find a therapist closer to you.

2. Anxiety crushes your true voice, creating panic or procrastination …

Someone who tends to be anxious may have trouble expressing his or her true feelings. It also may be difficult to keep reasonable boundaries by asking for the attention or space that is needed.

Since experiencing anxiety is uncomfortable, subconsciously you may try to postpone the experience of it. On the other hand, anxiety can cause you to believe that something must be talked about immediately, when in fact a short break may be beneficial.

If you don’t express what you truly feel or need, anxiety becomes stronger and anxiety destroys relationships. Plus, your emotions may eventually spiral out of control if you keep them in. You may become overwhelmed and defensive.

… so acknowledge your feelings sooner rather than later. A feeling or concern doesn’t have to be a disaster in order for it to be addressed. Approach your partner with kindness, so that you’re neither procrastinating nor panicking. Also, find time on your own to unpack some of the thoughts or fears circulating in your mind; they are draining your time and energy.

3. Anxiety causes you to behave selfishly …

Because anxiety is an overactive fear response, someone experiencing it may at times focus too much on his or her own concerns or problems.

Your worries and fears may be putting unnecessary pressure on your relationship. You may feel like you need to worry in order to protect yourself in your relationship, but it might be keeping you from being compassionate and vulnerable with your partner.

If your partner experiences anxiety, you may build up resentment and react in selfish ways as well. The attitudes and perspectives that we have are contagious. Keeping your stress levels under control is especially hard when your partner is feeling anxious, upset, or defensive.

… so attend to your needs, not your fears. When you notice yourself becoming fearful or defensive, take a moment to consider the compassion that you have for yourself and your partner. Clearly ask for the support you need to feel loved and understood. Apologize for letting anxiety make you self-absorbed.

4. Anxiety is the opposite of acceptance …

A healthy form of worry will tell you “something isn’t right”; it comes via that quick pull at your heart or that tight feeling in your stomach. This signal helps you act, such as when you speak up for someone who is being treated poorly.

Unhealthy levels of anxiety make you feel as though an emotional “rock” is in your stomach almost all the time. Anxiety causes you to reject things that are not dangerous and avoid things that might benefit you. It also can stop you from taking healthy action to change things in your life that are hurting you because it makes you feel hopeless or stuck.

… so practice being uncomfortable. You don’t need to either ignore or obsess over an uncomfortable thought. Take constructive action if you can. Sometimes your partner just needs you to be present with his or her feelings, and sometimes you need to offer that same gift to yourself. You can show your presence to your partner with soft eyes or a soft touch, and be present for yourself with a calming breath.

5. Anxiety robs you of joy …

Experiencing joy requires a sense of safety or freedom. Anxiety makes us feel either fearful or limited. Also, a brain and body trained to stress may have a much harder time enjoying sex and intimacy. Negative thoughts and fears impact a person’s ability to be present within a relationship, potentially sucking the joy out of a moment.

… so don’t take yourself too seriously. You can use your sense of humor to overcome anxiety. Remember to laugh and play with your partner. Joy physically heals and comforts your brain in ways that are vital for a healthy relationship.

As Anxiety Weakens, Your Relationship Strengthens

Building trust within your relationship may reduce the power of anxiety. By understanding how anxiety impacts your relationships, you can create positive change within a relationship dynamic.

A therapist who specializes in anxiety treatment can help you further understand anxiety and help you stop harming yourself and your relationship.

Billing Best Practices: When Should I Bill Clients? 

For therapists, there are few better professional feelings than opening your own practice.  

Not only do you get to determine the communities you serve, the office you work out of, and your own schedule, but you also get a much bigger slice of the revenue your work brings in. 

Having your own business also enables you to figure out exactly how you want to structure your practice, including what kinds of clients to take on, which insurance providers to work with, and what areas of practice to emphasize. 

Yet at the same time, running your own practice also exposes you to a number of significant challenges. Chief among them? Billing. 

In an ideal world, clients would pay you predictably, and you would never have to track down late payments. Unfortunately, it rarely works out that way. Unless you make it a point to prioritize your billing process, you’re bound to run into billing issues sooner or later.  

To answer the question posed in the headline, there’s no rule that says you need to bill clients on any particular cadence. It is, however, important to bill clients consistently — whether that’s weekly, biweekly, monthly, or even quarterly is up to you.  

Before we take a look at some actionable tips you can use to improve your billing processes, let’s first turn our attention to some of the reasons why successful practices prioritize consistent billing experiences. 

Billing Therapy Clients: 5 Reasons Why Consistency Matters 

While the following list is by no means exhaustive, here are some of the more persuasive reasons why you should do everything you can to deliver a consistent billing experience to your clients.

1. You won’t catch your clients off-guard.

Ever get hit by an unexpected bill in the mail? It’s not the most thrilling experience in the world, to say the least. 

As a therapist, your job is to help clients move past traumas and become the best version of themselves. The last thing you want to do is be the source of stress or grief. 

By billing clients consistently, they will know when to expect bills and how much they’ll have to pay. In other words, no surprises — the way it should be.

2. You’ll avoid the appearance of fraud.

If you’re not in the habit of billing clients consistently, you might fall into the trap of billing them whenever you feel like it. For example, maybe you send a client a bill after two sessions, then after five sessions, then after three sessions. 

With no rhyme or reason to your billing practices, you might raise red flags for credit card companies — or even your clients themselves!  

In most other areas of our lives — whether it’s insurance payments, rent or mortgage expenses, or utility bills — we’re billed once a month, like clockwork. By sticking to a predictable billing cycle, you can avoid the appearance of fraudulent accounting behaviors.

3. You’ll never leave a big pile of invoices on your desk.

As every small business owner knows too well, invoicing can be quite the bittersweet activity. On one hand, you’re getting paid for your work, which is exciting. On the other, if you put the task off long enough, you’ll have to deal with a mountain of paperwork (or tons of emails if you bill electronically), which is probably not on your list of favorite things. 

By building a consistent, repeatable billing system, you can make the process as efficient as possible.

4. You won’t work for free.

The longer you put billing off, the higher the chances you’ll miss charging for  a session or two, and maybe even more.  

While you went into your line of work to help people, you knew this  would also be your job, and you didn’t sign up to work for free. Consistent billing processes significantly reduce the likelihood you’ll forget to bill a client for a session.

5. You’ll have a steady income stream.

Cash flow issues are one of the main reasons small businesses fail, and therapy practices are no exception. After all, you need money to pay your utilities, office expenses, taxes, and any wage expenses you might have. 

Unless you are sitting on a massive pile of cash, you need to bill your clients consistently to avoid cash flow gaps. Generally speaking, the faster you send out invoices, the sooner you’ll get paid.  

By billing at regular intervals, you benefit from a predictable cash flow. This makes it much easier to help your clients to the best of your abilities — instead of worrying about how you’re going to pay next month’s energy bill, for example. 

Now that you have a better idea about why billing clients consistently is the right thing to do, let’s take a look at some of the specific steps you can take to get your billing function in a better place.  

4 Steps to Take Now to Transform Your Practice’s Billing Processes 

Ready to take your practice’s billing process to the next level? Here are four simple steps to make that happen.

1. Change the way you think about billing.

First things first: You need to treat billing as the most critical part of your business, because it is. If your clients don’t pay you promptly, it’s going to be that much harder to fulfill the mission of your practice: helping clients live their best lives. 

If billing’s been an afterthought to date, it’s time to change your mindset and treat it with the importance it deserves.

2. Communicate transparently.

Before you take on a client, it is imperative that they know exactly how much you are charging, whether their insurance covers it, and how much they can expect to be billed for each session.  By outlining your billing processes as early as you can, you reduce the chances there will be any confusion when it comes time to settle the account. 

For the best results, be responsive to client concerns and answer any questions they might have. If you’re planning to raise your fees at any point, communicate those increases well ahead of time.

3. Invest in your billing function.

There’s no rule that says you have to run your billing department yourself just because you own your own practice.  

As your business begins to scale, consider making smart investments in billing to lessen your load. For example, you might decide to hire an accountant, invest in billing software, or even bring in new in-house staff to take care of billing. 

When you don’t have to manage billing yourself, you can bring a clearer mind to each session — and achieve better client outcomes because of it.

4. Set automatic reminders.

You might decide that you like handling billing on your own, and that’s perfectly okay. If you continue with this setup, be sure to set automatic reminders that will let you know that it’s time to send out invoices. 

By doing so, you won’t have to worry about forgetting to bill your clients on time, which improves the client experience while strengthening your cash situation. 

Ready to Upgrade Your Billing Function? 

As a therapist, you went into business to help clients live more rewarding lives — not to crunch numbers and stare at spreadsheets. 

If you’re struggling with billing, look into a practice management solution like Therapy Partner, which gives you all the tools you need to manage your schedule, document each session, and bill your clients with ease.  

For more information on how Therapy Partner can transform your approach to billing and ultimately help your practice get to the next level, check this out. 

Trying to figure out why your partner/spouse left you can become the bane of your existence. Even if there appears on the surface to be an obvious and uncomfortable reason, your brain will search for answers that feel satisfying and rational.

The truth is that there are probably a million reasons for his or her departure, but the one you choose to believe will set the tone for your perspective, attitude, and experience going forward.

For example, it’s typically easier to digest the idea that you and your partner “grew apart” than it is to consider the possibility that he or she fell out of love with you. The first reason is practical and plausible; the latter can be a devastating blow to the heart and ego.

You may never get the answer you are looking for from your partner, but there are several common reasons why someone leaves a relationship. Below are the top five reasons for leaving that I hear about while working with divorcing couples in my therapy practice.

Reasons Partners Leave

1. Your partner wasn’t in love with you anymore. This is one of the most common reasons people leave a relationship. You could argue that all long-term relationships lose their spark, but falling out of love usually is code for “I’m done here.” While there are cases in which couples fall back in love, most often it’s hard to renew this emotional connection.

How to cope: As hard as it is, try not to take this personally. Remember that people fall in and out of love all the time, and you probably don’t want to be with someone who doesn’t love you deeply anyway. Heal your ego and your heart first, and then see where you stand with your emotions.

2. Your partner felt like you became more like a sibling than a partner. Many committed relationships and marriages, particularly those that start at a young age, turn from romantic to familial. [fat_widget_right]These are couples that “grow up” together and then “grow apart.” Husbands become brotherly, and wives become sisterly, until it just feels too weird to be romantic. These are hard situations because there is still a strong emotional connection, but no physical connection. Many people choose to stay in these kinds of marriages, but for many, giving up romance and sex is just not an option.

How to cope: If this is the reason for your divorce or breakup, you probably had a good go of it. The relationship was most likely very comfortable and “good” in many ways, but trust that you will rekindle some of your romantic spark and realize that your marriage was unfulfilling. Cherish what you had, and work on closing that chapter as you prepare for the next.

3. Your partner felt ignored and unappreciated. As with a garden, when a relationship isn’t tended to, it withers and dies. If you under-appreciated your partner or neglected to nurture the bond between you, your partner might have broken off like a dead limb on a tree. Maybe there were reasons you didn’t want to put energy and time into the relationship, or perhaps you felt like it was your partner’s job as much as yours. This all may be true, but once the life goes out of the partnership, it takes a lot of work to cultivate it back to where it needs to be.

How to cope: Work on taking responsibility for your part, forgiving yourself for what you could have done differently, and letting go of how you think it should have been. Try to relinquish anger and resentment to create space for understanding and growth.

4. Your partner met someone else. This is often the most painful reason for a leaving, but it’s also sometimes the easiest to accept. The message is so strong and clear when there is infidelity. Infidelity can severely strain a relationship and the people involved unlike opaque reasons such as boredom or lack of compatibility. Coming back from an affair is possible, but most often the trust is severed and cannot be recovered. Cheating partners often don’t even want to work on saving the relationship or marriage, increasing levels of frustration and hurt.

How to cope: Try not to take too much of a righteous or moral stance. The reasons for affairs are very “gray” and multilayered. It’s easy to get trapped in black-and-white thinking, but you will need to expand your concept of the situation to truly heal.

5. Your partner doesn’t have anything in common with you anymore. This always seems like something that can be worked on or fixed, but when two people live separate lives, they can eventually grow too far apart. This happens slowly and mysteriously until, one day, there are no common interests and someone gets bored and wants to move on. In many cases, there were no common interests to start with, making coming back together even harder.

How to cope: This is a great opportunity and time to ask yourself what you want to do with your time and how you want to live. As hard as it can be to lose your partner, there probably is some part of you that shut down or got lost in the relationship. Rediscover that now.

Coping with the end of a relationship can be difficult on many levels. There is no shame in seeking professional support from a counselor or therapist if you need or want it.

by Connor D. Jackson, JD

Connor D. Jackson is a healthcare attorney based in Chicago who serves independent practices. Visit his firm’s website to learn more.

Telehealth: Insurance & Legal Considerations

When evaluating whether telehealth services are covered by insurance, three concerns should be top of mind. The requirements of individual states, insurance companies, professions, and claims vary widely. Thus, something that might cause one claim to be denied could be irrelevant to another claim’s approval. It’s important to know what questions to ask and what the answers mean for your practice’s procedures.

1. Is it covered, and will I get paid?

First, determine whether your state legislature has enacted telehealth insurance parity laws. These laws typically require parity between the types of services covered or the reimbursement value of the services. For example, coverage parity requires that insurers cover telehealth-based services that they already cover when offered in the office. If a state also requires payment parity, insurers reimburse providers for telehealth services at the same rate as in-person encounters. 

Many states have coverage parity laws, but achieving payment parity has been a tougher battle for providers. CMS has already announced that some payment parity changes will be rolled back once the COVID emergency ends. Legislation is pending in several states to protect temporary payment parity changes, but even if passed, these laws will apply only on a state-by-state basis.

2. Do I need to change how I file claims?

The second insurance-related consideration requires that the provider bill the services using the correct codes, including any modifiers. Most mental health providers are already familiar with the “95” CPT code modifier for telehealth services. 

During COVID, however, CMS reminded providers that claims should include “DR” (disaster-related) and “CR” (catastrophe-related) modifiers as needed to ensure payment.  DR/CR modifiers aren’t generally needed for outpatient mental health services, and they were used more by those whose underlying roles shifted during the pandemic. 

For example, an ambulance company could seek reimbursement for responding to a 911 call and rendering paramedic services, even if they didn’t transport the patient back to the hospital, because COVID requirements didn’t allow them to follow that protocol. When filing their claim with Medicare, the company would add a DR/CR code to identify COVID as the reason they didn’t take the patient to the hospital.

3. Does it matter where I’m licensed?

The provider’s license matters to insurance companies. They use it to determine if the provider is eligible to provide services in the state where the client received them, and they verify it during the paneling or credentialing process before allowing that provider to be in their network. A “place of service” code and office address on a claim form could also reveal that the provider is located out-of-state.

Licensing for Telehealth Care

Traditionally, providers were licensed in the state where they lived and offered care. The client’s state of residence was generally irrelevant because clients saw their clinicians at a physical location. 

The emergence of telehealth in recent years was accompanied by an all-too-common expansion of technology at a faster pace than legal developments. The majority of clients continued seeing their providers in person, and coverage parity laws became the norm only shortly before COVID began. When the pandemic forced providers to suspend in-person care, they faced a new and existential question: whom can I treat?

1. If I’m only using telehealth, am I restrained by my state license?

Under the framework in most states, the law considers a telehealth visit to take place where the client is located during the encounter. This means that the provider must be licensed in the state where the client is actually located — a requirement that theoretically ensures that the provider is regulated by the client’s state and is aware of that state’s practice requirements, such as:

• scope of practice
• standards of care
• informed consent requirements
• state medical privacy rules

In reality, an excellent therapist in Illinois is likely also an excellent therapist in California. Technology now allows them to bridge that geographic divide — if only the law followed suit.

For example, say that you’re licensed in New York, live in New York, and have always seen clients at your New York office. During COVID, some of your clients permanently moved out of the city and into suburbs in New Jersey and Connecticut. Unless New York has a border-state exception, the law prohibits you from treating your NJ and CT clients via telehealth. Some dense geographic areas, like the DC-VA-MD metro area, have recognized the challenges of regulating certain professionals individually and have implemented border-state licenses or waivers, 

Some of these requirements arise from the expectation that providers and clients do reside in the same place. Proximity may even be clinically necessary — if a provider determines that a client’s care necessitates an in-person visit, then they could schedule that appointment promptly. This is particularly a consideration in psychiatry or for therapists working with youth or those with significant mental illness. 

If providers and clients are in different locations, then an in-person visit would be impractical or impossible — even if the standard of care required it. COVID, however, upended some of these norms. Providers were forced to ask themselves whether a client was “safer” receiving teletherapy from home or risking COVID infection by entering their office. Providers also had to consider their own health and how in-person encounters could impact their families, staff, and other clients. Telehealth rapidly became the norm, and emergency orders allowed providers to continue treating their clients even if people had moved around a bit in response to the pandemic. 

2. My profession has an interstate licensure compact. Does that change things?

The Psychology Interjurisdictional Compact (PSYPACT) coordinates the practice of telepsychology across state lines, giving licensed psychologists more flexibility. Currently, over one third of U.S. states have effective PSYPACT legislation, and by the end of 2021, that number will jump to half of states.

Under PSYPACT, psychologists must be located within a compact state in which they are licensed. Meanwhile, the client must also be located within a participating state.  The authorization does not come automatically, however. To practice telepsychology under the authority of PSYPACT, psychologists must obtain an Authority to Practice Interjurisdictional Telepsychology (APIT) and possess an active ASPPB E.Passport. 

The pace of new PSYPACT legislation suggests that lawmakers recognize the value and the demand for teletherapy services that reach across state lines. Nonetheless, the laws still lag behind the technology. Therefore, therapists who wish to set up an interstate practice must understand the laws that apply to their situation.

Figuring out exactly what is required of you and what path makes sense for your practice isn’t something you have to do alone. Law firms like Jackson LLP Healthcare Attorneys specialize in providing counsel to mental health providers to help you get it right in your practice of psychotherapy.

This article is made for educational purposes and is not intended to be specific legal advice to any particular person. It does not create an attorney-client relationship between Jackson LLP Healthcare Attorneys and the reader. It should not be used as a substitute for competent legal advice from a licensed attorney in your jurisdiction.

For those in or getting out of a romantic relationship with a self-absorbed individual, the silent treatment can feel like a punishment worse than death.

Why Narcissistic People Use the Silent Treatment

The silent treatment is a form of emotional abuse typically employed by people with narcissistic tendencies. It is designed to (1) place the abuser in a position of control; (2) silence the target’s attempts at assertion; (3) avoid conflict resolution/personal responsibility/compromise; or (4) punish the target for a perceived ego slight. Often, the result of the silent treatment is exactly what the person with narcissism wishes to create: a reaction from the target and a sense of control.

The target, who may possess high emotional intelligence, empathy, conflict-resolution skills, and the ability to compromise, may work diligently to respond to the deafening silence. He or she may frequently reach out to the narcissistic person via email, phone, or text to resolve greatly inflated misunderstandings, and is typically met with continued disdain, contempt, and silence. Essentially, the narcissistic person’s message is one of extreme disapproval to the degree that the silence renders the target so insignificant that he or she is ignored and becomes more or less nonexistent in the eyes of the narcissistic person.

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Emotional Maturity of a Typical Narcissistic Person

The emotional maturity of a typical narcissistic person is akin to a 5-year-old child who pouts and refuses to play with a friend in the sandbox because the friend wants to share the pail and shovel. The 5-year-old refuses to talk with the friend and angrily storms off to play on the jungle gym with someone else. The bewildered child with the pail and shovel may feel confused, rejected, and may not understand why they can’t share. He or she just wanted to build a sand castle together.

Because no further communication can ensue unless and until the narcissistic person decides to give the target another chance, a false sense of control is nurtured. Often, the narcissistic person will demand that the target apologizes for whatever inflated transgression the target may have committed (the target may have set a limit or asserted a boundary against emotional abuse, for example). Sometimes, a person with narcissistic qualities will decide to abandon and discard the relationship when his or her partner presents an ultimatum or attempts resolution requiring compromise. The person with narcissism may prefer to end the relationship and start over rather than be in a position of potential abandonment. The 5-year-old storms off and plays with a new, innocent target on the swing set. It is too much work to share the pail and shovel.

How to Deal With the Silent Treatment

So how does one deal with the silent treatment from a person with narcissism? For those leaving a toxic relationship with such an individual, many therapists suggest that the survivor understands that the person with narcissism has not developed the ability to express a high level of empathy, reciprocity, and compromise. The silent treatment is a form of emotional abuse that no one deserves nor should tolerate. If an individual experiences this absence of communication, it is a sure sign that he or she needs to move on and heal.

The healing process can feel like mourning the loss of a relationship that did not really exist and was one-way in favor of the ego-massaging person with narcissism. The minute the partner disagrees with the narcissistic person or asserts his or her healthy boundaries, the narcissistic person deploys an arsenal of abuse tactics. The silent treatment is a favorite weapon.

Do not accept emotional abuse. Know that you are worthy of a healthy relationship with someone who can communicate in a mature, emotionally healthy manner. Play with someone who has the ability to share the shovel and pail. You deserve no less.

Discussions about coming out typically deal with telling the parents. That makes sense, especially for young people still living at home. However, siblings play a role in the process as well: they can help ease the way or contribute to the conflict. They may have issues of their own stemming from a sibling’s coming out. No matter the situation, these issues should be acknowledged.

There are many factors that may determine how siblings react to your coming out as lesbian, gay, bisexual, or transgender: their age, their relationship with you, maturity level, parental influence, religious views, and so on. In general, if you were close before, you will probably remain close. Your sibling may even have guessed already, or maybe you told him or her first. The sibling may take your side if your parents give you a hard time. Even if the sibling is much younger than you, his or her support may be very meaningful.

On the other hand, if the relationship was not good to begin with, siblings can make the experience all that much harder. Old jealousies or resentments may have new fuel. There is a new vulnerability that the sibling can choose to take advantage of. In cases where parents are accepting of who you are, such a sibling may be even more enraged and do everything he or she can to make your life miserable.

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When you come out, your life changes—hopefully for the better, but in some challenging ways, too. The life of a sibling can also change as a result of having a LGBT brother or sister. Sometimes siblings are pressured to take sides. In some families, they may be forced to play peacekeeper. They bear witness to anger, disappointment, fears, and criticisms that may fly back and forth. If they are of school age, they may be the butt of jokes, bullying, or even hatred. Parents and the LGBT child may be so wrapped up in their own problems that the sibling issues aren’t addressed.

When you come out, your life changes—hopefully for the better, but in some challenging ways, too. The life of a sibling can also change as a result of having a LGBT brother or sister.

Many of these issues may occur even when you and your siblings are adults when you come out. The relationship issues you had as kids may never have been resolved. Old rivalries may be stirred up, and the chance to be the “good” child may be too strong to resist. In addition, adult siblings may have to deal with the feelings and reactions of a romantic partner and/or children. If the partner’s feelings differ from the sibling’s, it could cause conflict in the relationship. The adult sibling may feel protective of older parents, sympathy or empathy for his or her brother or sister, sadness over the rift between the parents and the newly out sibling, and so on. These feelings may be subconscious, making them even harder to work with.

Naturally, there are families in which both the parents and the siblings are loving and accepting of their LGBT family member. That is, of course, the best-case scenario, an ideal outcome of coming out. When this is not your situation, however, here are some things to remember:

• Acknowledge any support you get from siblings in coming out. Share your gratitude.
• Regardless of what your relationship is like, know that your siblings may be affected by your decision.
• Be aware of how your relationship may affect a sibling’s attitude. If the relationship is poor, you may think you don’t care what the sibling thinks. But he or she can abuse this new knowledge to “out” you to the rest of the family, friends, or school when you aren’t ready.
• Don’t use your sibling as the middle person between you and your parents. Let your sibling act (or not act) on his or her own.
• Give your sibling a chance to share his or her experiences. Try to be sympathetic and offer support, regardless of his or her level of support for you.
• Remember that if a sibling is young, he or she might have questions or be confused. Talk about it. Be as open as is age-appropriate. And, hard as it may be, try not to bad-mouth your parents. Your sibling needs them.

No matter what your relationship with your siblings is like, your decision to come out is likely to affect them—and, more than likely, your relationships with them. Being aware of this, and being prepared to handle it, can help your coming-out process go as smoothly as possible.

Ending a relationship and letting go can be incredibly difficult no matter how toxic it is. Part of this is for simple biological reasons, as some scientific studies have shown that being in love activates the same areas of the brain as being high on cocaine.

Brain scans of lovers and people experiencing cocaine addiction both display increased activity in the pleasure centers of the brain (most notably the dopamine centers) and decreased activity in the frontal lobe, which is the area responsible for cognition. This means that while falling in love can make us feel good, it can also profoundly affect our judgment.

It is for this reason that love can sometimes be compared to an addiction. In love, much like addiction, there may be negative side effects such as abuse or gaslighting. But despite all of those bad circumstances, it can still be difficult to kick the romantic attraction and feelings of love when letting a relationship go.

If you find yourself feeling trapped in a relationship you know is not healthy, consider these 15 tips for letting go of it for good:

1. Recognize the Problem

Awareness is the first step.  Educate yourself or consider talking to a therapist or counselor about what constitutes an unhealthy relationship. Take a good, hard, and objective look at your relationship and be honest with yourself.

Ask yourself these questions:

• Is this relationship serving my highest good?
• Is this relationship negatively impacting other areas of my life?
• Is this relationship detrimental to my self-esteem?

If you answered yes to any of these questions, consider ending or talking to a professional about the relationship.

2. Allow Yourself to Feel

[fat_widget_right]Letting go of a relationship is usually not easy. It can be painful to end a relationship even if the relationship was not serving your highest good. Honor any feelings of grief you may have, and allow yourself to feel those emotions rather than attempting to suppress them. Accept grief as a part of the experience, and allow yourself the time you need to heal.

Reach out to one of our therapist in Raleigh, NC or find a therapist closer to you.

3. Discover the Lesson

Many people who move on from a toxic relationship feel guilt or shame as they perceive the time they spent in the relationship as a waste. However, every person who comes into our lives can teach us something. Rather than looking at your relationship as wasted time, try to find the lesson in it. What did this person teach you? What are you taking away from the relationship? How have you changed as a person, and how might you do things differently next time?

In life, lessons may often be repeated until they are learned. Look for the lesson from this relationship and you may be less likely to carry the same lesson over into your next relationship.

4. Create Separation

It can be hard to distance yourself from someone you’re used to spending so much time with, but it is usually necessary if you want to move on from the relationship. This doesn’t mean you can’t maintain a friendship with your ex, but it’s usually best to allow some time for both parties to heal before you try to spend time together as friends.

5. Let Go of the Mementos

It can be tempting to hang on to all the old relics of a past relationship. Doing so, however, may prevent you from moving on with your life. If you must keep the old love letters, movie ticket stubs, photos, or romantic gifts, you may want to store them somewhere out of sight until you’re ready to move on.

6. Take Off Your Love Goggles

Love often has a way of clouding your perception, which sometimes makes it difficult to a see someone for who they really are. If you really want to get out of an unhealthy relationship, you must be willing to take off your love goggles and look at the person objectively. Consider talking with a close family member or friend or even finding a therapist to help you look at the relationship impartially.

It isn’t uncommon to only hold on to the good memories of an ex and completely shut out the bad memories. Maintain your perspective by remembering both sides of the experience. Remind yourself of the good times, but don’t forget those bad times or you could end up forgetting why you ended the relationship in the first place.

7. Compose a Letter to Your Ex

Consider writing out all your feelings in a letter, even if you have no intention of sending it. You can choose to give this letter to your former partner or destroy it when you’re finished. The point of the letter is to allow you to release your feelings. Writing or journaling can help you reflect on the relationship as a whole, while giving you a way to further your mental and emotional wellness.

8. Focus On Empowering Yourself

Try your best to shift focus off the relationship and back to yourself. Consider trying new things or putting your energy into a hobby you’ve neglected. Remembering why the relationship was unhealthy and focusing on what it is you do want in a relationship can be empowering.

Most importantly, work on your relationship with yourself. Focus on cultivating self-love and respect. Remind yourself that you are worthy of love and that you deserve a healthy relationship.

9. Rewrite Your Story

We often tend to place the weight of our identities into our self-professed life stories. We believe we are what we continually tell ourselves. Examine your story and rewrite it in a more empowering way to start making positive changes in your life.

If you continually tell yourself you lost your soul mate and you’re destined to be alone, you might struggle to hang on to a relationship that is no longer serving you. Reframe your story and consider the fact this relationship may have just been one step on the journey toward an even better relationship in the future.

10. Practice Forgiveness

Release any feelings of guilt or regret you have surrounding the relationship. Forgive yourself for anything that happened in the past because you can no longer change it. You can only move forward and learn from it.

Be willing to forgive your former partner as well. Let go of any resentment you have regarding the relationship. Look at your partner with compassion and empathy and understand that all humans are susceptible to mistakes.

11. Live in the Present Moment

Life exists in the present moment. Choose to live in the present rather than getting lost in nostalgia. Often, people stay in a relationship that is no longer healthy because they are clinging to the past. Judge your relationship based on how it is at present rather than how it once was.

12. Accept What Is

We must be able to accept things as they are if we want to move forward. Many people remain in relationships that are unhealthy hoping they can somehow change their partner. It is important to remember you cannot change anyone, especially if they have no willingness to change themselves. If the relationship isn’t working for you, then you have the choice to leave and move on. That is something you can change.

13. Contribute to a Cause You Care About

If you’re having trouble letting go of the past, consider getting involved in a cause you feel passionate about. Doing this can not only occupy your time and mind as you process feelings and let go of the relationship, but it can also help shift your focus to something bigger than yourself. Studies have shown volunteering can significantly improve overall well-being. This can provide perspective and help you feel good as you also help your community.

14. Practice Self-Care

Most importantly, work on your relationship with yourself. Focus on cultivating self-love and respect. Remind yourself that you are worthy of love and that you deserve a healthy relationship.Letting go isn’t easy, and it isn’t uncommon to forget our own physical and emotional health after a painful breakup. The grief can be overwhelming and we may start to neglect our own needs.

Help yourself by choosing to practice self-care every day. Get plenty of rest. Eat nutritious food. Indulge. Take a hot bath. Get a massage. Whatever it is, just do something to meet your personal needs.

Furthermore, learning how to practice self-compassion. Moving on can be a big and scary step, so be gentle with yourself as you heal and create a new life after this relationship.

15. Embrace the Impermanence of Life

Forever is a misleading term. The only constant that exists in life is change. Despite our efforts to the contrary, we truly cannot hold on to anything in life forever. Everything—friends, family, and relationships—come and eventually go.

When it comes time for something to end, rather than clinging to what no longer is, realize impermanence is the nature of life and try to embrace it. Appreciate the good moments you had, cherish those memories, and let them go in exchange for new experiences.

Know When to Ask for Help

The first few moments, days, or weeks following a breakup can seem debilitating. For some, ending a relationship means a loss of identity, support, and normalcy. Ending a relationship—even a toxic one—can be incredibly challenging and emotionally draining. However, you do not have to do it alone. Know when to seek support if you need it.

If feelings of grief, shame, guilt, or other negative emotions persist and begin affecting your daily life after a relationship ends, consider finding a qualified therapist or counselor who can help you process and acknowledge your feelings in a healthy way. A qualified mental health professional can help you examine the past relationship in a safe place free of judgement while you work toward achieving a more complete sense of self after the relationship has ended.

Even if you feel like there is no hope after severing an important tie in your life, remember you can heal and you deserve a healthy relationship that meets your needs and complements you and your happiness.

References:

1. Lahat, I. (2014, July 9). The brain looks the same when we’re in love or high on cocaine. Retrieved from http://www.businessinsider.com/the-brain-looks-the-same-high-on-love-or-cocaine-2014-7
2. Tabassum, F., Mohan, J., & Smith, P. (2016). Association of volunteering with mental well-being: A lifecourse analysis of a national population-based longitudinal study in the UK. BMJ Open, 6(8). doi:10.1136/bmjopen-2016-011327

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Have you ever met those clients who are resistant to change?  Do you have clients that are noncompliant to your recommendations and never complete assigned homework? Or do you find that your work in therapy with one of your clients has stalled and become stagnant?

Many clinicians experience resistance from clients. In general, a therapist will have one of two responses:  (1) to blame the client; or (2) to blame the self.  Neither is appropriate. Blame never brings any type of positive result – especially in the mental health profession. Instead, it is recommended that a clinician address the following six reasons for client resistance:

1) Therapist’s inability to develop rapport with the client.

Oftentimes a therapist will assume that client resistance is 100% based on something within the client. In reality, the therapist’s inability to build a strong therapeutic relationship with the client may be a contributing factor.

Building rapport requires:

• Managing eye contact appropriately.
• Helping clients feel a sense of relatedness to you. You can do this by trying to match the client’s initial demeanor, disposition, and rhythm.
• Keeping negative topics neutral—avoid framing statements using negative connotations.
• Using the client’s name.
• Setting the tone.
• Letting clients get to know you—that is, being a real person.
• Being approachable and engaged.
• Acting interested. Even if you feel bored, step in toward the client and help them feel seen, heard, and important.

2) Therapist imposing their agenda onto client.

Therapy needs to be conducted by developing client goals based on collaboration between the client and the therapist. If a client is being resistant or otherwise “noncompliant,” then the issue should be directly and honestly discussed.  If a client is not accomplishing certain tasks in therapy, then perhaps these aren’t important to the client and the therapist is simply imposing their own agenda on the client.

3) Therapist inflexibility.

If a therapist lacks a client-centered approach, then the client will notice (if not consciously, then unconsciously) that their therapist is inflexible or rigid. If a client has issues from childhood resulting from a controlling parent or has problems with authority figures, then they may unconsciously resist what is being perceived as external control from the therapist.

4) Failing to realize that noncompliance is part of the “pathology” that needs to be treated.

If goals for therapy have been arrived at collaboratively between therapist and client and there is still noncompliance, then resistance can be addressed as part of what needs to be focused on in treatment. The resistance should be actively discussed with the client, without judgment or surprise. Issues contributing to client resistance may include fears of failure or the fear of terminating therapy. One question a therapist can use to address these types of fears is, “What would happen if you were successful?” or something else along those lines. Always explore topics of resistance with curiosity and encouragement.

5) Need to process fears and early life “schemas” or experiences.

A therapist can explore a client’s fears and early life experiences by using the Socratic questioning method. Determine what the client’s underlying beliefs about life are. For example, does the client have a strong need to manipulate others or have power over them? Unmasking and revealing underlying maladaptive schemas, along with addressing their protective factors, should be addressed in the treatment plan.

6) Therapist fears of engagement.

A therapist needs to be willing to fully engage with their clients, even if it puts them out of their comfort zone. When a therapist tries to keep the relationship with their clients at a distance because of fears, such as fear of countertransference issues, the clients may sense this distancing. The effectiveness of therapy might then be diminished. A therapist can benefit from taking emotional risks with their clients. Client relationships aren’t so fragile that mistakes can’t be dealt with and overcome.

To address therapist anxieties, a therapist needs a good support system, including people with whom they can discuss their fears. It is also good for a therapist to reframe their fears with anxiety-reducing strategies, such as:

• Challenging unrealistic performance expectations placed on the self
• Reminding oneself that it’s okay to make mistakes
• Focusing on the client rather than on the self
• Realizing that no mistake is fatal and that part of good therapy involves the concept of “rupture and repair.” When ruptures in the therapeutic relationship occur, repairing of the relationship can be healing in and of itself.

It is always helpful for therapists to realize that everyone has limitations – including therapists and clients. It is important for therapists to understand when they are placing unrealistic expectations on clients based on the therapist’s own experiences. Remember, clients have their own personal experiences that may or may not be conducive to certain treatment outcomes.

Treatment Plan

The best way to ensure effective therapy is for clinicians to formulate a well-thought-out case formulation and treatment plan, including the following:

• Determine client’s core problem(s).
• Examine client’s developmental contributing factor(s) to core problem(s).
• Evaluate client’s relationship wants/needs in the therapeutic relationship:
  • What does the client want from me or others?
  • What does the client expect from me or others?
  • What is the client’s experience of self in relationship with others?
  • What are the client’s core beliefs?
  • What are recurring themes in the client’s relationships?
• Establish best therapy interventions to incorporate into treatment.
• Address client self-sabotage.
• Assess and evaluate effectiveness of current strategies, and make adjustments as necessary. Remind yourself that therapy is supposed to be a fluid enterprise rather than a stagnant one.

Concluding remarks

The best approach to coping with client resistance or noncompliance is for the therapist to look in the mirror. If all efforts at treatment have apparently failed, then the therapist can step back, regroup, and assess the problem(s) in the treatment protocol. In fact, if the therapist finds themself frustrated with the client’s effort, they may be best-served to “let go” of expectations, as this is a sign that the therapist’s personal agenda is not being met.

Realistically, most of the “work”  is in the hands of the client in between sessions.The therapist is simply one “tool” in the “tool belt,” and time spent in therapy is limited. Ultimately, the client is the one who is responsible for their own recovery.

References: 

1. Lang, E. (2012). A Better Patient Experience Through Better Communication. Journal of Radiology Nursing, 31(4): 114–119.
2. Shapiro, F. (2018). Eye movement desensitization and reprocessing therapy, third edition: Basic principles, protocols, and procedures.  New York, NY: The Guilford Press.
3. Smith, A. (n.d.) Building (and maintaining) rapport in the classroom. Retrieved from: https://www.depts.ttu.edu/tlpdc/Resources/Teaching_resources/TLPDC_teaching_resources/Documents/Building_Rapport_new.pdf
4. Teybor, E., McClure, F. H. (2011). Interpersonal process in therapy: An integrative model. Belmont, CA:  Cengage Learning.

For many people, therapy is the best investment that they will ever make. A successful course of therapy is much like getting a correct prescription for glasses, in that it can alter the way a person sees the world. Though the process is more involved than getting a prescription, the results can be equally dramatic.

At the same time, psychotherapy requires a commitment of time, emotional vulnerability, and financial resources. Many people are understandably ambivalent about beginning the process. In this article, I will explore research on the benefits of psychotherapy that underscore why investing in therapy can be a wise decision.

What Therapy Seeks to Accomplish

To understand why committing to therapy is a good idea, it is worth reflecting on what therapy accomplishes. Most people who enter therapy come with only the broad knowledge that they have psychological distress. Yet their symptoms are often a reflection of irregularities in the brain.

A person seeking therapy will likely have had painful experiences. These incidents may have heightened their brain’s sensitivity to threats. These incidents could have diminished the brain’s reaction to positive social experiences as well. The way the person’s brain adapted to manage past pains may no longer be serving them well in the present. Instead, these changes may be contributing to emotional distress.

Neuroimaging studies have shown therapy can help re-balance the activity in people’s brain structures. This holds true for people with depression, phobias, posttraumatic stress (PTSD), and other conditions. Therapy can strengthen activity in the brain regions that allow people to reflect on and reinterpret distressing events. It can also reduce activity in the regions of the brain that send out fear signals.

The Value of Therapy

Anyone who has completed a successful course of therapy can attest to its value. But it can be hard to have the faith it takes to invest in the process long enough to see results. People who are considering therapy for the first time or who did not have a good fit with their first therapist may be nervous about making a commitment.

While therapy is certainly a commitment of resources, it is often worth the investment. Recent studies may help assign some concrete numbers to therapy’s value. One group of researchers looked at the relative value of therapy to direct financial compensation. They found therapy was 32 times more cost-efficient at alleviating psychological distress than money.

Another study compared how much life satisfaction is derived from changes to personality versus from monetary gain. Neuroticism, a tendency to react to stressors with negative emotions, was one of the most influential personality traits. The study found a significant reduction in neuroticism had the same value to life satisfaction as being given $314,000. As it happens, reduced neuroticism is a common outcome of therapy.

Therapy may also improve a person’s physical health. Research shows processing traumatic experiences can improve a person’s immune functioning. For people who have received a mental health diagnosis, engaging in therapy reduces their overall future medical costs by about 17%.  People who do not receive treatment can expect to see their overall medical costs increase by about 12% over time.

While these studies on the benefits of therapy may seem surprising, on some level they are intuitive. A person who resolves a physical symptom such as lower back pain often has a lasting increase in life satisfaction. This boost would be hard to replicate through material gain because the outcome is with the person wherever they go. Through reworking our brain’s functioning, therapy can provide a similar increase in well-being. While therapy is certainly a commitment of resources, it is often worth the investment.

References :

1. Abbass, A. A., Nowoweiski, S. J., Bernier, D., Tarzwell, R., & Beutel, M. E. (2014). Review of psychodynamic psychotherapy neuroimaging studies. Psychotherapy and Psychosomatics, 83(3), 142-147. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/24732748
2. Boyce, C. J. & Wood, A. M. (2010). Money or mental health: The cost of alleviating psychological distress with monetary compensation versus psychological therapy. Health Economics, Policy, and Law, 5(4), 509-516. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/19919728
3. Boyce, C. J., Wood, A. M., & Powdthavee, N. (2013). Is personality fixed? Personality changes as much as “variable” economic factors and more strongly predicts changes to life satisfaction. Social Indicators Research, 111(1), 287-305. Retrieved from https://link.springer.com/article/10.1007/s11205-012-0006-z
4. Chiles, J.A., Lambert, M.J., & Hatch, A.L. (2002). Medical cost offset: A review of the impact of psychological interventions on medical utilization over the past three decades. In N. A. Cummings, W.T. O’ Donohue, & K.E. Ferguson (Eds.), The impact of medical cost offset on practice and research: Making it work for you. Reno, NV: Context Press.
5. Karlsson, H. (2011, August 11). How psychotherapy changes the brain. Psychiatric Times, 28(8). Retrieved from http://www.psychiatrictimes.com/psychotherapy/how-psychotherapy-changes-brain
6. Pennebaker, J. W., Kiecolt-Glaser, J., & Glaser, R. (1988). Disclosure of traumas and immune function: Health implications for psychotherapy. Journal of Consulting and Clinical Psychology, 56(2), 239-245. Retrieved from https://www.researchgate.net/publication/19783166_Disclosure_of_Traumas_and_Immune_Function_Health_Implications_for_Psychotherapy
7. Veenhoven, R. (2008). Healthy happiness: Effects of happiness on physical health and the consequences for preventive health care. Journal of Happiness Studies, 9(3), 449-469. Retrieved from https://link.springer.com/article/10.1007/s10902-006-9042-1