Humanity’s “Last Responders”

Written by: Peter Lazar, LCSW

August 14 of 2004 was just another sweltering summer day in New York City and we were approaching the third anniversary of 9/11. It was around 90 degrees; the kind of day that just a few minutes walk from the subway to work would render anyone a heap of sweat. On a day like that, ice and air conditioning are not taken for granted.  

At the time, I was working for an Employee Assistance Program firm that provided amongst other services, psychological counseling and resources for client company employees. For anyone seeking those services, they would call the hotline, and were greeted on the other end by a licensed clinician.  

I had finished a long shift working the hotline when at precisely 4:10 PM, the power cut out. At first, my colleagues and I were a bit confused about what was happening. Thinking that the power was out just on our floor, we quickly learned that the building was dark and we needed to leave. We made our way down 21 flights of stairs to reach the street and it was then we discovered the entire city was dark. At that moment, we certainly didn’t know that this would hold true for most of the Northeastern United States and parts of Canada. 

In 2004, there was barely any internet and certainly no smartphones. There was no way for us to know the cause until one could get their hands on a battery-operated radio. Walking up Second Avenue, I could see a sense of panic in other’s eyes. As we were literally and figuratively in the dark, the city was eerily silent as we awaited, well, anything really. Was this a routine summer power outage or were we under attack again? We later found out that the cause was a software bug in the alarm system of an energy company’s control room in Eastlake, Ohio.  

The blackout lasted just a week, but little did we know that the impact would reach further than our collective experience of that day. Within just a few weeks, the hotline filled with calls from New Yorkers complaining of anxiety, restlessness, irritability, and medicating behaviors such as increased alcohol consumption.  

It wasn’t a stretch to see that these people were experiencing symptoms of Post Traumatic Stress Disorder (PTSD) and needed professional help. At our clinical team meetings where we reviewed these cases, a pattern began to emerge. We realized they all had something in common: they were in or near New York City during the attack of 9/11, and these people did little to nothing to deal with the emotional aftermath.

This is not an uncommon phenomenon. People who lived through the Great Depression developed money-related disorders, such as hoarding behaviors. Another example would be Holocaust survivors, many of whom subsequently exhibited severe anxiety and hyper-vigilance. Given what we now know about the epigenetic aspects of trauma, we also saw many of these behaviors in their descendants. There is no doubt that when the veil lifts on the COVID-19 pandemic, we will experience an emotional reckoning, and those in the mental health field need to be prepared.  

University of CA, Irvine professor of psychology, Roxanne Cohen Silver, Ph.D., believes that various factors will determine an individual’s response to the pandemic. 

“Decades of psychological science on collective traumas indicate that individuals’ responses are likely to be based on several factors. These include their pre-pandemic circumstances and resources—prior exposures to adversity, physical and mental health vulnerabilities, and economic and social supports.” She goes on to say, “One must also consider exposures encountered during the pandemic: Did a family member get sick or worse? Did the person lose a job or health insurance? Was the individual an essential worker whose actions ensured others’ well-being?” (1)

All this to say, for any mental health professional, now is the time to at least familiarize oneself, if not receive proper training in the assessment of trauma & PTSD. For we have been and will continue to be humanity’s “Last Responders.” We are the place for people, when after the body may have healed, the spirit still has a ways to go. Fortunately, there are plenty of continuing education and training opportunities from which one can choose. Equally, if not more fortunately, humanity has proven time and again our resiliency through its myriad of challenges and calamities. 

  1. https://www.researchgate.net/profile/Roxane_Silver/publication/34265310_Surviving_the_trauma_of_COVID19/links/5f54339d299bf13a31a4dd84/Surviving-the-trauma-of-COVID-19.pdf

About the Author

Peter Lazar, LCSW

For over 20 years I have made it my mission to help people who struggle with the things that hold them back from living happy, valuable, and productive lives. In addition to my longstanding commitment to the treatment of addiction & co-occurring mood disorders, I have expanded my practice in the New York Metropolitan area to include the particular challenges of the divorced single parent, as well as addressing individual dilemmas in the workplace. Cognitive Behavioral Therapy, & various other informed treatment approaches are the cornerstones of my work. I am recognized nationally for my understanding of treatment options & I gladly serve as a resource.

I have presented at the Cape Cod Symposium on Addictive Disorders, and I have been a guest lecturer at Boston College, Adelphi University, and the Institute For Addiction Studies at National Counsel on Alcohol and Drug Dependency (NCADD) Westchester County, NY.

Peter Lazar, LCSW, serves as an advisor to the leadership team of TPN.Health.

A Lesson In Listening

Written by: Mark Wilson, MSW

With the pervasive influence of social media in our culture, we are robbed of the need to be present. We slip into a pattern of virtually shouting information instead of engaging humanity, fumbling for an independent voice amongst a sea of hollow opinions, and seeking a sense of community in a faceless space, all the while slowly losing our ability to listen.

My pursuit of a master’s in social work made it quite clear the power of being a listener. It wasn’t until I had the privilege of being supervised that I realized components were missing. A therapeutic relationship is not sustainable without the capacity to listen. Clients want to be heard but more so understood. Active listening* is taught consistently throughout a clinician’s education, but it lacks comprehension ability. Active listening is the chassis of the listener’s “vehicle,” but it’s missing a vital component, an engine.

Comprehension takes active listening a step farther. It understands the message and also the intended message. It allows a client to feel connected, express their emotions, and be reciprocated by the clinician in advocacy, not judgment. It’s important to note that speaking has its place but needs to be followed by a level of comprehension. The behavioral health space needs listeners, people that bring humanity back into the fold of a dialogue. Allowing voices to be heard and opinions to be shared will aid in the need for more human conversations in our loud, noise-filled world.

A challenge: Pick three conversations you have in a day to be consciously proactive in listening. Whether it is a business meeting, a scheduled check-in with a friend, or an encounter with a grocery store cashier, yield to sharing personal experiences, instead seek clarification, comprehension, and seeking the “why” of a person’s words. The hope is that you learn your listening tendencies and continue on a path of becoming a well-rounded listener. 

*The process of listening attentively while someone else speaks and withholding judgment and advice.

About the Author

Mark Wilson, MSW

Mark Wilson, CSW serves as the Clinical Liaison for the Trusted Provider Network. He pursued his Masters in Social Work from Louisiana State University to better understand the behavioral health world. He hopes to continue TPN.Health’s goal of incorporating new and innovative technology to allow the mental health field to thrive in a digital world where access can be unlimited.

Changing The Conversation

For some, there’s a negative stigma surrounding the word ‘therapy’ that can serve as a major deterrent from seeking help. Many may feel disappointed in themselves or judged by loved ones. Some even grapple with feelings of guilt or worthlessness after recognizing the need for therapy. As a clinician, do you seem to find yourself looking for effective ways to normalize getting help for your clients? 

The negative feelings a person may have regarding therapy can stem from any number of past or current experiences. Consequently, there is no one recommendation that will help you remove the stigma for each patient – but a varied approach could help address and normalize these issues. 

Ask Your Clients About Therapy Sessions

It is natural to focus on the immediate matter at hand during therapy sessions, whatever the reason may be. However, it is also important to ask clients about their thoughts on why they are seeking help and how they went about it. Some may share their feelings about being in therapy or how others have reacted to the information. This may be important to understand their immediate attitude and how you can help break the stigma surrounding seeking care.

Break the “Crazy” Myth

Research from Bradley University points out that the stigma surrounding therapy is directly correlated with society’s view of mental health. It confirms that these stereotypes reduce the likelihood of people seeking help and also hinder the healing process. Those who seek help often struggle with personal feelings or external bullying that paints a picture of the “crazy” person needing treatment. An open mind is essential to getting better, and sometimes professionals have to help their clients get to that point. Anyone can benefit from therapy – no matter what their background is.

Teach Coping Mechanisms

Professional behavioral health services can help people overcome some of the most devastating trials in their lives, one of the many reasons why it’s so valuable. However, if your client does not know how to cope with the adverse reactions to therapy from others, they may begin to see therapy as part of the problem. Prepare them for potential negative reactions from family and friends and equip them with the coping mechanisms necessary to tackle this. Then, return to the issue at hand.

Consider Group Therapy

Research done by Bradley University believes that clients may feel less awkward about therapy once they realize how many other people from all walks of life rely on it. Occasional group therapy sessions may help make this possible. If you do not personally host group therapy sessions, you may recommend local community outreach programs instead.

Be Mindful of Word Usage

Sometimes, how clients feel about therapy comes from subconscious reactions to specific words. For instance, if someone already thinks they are ‘crazy’ for seeking help, terms like ‘patient’ and ‘suffer from’ may not help break this mindset. Research  confirms that these terms and others like them often have negative connotations that may also dehumanize the individual. It also recommends reconsidering the phrasing of diagnoses. For instance, it is better to say “someone who has schizophrenia” instead of labeling an individual as “a schizophrenic.”

Encourage Daily Sessions

The more often someone engages in a particular activity, the more desensitized to it they become. Your client may not have the means or time to meet with you several times per week. However, there are other things they can make personal time for each day. The regular addressing of mental health may help to desensitize the negative feelings that accompany therapy sessions. These are some tasks to consider assigning for personal me-time sessions such as journaling daily, keeping a gratitude journal, and doing daily meditations.

Take Varied Approaches

As mentioned earlier, the reasons behind the stigma people internalize may differ. Take time to understand the problem and the client before deciding how you will address the issue. In some cases, you may find it is better not to address the issue at all or not in the beginning. There are many instances of clients starting sessions enthusiastically and only running into negative perceptions from others after the fact. In some cases, they may never experience this negativity at all. Being the first to bring up the potential stigma to prepare patients before it happens may do more harm than good.

Regardless of how you think your client should treat therapy, they will have their boundaries in place. Strike a balance between guiding them in the right direction and respecting their existing boundaries. 

The Bottom Line

One of the biggest mistakes behavioral health professionals make is to wait until the beginning of sessions to advocate for clients. The work begins outside of the office. It starts with family, friends, and even other colleagues. Educating the general public can help reduce the likelihood of negative reactions for others. There are more people in therapy than ever before. Millennials have been credited with spearheading this development. This trend signals that the stigma is lifting, making it easier for you to normalize therapy. Having a stable platform to depend on for strong referrals can further help build trust in behavioral health services as part of a standard, holistic treatment. Start your free trial on TPN.Health to access more trusted referrals today.

Lessons From My Mentors

Written by Brandy Price Klingman, LCSWBACS

In my career thus far, I’ve been blessed to have some great mentors, supervisors, and colleagues. These leaders have helped shape me into who I am today through their generosity and knowledge of wisdom. In the spirit of sharing the wealth, here are my favorite tips for new or developing therapists that I have learned from many mentors and supervisors (P.S. I’m naming these great masters to honor them.)

1. Strangers on a Train

An early tip from a great mentor came from my internship’s first supervisor, Butch Robicheaux, LCSW, BACS. I was excited to be interning at this site and had prepared a beautiful binder full of handouts for my clients, covering every topic from coping skills to grief and loss. 

I asked him, “What should I do before going into my first individual session?” He looked at my color-coded binder and was kind enough to say, “That’s very nice, but you won’t need that. You will have a conversation in this session. You will speak to this person with sincere curiosity and compassion like a stranger on a train. You don’t need to have anything wise to say because the connection is good enough to start the relationship. You won’t connect with a handout from that binder.” 

I often reflect on this “strangers on a train” guidance and smile because I’ve now made my career off of this simple piece of advice. The importance of a connection that comes from the simplest of conversations filled with compassion and curiosity can change the session’s dynamics from ‘therapist driven’ to the ‘client here and now.’ It’s helpful because there are so many problems a client could bring into a session that are out of anyone’s control, and I could never create enough handouts for all those stressors. But, I can always go back to the idea of a conversation with a stranger on a train.

2. Crisis Is Contagious, So Prepare Yourself

One of my first jobs required me to provide psychotherapy to groups of 10-12 people in a partial hospitalization program. I loved this work. I enjoyed and feared these groups. Often these settings had many personalities and a shared struggle of emotion regulation. The job was simple in my mind – find the problem with all the clients, and fix it. 

But the issue was complicated because there was always a crisis. Luckily, I’m good at crisis management, and during this time, I considered myself a professional firefighter (always looking for small fires to put out, as I was feeling better and better about my skill set). However, I was exhausted at the end of the day, week, or month, and I knew I would quickly be spent by the end of my career. This must be what they taught us in school about burning out. I understood at this point. 

When I discussed this with my clinical supervisor Karen Travis, LCSW, BACS, CGP (even more letters behind her name), I told her how well I was managing these crises, and she asked me how I felt. I described myself as tired, overwhelmed, and anxious. She then told me, “Crisis is contagious girl, and you are catching it.” She discussed the importance of understanding the client’s crisis separate from the therapist’s. She reviewed the importance of not meeting their situation with my crisis of “managing,” “fixing,” or “resolving.” She taught me how to help them explore their concern and process their feelings around it. 

Karen also told me the importance of allowing them to sit in the crisis until they were ready to move on. I will forever hear her voice when I think of rescuing my clients in crisis. I now even reposition myself the same way she did when I notice this happening in a session (very relaxed, arms casual on the chair, shoulders back and low, and voice soft, calm and confident). I’m grateful for this lesson as a professional and as a person. It turns out to be great advice for parenting, too!

 3. Permission to Feel in the Session

In school, I had a professor, Sherry Smelley, LCSW, who taught a Grief and Dying Class. The class was particularly difficult for me to remain in my cerebral safety zone due to all of the presenters’ vulnerability in sharing their experiences of grief or loss. At one point, I remember a speaker sharing something so sad, the entire class (including me) became tearful. When I asked my professor, “How are we supposed to hear these kinds of stories and not feel too much?” She smiled and said, “Well, honey, you are supposed to feel…you are human. It’s what you do with these feelings that’s important. You’re permitted and even encouraged to feel in these sessions.” She said this with a soft, buttery voice and a southern accent that reminded me of my grandmother. 

Permission to feel is vital in our daily work. It is our job in individual therapy to serve our clients in the ways they need, and one of those is by checking in with our feelings, thoughts, and judgments as a barometer of the room and the world concerning them. Our emotions are important and helpful in figuring out ways to serve our patients best to achieve their goals. 

This advice is incredibly useful these days due to the overwhelming stressors of current times. I encourage my staff to be mindful of their stress, grief, worry, fear, anger, etc. as they walk into a session. This personal awareness improves their ability to connect to the client in the here and now. 

As I write this, I am mindful of so many things my early mentors and supervisors have taught me – I could go on and on. For now, I will stop here, flooded with gratitude for so many great lessons from the masters who took the time to reach out to me. #blessed

About the Author

Brandy Klingman, LCSW-BACS

Brandy Klingman, LCSW-BACS, is a skilled psychotherapist with a small private practice, as well as an owner and operator for mental health and addiction clinics. Her mission is to improve behavioral health standards of care and decrease barriers to accessibility for all. She does this through direct patient care, professional supervision, academic/university affiliations, professional consultations, public speaking, business development, and legislative advocacy. She is a coveted speaker in professional workshops, academic settings, and trainings.

Who Are The Trusted Providers On Our Network?

As a behavioral health professional, it’s known that life challenges may make it difficult for people to cope without seeking help. Patients start asking, “Where can I find a behavioral health provider?” However, clients may not know about all the different types of resources available. They may understand that to be a behavioral health professional, you have completed some training in a field related to psychology, but they may not understand the various education and training levels required for specific credentials and the high degree of specialization involved. In this blog, we will go in-depth about the multiple licensed professionals our subscriber directory consists of; as there are many fine distinctions among the various practice areas that may help you to refer the patient to the right professional.

This information varies from state to state

Counselors

These professionals have at least a master’s degree in psychology or related fields, such as family counseling. Their specific training allows them to evaluate a person’s mental health and apply therapeutic techniques to help with addiction, job issues, conflicts in families, general stress, etc. If you have a client who is grappling with a particular problem, such as addiction, you may have to refer them to a counselor with specific training addressing that particular problem.

Psychologists

Psychologists need to have licenses and training in clinical psychology; psychology is a pretty broad field and only certain training paths can do therapy. Psychologists don’t go to medical school, but receive their advanced degrees in different psychology or counseling programs. If you have a client struggling with problematic thoughts/behaviors or having difficulty coping with stressors, it may be beneficial for them to see a psychologist who takes a specific approach. For example, dialectical behavioral therapy and cognitive behavioral therapy are mainly designed to teach coping skills and help clients change problematic behaviors and thoughts.  Child psychology is different from that of adults. If you have a pediatric client, it may be helpful to find a psychologist with specific training in dealing with this age group, whether in education or counseling.

Psychiatrists

If you have a client whose issues seem to stem from an underlying medical problem or whom you believe would benefit from a psychiatric evaluation, you may need to refer them to a psychiatrist. A psychiatrist starts by going to medical school to earn an M.D. or D.O. degree. To become a psychiatrist, the newly minted medical doctor has to undergo additional training in the specific field of psychiatry.

Like psychologists and counselors, psychiatrists may complete additional training to treat specific types of patients primarily. For example, some psychiatrists specialize in treating conditions in patients of a particular age, such as the elderly or children and adolescents. Psychiatrists can provide the same types of services that psychologists and counselors do related to diagnosing, assessing, and treating mental health disorders. However, because they also have medical degrees, psychiatrists can also prescribe medication to patients, which most behavioral health professionals cannot. The ability to prescribe medication can be incredibly helpful in treating patients with substance use disorders. A psychiatrist may provide medication-assisted treatment programs for addiction that combine FDA-approved medications that block the effects of illicit drugs with behavioral therapy and counseling, taking a whole-patient approach.

Nurse Practitioners

A nurse practitioner has undergone advanced nurses’ training and is licensed to provide general health care services. Working under the supervision of a medical doctor, a nurse practitioner has the authority to examine patients, make diagnoses, and prescribe medication. A Psychiatric Mental Health Nurse Practitioner receives training specific to the practice of mental health. Like nurse practitioners in other specialties, a PMHNP works under a doctor’s supervision, in this case, a psychiatrist.

Social Workers

Social workers are trained to help people cope with challenges in every stage of their life such as child abuse or neglect, domestic violence, unemployment, housing situations, etc. A licensed social worker focuses on clinical skills and developing relationships with clients while operating under an agency’s authority to deliver intervention.Further education and supervision can grant a licensed social worker with the qualification of a clinically qualified social worker (LCSW). These professionals work in a wide variety of settings to provide emotional support, mental health evaluations, therapy and case management services to people experiencing psychological, emotional, medical, social and/or familial challenges. Their scope mirrors an LPC and can individually practice.

A measure of overlap between the services provided by different behavioral health professionals may be confusing to clients. When patients seek help, clinicians have a responsibility to assist. Fortunately, when you subscribe to Trusted Provider Network, you gain access to resources that aid referrals to reputable and trustworthy behavioral health providers in multiple specialties.

The Dual Role of Faith in Gambling Disorder

Written by: Ramon Zelaya, LPC-S

The addiction treatment field is often rich with broad and diverse themes, often containing hidden meaning waiting to be discovered by the perceptive clinician. One such theme – faith – often intersects with the wisdom touted by the 12-step recovery tradition and emerges frequently throughout the treatment and recovery process.  Faith, I have found, plays a dual role in the world of disordered gambling: it is the manner by which gamblers remain bound to their gambling habit, yet it is also a means by which they may escape their bonds.

For many disordered gamblers, a key component of their inability to stop or control gambling behavior is a misplaced faith in the outcome of the bet. More accurately, it is their perceived outcome that becomes problematic, a “cognitive distortion” that is self-reinforcing and difficult to challenge. Each bet is an attempt to resolve problems that result from previous, failed bets: financial losses, strained relationships, emotional consequences, etc.

These problems accumulate as gambling inevitably yields more losses than wins. Yet the gambler infuses each attempt with hope: hope of breaking even; hope of making a fortune; hope for a better life, a mended marriage, or relief from the pain of every loss experienced thus far. The gambler keeps following the same path hoping that everything will get better, that everything will be okay again. They persist despite all of the physical evidence suggesting that continued gambling is a bad idea, and everyone’s insistence that they are doing the wrong thing. They continue to hold onto real, albeit misguided, faith.

The profound wisdom of the serenity prayer offers a solution to the problem of misguided faith. It calls the individual to find and employ the strength to change for the better all things within their locus of control. In therapy, the cultivation of autonomy, self-efficacy, and positive self-regard leads to a new type of faith for the disordered gambler: faith in oneself. The goal here is for the individual to learn how to take responsibility where responsibility is due, and to make active efforts toward recovery and personal growth.

Additionally, the serenity prayer guides the individual to seek acceptance, challenging them to become comfortable with the experience of powerlessness in affecting certain outcomes. In this regard, faith must be held in the providence of the individual’s higher power, as they understand it. With an addiction wherein so much is left to chance, it is ironic that disordered gamblers have such difficulty letting go of their attempts to control. Nonetheless, letting go is crucial to recovery, and inherently requires faith.

As treatment providers, we often tell our clients to “have faith in the process” of therapy and recovery. I would ask all who read this to pause for a moment and consider the depth of that statement. For many whom we treat, we are asking for a monumental shift: to relinquish faith in a substance or behavior and gain faith in us, in recovery, and in themselves. This is not a step to be taken lightly, and should be approached with as much care and compassion as we can muster.

About the Author

Ramon Zelaya, LPC-S

Born and raised in New Orleans, Ramon began studying psychology during his senior year of high school. Never deviating from the subject, he completed a BA in Psychology from Loyola University and an MA in Counseling Psychology from Lewis and Clark College (Portland, OR). Ramon has been working steadily in the mental health field since 2003 in various settings: inpatient, outpatient, university, and private practice. Over the years he also culminated an interest in and knack for technology, pursuing ways to enhance therapeutic practice with state-of-the-art solutions. This pursuit brought Ramon to TPN Health where he accepted the position of Clinical Outreach Liaison, then moving on to become Clinical Outreach Director. Ramon hopes to continue his contribution to the clinical community by helping others discover new dimensions of practice through the TPN Health platform.