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.

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.

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.

From Saying “No” to Asking “How?”: Changing Priorities in COVID-19

TPN.Health member Angela James, LPC, like many behavioral health professionals, wears several hats. In addition to consulting and practicing privately, she serves as Assistant Director of the Accessibility Center at Tulane University in New Orleans, LA. Years of experience working in disability services in higher education and a social justice lens inform Angela’s passion for creating solutions for people with a range of abilities and access needs.

“I have always been the ‘possibilities girl’.” -Angela James, LPC

Having worked for Tulane in the past, Angela entered the position this go-round with an open mind, which has served to help her orient to the changes as well as the similarities from when she worked there in prior years. She feels fortunate to be part of such a well-oiled work environment where the transition to fully remote online operations, given the COVID-19 climate, has been relatively seamless.  

“We are seeing opportunities to approach accessibility proactively versus reactively.” -Angela James, LPC

In Angela’s perspective, the world of accessibility services, in higher education and as a whole, is seeing a great shift in this climate. Now, because of the conditions with which we are all faced, access-challenges affect everyone, not just a subset of the population. Prior to COVID-19, Angela reflects that the biggest challenge in the accessibility realm was finding ways to eliminate institutional barriers. Now, the organizations and institutions where people work and learn, by necessity, are shattering some of these barriers preventing accessibility just to keep basic operations running.

“If we don’t address these barriers, none of the students can learn. None of the staff can work. So the barriers I have been advocating to diminish are now crumbling in some ways because the broader public has to reckon with them.” -Angela James, LPC

So, what does this mean for the future  of accessibility services in higher education? In the behavioral health field? In other professions or institutions of learning? It is Angela’s view that the collective’s approach to accessibility is fundamentally changing, now that people know the potential for solutions with available technology and are actively making those solutions a reality. No longer are these solutions centered around retrofits for a small group. Rather, the whole population is in consideration. She notes, “I think those shifts will be very meaningful for individuals who were always told, ‘This isn’t possible.’ Now we know what’s possible, so get ready.”

With the hope of a collective shift toward solutions in accessibility, now is also a time for deliberate and thoughtful considerations at the individual level. For Angela, who has never done online counseling prior to COVID-19, this means continued education and growth in the use of technology such as Telehealth. Likewise, it is an opportunity to attend to the small details, such as lighting, payment options, and delay time which contribute a great deal to a client’s experience on digital platforms.

At TPN.Health, we take seriously the needs of our behavioral health community, especially during this time. Want to have unlimited access to quality online CEUs and the opportunity to build your digital referral network? Click here to create your TPN.Health profile to get started!

Image credit: https://www.rollinginspiration.co.za/leave-no-one-behind/

A Different View Of COVID-19 Featuring TPN.Health Member Angela James, LPC

As a response to the COVID-19 outbreak framed in Charles Rosenburg’s work on the archetypal structure of an outbreak, Jones (2020) offers that epidemics are social phenomena that reveal the structures that drive a society’s operation. He notes, “Rosenberg argued that epidemics put pressure on the societies they strike. This strain makes visible latent structures that might not otherwise be evident. As a result, epidemics provide a sampling device for social analysis. They reveal what really matters to a population and whom they truly value” (Jones, 2020).

In the spirit of unpacking societal values, let us not forget that the entire month March remains International Women’s Month. So, in continued celebration of International Women’s Month and in the theme of considering societal structures, TPN.Health draws from the perspective of Angela James, LPC, Assistant Director of the Accessibility Center at Tulane University in New Orleans, LA and clinician in private practice. With a passion for the inquisitiveness and boundary-pushing that trademark the college student spirit, Angela’s intention from the fledgling stages of her career was to work in higher education. Her entrance into the world of counseling stemmed from an exposure to counseling courses while pursuing her masters degree and the experiences she had with students while working in disability services. 

Angela James, LPC

She found that many of the students that frequented her office for help were black women who were not part of the disability services population. The frequent encounters with these black female students prompted Angela on a journey of anecdotal and academic research to address what she was seeing in her office. From her initial exploration of therapy as a healing modality for black women sprung a deep-dive into the nuances of the client-clinician relationship specifically when the client is a black woman, and the clinician is from a dissimilar cultural background. The deep-dive involves considering the relationship through a lens of cultural competence and historically significant constructs involving a web of interrelating topics, such as access and equity.

“I think listening is the best resource.” –Angela James, LPC

Angela emphasizes that the core of her work as a counselor, social justice advocate, and human being is centered on a practice of listening to those with whom she is in relationship. For Angela, this means not just saying, “I hear you,” for the sake of responding but actually taking in their perspective whose depth is unknown to you except through the words they speak. This is listening with the intention of considering that, just as you personally have a breadth of valid experiences informing your life, so do they, and you could stand to learn from their orientation. For instance, she sheds light on the importance of recognizing figure and ground when meeting people. She defines figure simply as “the immediate,” the living person standing directly in front of you. The ground, however, represents the goings-on of the world at large, which may be affecting a person’s realm of experience from a distance. She emphasizes the importance of considering how variables of the ground could be informing a person’s state of being in the world. 

Angela’s perspective is parallel to Jones (2020)’s reflection on the COVID-19 outbreak in that much of her work is centered around issues that, when unpacked, lay bare the internal structures of peoples’ lives that inform their relationships, occupations, and how they make sense of the world around them. In the same way, Jones (2020) illustrates that the pandemic serves as a mechanism to reveal the essential structures that drive a society’s day-to-day function. Ultimately, these parallel perspectives can inspire people, specifically behavioral health professionals, to steep in curiosity, deep listening, and consideration of all perspectives while operating in service of an approach that is oriented in research-informed action.

Angela is excited to use TPN.Health as a resource in continuing her work of creating a more inclusive community through a lens of social justice. She sees TPN.Health as an essential tool in the realm of cultural competence, specifically in that clinicians are enabled to feel confident around referring out when a client’s unique needs are outside of their realm of experience.

Looking to refer out? Want to access a diverse and trusted community of behavioral health professionals for networking and continuing education opportunities? Click here to create an clinical profile and begin interacting in TPN.Health today. There has never been a better time to be a part of this digital community!

References:

Jones, D. S. (2020). History in a Crisis — Lessons for Covid-19. New England Journal of Medicine. doi: 10.1056/nejmp2004361

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