Talking about Suicide
This morning our little community of Stone Oak in San Antonio, Texas was devastated by the news of an 8th grade boy who, last night, took his own life.
I am a trauma-informed trained crisis counselor who works with many of the youth in our community. This one hits particularly close to home. While I don’t know the family personally, I know many people who are connected with them or to them in some way or another. The kids in our community, whether they are ours or friends of our children, are all of our kids.
As our community grieves, I want to give parents and kids some resources and ways to open up dialogue and communication in your own home about this often-silent topic.
Here are some tips for parents to talk with your kids about suicide:
Use the word: When you talk about it, use the words “suicide” and “killing yourself.” Be direct with your child. Don’t circumvent the issue. Don’t say, “Have you ever thought about, you know, doing something to yourself?” Say it out loud. The words make it real for everyone.
Ask: The National Suicide Prevention Lifeline recommends the following questions be asked to address current suicide ideation or intent (commanly referred to as S/I): Are you thinking of suicide? Have you thought about suicide in the last two months? Have you ever attempted to kill yourself? As uncomfortable as these questions can be to ask, they are important ones. It’s also important to ask if they know of people or friends that talk about suicide or ending their lives.
Be prepared: If your child answers “yes” to any of the three questions, take it seriously. It is not a ploy or gimmick for attention. I can’t tell you how many parents I have had call me over the years tell me “I think they are just attention-seeking.” If your child tells you they have thought about killing themselves, believe them.
Check-In Often: Things change on a dime in a child or teenager’s life – friendships shift or end, romantic relationships go awry, pressure for grades can mount, peer-pressure, feeling like they don’t fit in or have a purpose…..there’s a litany of things that can pile on, and fast. Talk with your child about their goals, how they feel about the changes in their life, and what pressures or stress they are currently feeling.
Seek Help: If you think your child is depressed or has changes in behavior, contact a professional immediately. Don’t wait to see if it “blows over” or “is just a phase.” A counselor that specializes in depression, self-injury and one that has crisis and suicide experience is important.
Listen: Someone asked me today what the signs are for someone in trouble. The answer to that is……there is no perfect formula or way to know exactly. Sometimes there are whispers. Sometimes there are screams. Often there is silence. Watch for all three, along with the below warning signs.
The National Suicide Prevention Lifeline has the following list of warning signs to help determine if a loved one is at risk for suicide:
– Talking about wanting to die or kill themselves
– Looking for a way to kill themselves, such as searching online or buying a gun
– Talking about feeling hopeless or having no reason to live
– Talking about feeling trapped or in unbearable pain
– Talking about being a burden to others
– Increasing their use of alcohol or drugs
– Acting anxious or agitated; behaving recklessly
– Sleeping too little or too much
– Withdrawing or isolating themselves
– Showing rage or talking about seeking revenge
– Displaying extreme mood swings
I give my clients (teenage and otherwise) the following resources to plug into their phones:
National Suicide Prevention Lifeline: 800-273-8255
24/7 Crisis Text Line: Type “Hello” or “Hi” or “I’m Here” to 741741 and a Trained Crisis Professional will respond instantly.
Keep the dialogue in your home open. Let’s reach out to those that feel alone, hopeless and desperate. Talking about suicide is uncomfortable and painful, but necessary. And could save someone’s life.
Before You Go To Therapy……
So you’ve decided to go to therapy. Congrats on making such a big decision, and giving the gift of “you” to yourself! Of course I’m biased, but I believe therapy is one of the greatest things you can do for your overall health and wellness.
Finding a therapist can be daunting, and oftentimes people aren’t sure how to begin the process – or they give up before they make a first appointment. Here are some things to consider when searching for a therapist:
Shop Around – You shouldn’t make an appointment with the first therapist you Google. Ask around for reccomendations in your area, either from friends or your primary care physician. Research a few different therapy websites to read about what kind of client they serve and the type of therapy they offer. Talk to a few for an initial free phone consultation (I give a free initial 15 minute one).
Get the Deets – Does the therapist take insurance, or are they cash-pay only? Do they offer after-working hour and weekend appointments, or M-F, 8-5 only? Do they see children under 18 or only adults over 18? Do they have specializations or certifications in an area that you are seeking, such as addiction, play therapy or hypnotherapy? Do you have to travel into their office, or are they willing to come to you or do video/phone sessions? Find out as many details about the practice as you can so you can ensure a good fit for your needs.
Commit – Therapy is a process, and not always a quick, one-or-two session fix. Therapy takes time and money, so be sure you are willing and able to commit to regularly, scheduled meetings for a few months (or more, depending on the issues). Teenagers and children especially benefit most from consistently scheduled appointments.
Do the Work – Anyone that comes into my office will be told this: I’m one hour of your week. There are 167 others. So if your therapist gives you readings to do, assignments to compete, or activities to participate in – do them. It’s all part of the work that needs to be done out of the therapy appointment time, and to maximize the overall success of your therapy.
Change – Much like a doctor, lawyer, or hairdresser, sometimes the therapist you try simply isn’t the right fit for you. That’s ok! Therapy will only work if you feel you can work with that person, so don’t be afraid to stop services with one and get referred elsewhere.
Give Feedback – Some of the best work I’ve done with clients were the ones who were truthful when I asked them, a few sessions in, how they thought therapy was going. Your therapist wants your feedback and honesty to ensure your are getting the most out of your therapy time. If your therapist isn’t working on the things you want or need, or you feel stalled – tell them! The best clients I have give me feedback on what they think is or isn’t working for them during our sessions.
I hope this helps in your search for a therapist. Best of luck!
Private Practice Chronicles, Part 12: Rookie Mistakes, Part Two
I’m a year-and-a-half into owning my private practice (woot, woot!!). I wrote a blog back in June about my first set of Rookie Mistakes, and now I’m back to share Part Two of a few things I’ve learned the hard way.
I know in retrospect when I read these they seem so obvious…like, DUH-obvious……but the fact of the matter is these things are easy to overlook when you’re flying solo.
So here are five more Rookie Mistakes for you to avoid if/when you are thinking of opening your own private practice:
1) Keep your Forms Updated – Then Update some More – I had an emergency contact space on my original form…..oh wait, no I didn’t!!! I mean, can you believe I did that? How did I discover this huge oversight? When I had a client in a really bad situation contact me and I needed to get in touch with a family member. Only when I pulled his file did I realize this horrible mistake. I now get at LEAST one emergency contact name and number per client. And I’m constantly updating my forms to add other crucial info (pregnancies, miscarriages, etc.)
2) RUN the Credit Card your Clients give you to Keep on File – One of my business practices includes keeping a client’s credit card on file to charge future appointments (or no-shows and less than 24-hour’s notice of cancellation). I have a form where clients voluntarily fill in their Credit Card info, then I manually run them at the end of the day. Oh, how naive I was to think they were writing down the correct number!!!! This is especially crucial for a cash-pay only business. Run that card with them in the office first to ensure it is a valid card.
3) Don’t Scrimp on Office Space – My first office space didn’t have a window, because, quite frankly, I didn’t have any clients and a window seemed like an unneccessary luxury. My practice grew quickly, and soon my tiny windowless office just wasn’t adequate for my clients – or myself. Upgrading to an office with a window makes all the difference in the world. So get the best office space you can (even if it means you have to hustle extra). I chose a secure building in a nice area with a shared receptionist and coffee/tea service included. It’s a nice space for my clients, who are spending their hard-earned money to come and see me. And now they have a window!!!
4) Wasting Precious Advertising Dollars – When you start out, everyone and their brother is going to call you (and call on you) to advertise with them. I have a marketing background, so I know the value of advertising and I needed to grow my business. One of the worst investments I made was buying a very expensive print ad in a local paper. I didn’t receive one call or email from that ad, and I think I’m the only person that saw it. My dollars would have been better spent on online advertising, where I receive the most return on my investment.
5) Not Setting Personal Boundaries – Starting a business is a 24/7 venture. It’s not a 9-5, Monday through Friday job. You must feed it constantly, or it simply won’t grow. But here was my problem: You want a 7:00 a.m. slot? Yes. You want an 8:00 Saturday morning slot? Yes. You need to text me at 10:00 at night? Yes. You need an 8:00 pm slot? Yes. Answer my business line at 10:00 a.m or 10:00 p.m. on Sunday? Yes. Pretty soon all of these “Yeses” were taking a personal toll, on both myself and my family. I’m still working hard on this one, but I’m setting more limits starting with phone and email activity, and I have a hard and fast last 7:00 p.m. appointment during the week.
My mistakes are and have been an amazing way for me to learn and grow, both personally and professionally. What are your (if any) rookie mistakes? I’d love to hear about them, how you discovered them, and how you handled them.
Blog Post: Happiness isn’t a Goal…It’s a Mindset
It’s 2018 and everyone is talking about their New Year’s Resolutions. Regardless of the time of year, I always ask clients to tell me a few goals they want to work on in therapy. Of all the goals people state, one of the most common ones I hear is this: “I just want to be happy” or “I want my kid/spouse/marriage/parents to be happy.”
When clients say that, I know therapy most likely will not give them what they need. Because happiness isn’t a goal. It’s a mindset.
I think a lot about happiness. I talk at length about it with my clients ranging in age from 10 – 91. What differentiates happy people from ones that are not? How can we be happy when we are in the midst of a personal crisis? How can depressed people be happy? What is happiness and how can we measure or judge it?
While the answer to happiness is far from simple, and it’s different for everyone, there are a few things to think about regarding happiness….and how to make it a mindset, not simply a goal:
1) Manage expectations – Remember Prom? Or Homecoming? Or New Year’s Eve? Probably wasn’t as great as you thought it was going to be, right? Sometimes, we need to manage our expectations. Focusing on the small, funny, happy moments even if a night or big event goes awry can put a positive – and fun – spin on things.
2) There’s no Magic Happy Pill – Many clients expect happiness to appear out of thin air. I hate to tell them this, but it doesn’t. That’s not how happiness works. I recently had this discussion with a client who told me she was “waiting to be happy.” My answer to her was, “You’re going to be waiting a long time if you think happiness is just going to show up.”
3) Look for the Small Things – Often there is happiness or joy all around us. We just sometimes miss it because we are too wrapped into our own thoughts and our state of mind gets in our way. For instance, at the airport in California where I began writing this post, I observed an elderly couple holding hands. I saw a young child wearing his Disneyland sweatshirt and clutching a stuffed Mickey Mouse, his eyes still wide with the wonder and excitement of his magical vacation. I could have chosen to focus on the traffic and crowds and other common annoyances of traveling, but I was too busy focusing on the positive things all around me.
4) It’s Not Up to Other People – Rule number one is that happiness needs to come from within. Expecting others to be that source is simply setting yourself up for failure. Of course, we derive great happiness from our personal interactions and relationships, but those cannot be the sole source. Being happy with ourselves means accepting the good, bad and ugly of ourselves, and realizing that at the end of the day, our state of “happiness” is up to us – and only us.
5) Not Every Moment of Every Day is Happy – and That’s OK. We live in a world where we literally have a front seat to everybody’s lives on social media. And I always, always remind my clients that no one posts the bad stuff. Case in point: a client told me about a friend that was posting amazing holiday pictures – family at church, everyone in matching pajamas on Christmas Eve, opening presents, everyone smiling and happy. When she spoke to that friend, she learned about some of the fighting and things going on all while those “picture perfect” photos were being snapped and posted. We carefully edit and delete the bad pictures, the imperfections, the out-of-focus shots. No one is happy 100% of the time. No one.
6) Focus on the “Happy.” – One of the exercises I utilize in my clinic is asking clients to state the “highs and lows” that occurred since our last session. I usually ask for at least three each. When clients tell me “there were no highs” I don’t let them off the hook. I ask them if they saw any friends, did anything fun, at at a restaurant they like, had a text from someone that made them laugh. Focusing on the positive, no matter how miniscule it may seem, can slowly, over time, help shift our mindset.
7) Surround yourself with Happy People – Let’s face it – hanging out with Debbie Downers all the time can have a domino effect. Think about the happiest friend or family member or co-worker you know. Be around them more. Pull back from the people in your life that constantly emote negative energy.
How to Choose a Counselor for your Child
School is out for the first semester, and maybe your child is struggling with a transition or an issue that needs some outside help. That’s when a counselor might be the answer. A good counselor can help someone work through challenges, problems and sorting out life’s pressures.
There are some important things to consider when choosing who will work with your child. Make sure you have an initial phone consultation with any potential counselor and find out the following:
1) Availability – Some counselors book appointments only during work hours, and others offer weeknight and weekend hours to accommodate school, sports and other activities. Some counselors offer in-home or distance counseling options as well.
2) Specialization – Make sure the counselor is adept in the specific area you need. Does your child have anxiety, depression or a substance use issue? Do you need someone with experience with eating disorders? Children under age 10 usually benefit from someone who is a Registered Play Therapist. Ask a counselor upfront about their area(s) of specialization.
3) Payment – Find out about the payment options offered by the counselor or counseling practice – do they take insurance or are they cash-pay only? And what payment types are accepted? Some counselors (such as myself) offer discounts for military or first responders. I also offer discounts for multiple, pre-paid sessions. Don’t be afraid to ask if there are options for discounts.
4) Consistency – The therapeutic process is maximized when there is consistency. Make sure you are willing – and able – to commit to a regular appointment schedule. Oftentimes, people make the mistake of thinking that one or two appointments here and there are enough. A lot happens in the weekly life of a child or teenager! Regular, scheduled appointments will help bring the best results.
5) Credentials – Be careful with this one. Vet the credentials of any potential counselor. Some people take “online certification” courses and call themselves a counselor. Make sure yours holds a minimum of a Master’s Degree and is licensed to practice in in the state where you live. You can verify credentials at any Department of State Health Services’s website.
Above all, make sure your child is comfortable with the counselor they visit. The therapeutic relationship will work only if your child feels the counselor is someone they can work with and confide in. Good luck with your search!
Private Practice Chronicles, Part 11: A Few of my Favorite (Business) Things
The holidays are approaching, and maybe you’re thinking of gifts to get yourself or your small business.
While I found I didn’t need much to get my practice up and running, these are some things that I have found invaluable for keeping my business running smoothly and efficiently :
Line2 – When I was setting up my practice, I was going to buy a completely separate phone, and didn’t want the a huge expense. When asked a few other clinicians how they handled their business line, a trusted mentor told me about the Line2 app. It costs 9.99 a month (10.81 with tax), and completely interfaces with my iPhone. It has the calling and texting features I need, and when it rings it comes through the app so I know it’s a work-related call. The only drawback is that sometimes it “acts up” and there is a delay in texts. Other than that, it’s easy to use and I love love love it. So I have one phone but it functions as two.
Bluehost – My website is hosted there. They are reasonable for hosting fees ($12.00 per month) and customer support is available 24/7 if there are problems.
Gmail – It’s just the best email system out there. Nothing else to say here.
Google Calendar – I keep all appointments in a Google calendar. It took a little time for me to get used to using it, but now I – and my business – couldn’t survive without it. I also sublease my office for a few hours a week, and my calendar is shared so my officemate and I can book appointments around each other’s schedule.
Quickbooks – My CPA will be so happy with me at tax time! I love the ease of Quickbooks for tracking all of my income and expenses. They have a cool mileage feature as well as an easy way to upload any business-related receipts.
Square – I use this for my credit card )processing. There are admittedly a lot of features I don’t use (like appointment reminders but the reports are awesome and it’s really user-friendly. I did have to order another chip reader this year (mine conked out , of course, just after the 1-year warranty) and since I’m cash-pay, most of my transactions are done through credit card.
Vsee – This is a HIPPA-compliant platform that I use for distance counseling. It can be used for both calls or for video conferencing. I currently am utilizing this more frequently with clients that don’t live in San Antonio. It’s a great option for people that have transportation issues, or feel more comfortable in their own home. Best of all….it’s free!!!
I’m always seeking ways to improve and be more efficient at work. What are your Favorite Business things? I’d love to hear.
Blog Post: A Letter to My Addiction Clients
Dear Addiction Client,
I am writing to tell you a few things that were on my mind after our last session – actually, things that have been on my mind since the first time you walked through my door.
I can always tell when you are lying to me. Believe me, I’ve heard it all. You’ve been lying to yourself for so long that I know at this point, even you may believe the stories you tell. But I don’t. And the people around you that know you even better than I do better don’t believe you either. Beginning with the truth is a first and crucial step on your journey to recovery.
Show up for your appointments. You are wasting money if you don’t show up. And show up consistently, and on time. The only way you are going to get better is with consistent and continual therapy. Showing up for appointments holds you accountable, and forces you to be responsible.
Oh, and besides the importance of showing up for appointments……don’t show up high. Truly. Just don’t. It’s not funny, or cute or anything else. It is disrespectful to me and my time. And it is disrespectful to you and your time. You’ll never get anything done in that session – anything that you remember. Plus, I’m not going to let you drive home so besides the money you waste on the hour of therapy….you’ll also have to have an Uber to drive you home, or someone come pick you up.
If you were voluntold to come to therapy, that’s ok. Don’t be angry about that. Someone in your life loves you and is desperately trying to get you the help you need. Be glad there is someone that still cares enough about you at this point to try and get you some help. Because trust me: soon, if you don’t get serious about your recovery, they will get to the point where you will lose them forever. And they’ll be gone. Think about that while you complain about them to me. Picture your life without them for a
No one is going to do the work for your recovery. That comes from you. Not me, not your mom, dad, grandma, grandpa, aunt, uncle, daughter, son, girlfriend, boyfriend, cousin, neighbor, Pastor, Rabbi, partner, friend or spouse. You will most likely have the support of one or more of those people I just named, but you and only you are responsible to do the actual work. Period.
Do I sound like I’m being hard on you? I am. I want to help you, and I want you to get better. I wouldn’t be doing my job if I don’t call you out from time to time. I know you are hurting. I know addiction is a beast to overcome. But you can fight it. I’ve seen people fight tooth and nail for their recovery. It’s possible. Anything, anything you want….it’s possible if you want it bad enough.
Recovery can happen. It can. I know you don’t think that now, and it feels like everyone is against you and the world is a hopeless place…..but stick with me. I believe in you. I know you can do it, you just gotta dig down deep and do the work. I have seen nothing short of many miracles in the time I have been working with people in addiction. I’ve seen people hit rock bottom and come back stronger and better and totally opposite of how they were before.
I can’t wait for you to re-read this letter once you’re in recovery. Do me a favor, and let’s read it together. It will be the biggest gift to me as a therapist, to see how far you’ve come.
Thanks for listening. You mean a lot to me, and I know you mean so much to the people in your life. We all want the best for you. Nothing more, nothing less. Just the best.
I’ll see you next session.
Private Practice Chronicles, Part 10: One Meeting a Week
When I officially opened the doors to my private practice on August 1, 2016 I didn’t have one paying client.
Yes, you read that right. Not. One. Paying. Client.
You might be reading this and saying “Is she out of her naive mind, she opened a practice without one client on board?” Believe me, I agree with you! But here is what I did have: a shared office space in a central location (so I was only responsible for 1/2 the rent), a website and presence on four social media channels (Facebook, Instagram, Twitter and LinkedIn), a marketing plan, great experience and a whole lot of hope, fear and determination. My eyes were completely focused on the prize, and for me, that prize was having a successful practice. I was going to make it happen.
I set a goal right away to have at least one meeting a week (it was usually more) with people in my industry because, as a former marketing executive, I know the power of network marketing. And let’s face it, I obviously had way more time on my hands than I did clients!
So began my meetings. I met with fellow students from grad school at their private practices. I toured substance use and abuse facilities and hospital behavioral health departments. I attended local (free) CEUs at agency venues and handed out my cards. I called former colleagues that I worked with at various agencies to meet up for coffee, and invited them to see my office space. I joined a network marketing group of local business women. I met with doctors, physical therapists and other health-care providers. I partnered up with other people and developed some education and training courses. I volunteered to run groups at a treatment facility. I cold-called and emailed other counselors that I knew in the area, and met with them over pizza, salads and sandwiches to pick their brains about their private or group practices, and to let them know I was ready for referrals.
My very first client came from one of those meetings. And then my next. And then my next. And while I do rely on paid advertising to market my business, some of my best and long-term clients have come, and continue to come, from these word-of-mouth referrals.
I have also received other gigs from these meetings to diversify my practice, including writing and training opportunities, contracting positions (I currently have three outside contracts) and have been offered a position to sit on the board of a large local agency.
As my client base and practice grows, I still make time for at least one meeting a week. Again, it’s usually more, but as my clinic hours fill (and that’s how I pay myself), I stick to my rule of at least one. These weekly meetings have benefitted me in many ways, and not only business-wise. It gets me out in the community and keeps me on top of new resources for my clients, as well as gets me in touch with other people in the business – something that is crucial for this sole practitioner. In fact, I’m writing this after reaching out and meeting a counselor for coffee that I sat next to at a networking event this past summer. Next week I’m touring a substance-use treatment center in the Texas Hill Country and being hosted as a guest for a paid CEU course. The week after that I’m speaking at a middle school on the South Side of San Antonio for their Career Day. My meetings will continue into 2018 and beyond.
When and where is your next meeting?
Blog Post: What Therapy Is…And Isn’t
So you’re thinking about therapy. For most people, that’s a really huge step forward….and a great one, in my opinion. (‘Cause obviously any therapist would be totally stupid to say anything else otherwise.) No, but all jokes aside. I think therapy is one of the best gifts you can give to yourself and your mental well-being.
But here’s the thing. Therapy isn’t the answer to all your problems. It’s part of the solution to your problems, but it’s not the be-all-end-all answer to everything.
I can’t tell you how many people walk into my office for their first appointment and expect to have life’s answers figured out and solved in a 60-minute timeframe. When they realize this is simply not the case, I can tell by the look on their face that they are not coming back. And they don’t. And that’s really too bad, because mostly these are the people that need therapy and would benefit greatly from it.
Or, I’ve had clients tell me they were in therapy previously but nothing was changing so they stopped going. One client recently told me this and I asked him how long he had seen the therapist. His answer? Two appointments.
Sorry people. Therapy is not a magic-bullet, quick-fix solution. It just doesn’t work like that. I wish it didn’t, but it doesn’t. Therapy is a process. Sometimes, issues can be resolved in a few appointments. Other times, longer-term, regular and consistent therapy is needed for a few months. It all depends on one thing: how much work a person is willing to put in. And how dedicated they are to making changes.
And here’s another thing. As a client, it’s your job to apply the techniques and work on the goals mutually agreed upon in session; the work is not all on the therapist. Oftentimes I assign clients “homework” of sorts. The ones who do it seem to have the most success and make progress. Others stay stagnant and frustrated. I tell them it’s because they have to be willing to put in the work outside of session. Behaviors don’t change because we want them to change. We have to constantly work to change them.
The other day a woman called me around 10 in the morning. She asked if I had an appointment at noon…that same day….on her work lunch break. I’m always leery of people that need an appointment RIGHT AWAY. Why? Because I know they expect it to solve something and have an instantaneous result. Of course, I assessed for crisis and suicide risk due to her sense of immediacy and quickly got to the root of the problem: her boyfriend had told her she needed to see a therapist or he would leave her. I knew if that was her motivation for coming in, she most likely would think that one therapy session would change everything.
Changes aren’t going to happen in one therapy appointment. Changes and progress can be made with steady, consistent attendance of therapy…and applying the techniques and suggestions that are worked on in session – out of session. I tell all of my clients this: therapy is the foundation. But it’s also work. The real work is done in between appointments. I’ve seen people make positive changes, get out of ruts, recommit to failing relationships, stop using substances and get out of jobs they hated – all due to self-discovery and changes they were willing to make in their lives. It wasn’t the therapy alone: it was the combination of them willing to show up, do the work and make the changes they wanted to make.
Therapy is a commitment and one that is worth it. It’s just not a quick and easy answer. It’s one piece of a puzzle that you have to work – with your therapist – to solve.
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