trauma

5 Things You need to know before you start counseling

So, you’ve decided to start counseling and you’re ready to go.  Perhaps you’ve never done therapy before or maybe you’re looking to take a new approach.  Here are some things you need to know before you start counseling.

1.  Finding a therapist that you feel safe with is most important. 

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You can line up a bunch of great therapists, but if they’re not the best fit for you, you’re not going to do the intense, deep work you’re looking to do.  The role of a therapist is to be a guide through your journey, reflect back to you what we see and help you to overcome obstacles towards meeting your goals.  If you don’t click with your therapist or don’t feel safe enough to trust them, reaching your goals with them is unlikely.  Your therapist should be someone you can relax around and speak freely without fear of being judged.  Trust and safety are of paramount importance when you’re looking to do deep work on things like eating disorders, trauma, PTSD, couples’ work or issues specific to the LGBTQIA community.

2.  Specialties mean that there’s been special training in a particular issue. 

Our training in graduate school and doctoral programs very rarely provides training for specific diagnoses like PTSD, eating disorders or addictions.  So when a therapist decides to have a particular specialty, we need to seek out training geared specifically towards these issues.  If you notice that a therapist you’re interested in has indicated that we specialize in a particular area, you might want to ask us what sorts of training we’ve done to qualify us as an expert.  This will give you a better idea of how equipped we are to help you with your specific struggle.

3.  When you hire a therapist, you are paying for a space that is yours, for you.

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I’ve heard people say that therapy is like paying someone to be your friend.  This is actually not true.  When you hire a therapist and you pay money, what you are paying for is a safe, neutral, objective space and time where you can do your work.  It is an energy exchange.  You are not paying your therapist to care about you, you are paying for an hour in a room that is completely and totally about you and no one else.  In friendships, there’s a give and take, there’s a social obligation to ask how they are and be a support to them.  In a relationship with your therapist, you are taking time for yourself only and receiving support that is not reciprocated emotionally, only financially.  This dynamic can be extremely healing and empowering and for many, it is the only time and space where healing can truly take place.

4.  The more consistently you go, the more effective therapy is.

Sometimes, in an attempt to save money or save time, people want to schedule therapy sessions every other week or once per month.  While there’s nothing particularly wrong with scheduling like this, you may want to rethink the frequency and consistency of your therapy schedule.  You don’t have to be in therapy forever.  You can establish and work towards specific measurable goals with your therapist and see regular progress.  However, progress is more difficult to measure when you attend therapy inconsistently.  You may be having symptoms of PTSD, for example, and when several weeks go by without working on those particular symptoms, it is more difficult to get traction.  If you’re struggling with binging and purging and you go every week, you can check in with your therapist about the particular triggers and behaviors that may have lead to your binge and purge.  Don’t take my word for it, check it out for yourself.  Set a goal with your counselor and try going weekly, write down your progress and notice the differences between your weekly sessions over a period of at least 3 months versus bi-weekly or monthly progress over a 3-month period.  You may be surprised with the results.

5.  Therapy happens in stages.

Sometimes we think that as soon as we set foot in the door of a therapy office, we will be “cured” immediately or within a few sessions.  The reality is that there’s a therapeutic process which happens in stages.  The first stage is joining with your therapist or learning to trust them.  When we meet a new friend, we don’t usually tell them our deepest darkest right off the bat, it takes time and trust building to get to a place where we know they are a good friend.  A similar concept is applied in therapy.  Depending on the client, the level and amount of trauma and defenses, this stage can take anywhere from about a month to sometimes a year or even more.  Safety, trust and a therapeutic bond, known as a therapeutic alliance, is formed in order for the therapist to really know and understand the client and for the client to feel safe enough to open up and do their work. 

The second stage is where the work is done.  Since there’s now an underlying foundation established between therapist and client, the second stage is about vulnerability.  There is an unpacking, uncovering, examining and exploring the process that happens with the client and their trauma or their history.  This stage is where people see their patterns and make shifts and changes in their thoughts, beliefs, and behaviors.  The second stage of the therapeutic process is where clients reach their goals.

The third stage may or may not be part of the therapeutic process, dependent upon the client’s preference.  This stage is for maintenance.  The client continues therapy but perhaps doesn’t come every week any longer.  They use their therapist to check in with, get help with issues as they arise and review the goals and behaviors they established during the second stage.  Some people choose to forego this step and skip to the fourth stage.

The fourth stage of counseling is a closure process.  After attaining goals in the second stage, and maintaining new behaviors and thought processes in the fourth stage, this last and final stage is a review of accomplishments, work together and closure of the therapeutic relationship.  If the client chooses to end counseling, this practice of review and closure can be especially healing for those who have experienced traumatic grief or loss.  Saying goodbye in a healthy way, honoring the relationship without suddenly cutting it off is a beneficial process to learn about emotional maturity and sophistication. 

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I hope these tips have been helpful.  Please feel free to comment below with any other tips or feedback you have on this topic.  If you’d like to speak further about starting counseling or have any other questions about some of the things I’ve mentioned, please contact me at TiffanySpilove@yahoo.com or call 610-314-8402.  I wish you luck in your endeavors and look forward to hearing from you soon!!

"We cannot love others until we love ourselves" by Mikala Morrow

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 "We cannot love others until we love ourselves"

by Mikala Morrow, Villanova Graduate Counseling Intern

This saying has been a cliché statement that has been thrown around as a way to encourage self-care or even used as a convincing statement to those who find it hard to love themselves. What does this statement truly mean?

It means that someway, somehow we must find, within us, love. This must mean that love is an innate ability and we all possess the ability to love ourselves without the assistance of others.

Personally, I do not believe this to be true. Can we truly have an innate ability to love ourselves without any help from others? If we truly cannot love others until we love ourselves, we have to be able to love ourselves without help, right? Which comes first, the chicken or the egg? Which comes first, our innate ability to love? Or is love taught to us from our caretakers, partners, peers or a higher power?

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What if, “We cannot love others until we love ourselves” becomes “We cannot love ourselves and others until we have been loved.” My argument is that in order to learn to love others, we must first be loved. We must learn how to love and what love is.

Imagine a child who is neglected by their caretaker. This child never truly learns love. Instead, to them, love means neglect. Later on in life when meeting new people, how will they love them? If all this older child has known is that love is neglectful, they too will neglect those that they love.

Compare the first child with someone who has a loving caretaker who has shown interest in who they are. This child will grow up with the idea that love is showing interest in others and will love in this way. These examples may not be true for all, but it is something to think about. The child in the first scenario may

learn somewhere how to truly love but this will not come as easily as the child in the second scenario.

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We need to learn what love looks like towards us and we also need to learn how we love.  We may love by giving others gifts or our time. We may show our love through compliments or by offering a shoulder to cry on. We all have a unique way to show love. In order to practice our ways of loving, we need people around us to accept our love. If our unique way of showing love is rejected, we learn that we are not good at loving, or our way of loving is wrong.

Let’s say you show love with your time but your partner becomes annoyed and tells you they just want space. Your way of loving has been pushed away. We need other people around us to affirm the way we love.  While the statement, “We cannot love others until we love ourselves” has a good message at the core, it can be damaging for those who have never learned how to love themselves.

We all need love whether it is from other humans on earth (maybe even from a pet) or a supernatural love. Then we can truly love others’ authentically and comfortably.

Mikala, Villanova Graduate, Counseling, Bryn Mawr, Love, Therapy

Mikala has an intensely compassionate and unique way of connecting with you to help you identify and express your feelings and your deepest sense of self.  She is persistent and encouraging in the face of hopelessness and despair.  She especially loves working with women to provide tools to alleviate anxiety and depression.  Mikala has a wealth of experience and is skilled in the mental health field working with domestic violence, food & body issues and addiction.  If you're struggling to tolerate your emotions and you're looking for a guide to help you get to know yourself better, give her a call now at 570-412-4516. 

 

The Number 1 Trauma Treatment: EMDR Explained

Lucky us!  Scott Giacomucci, MSS, LSW, CTTS, CET III, trauma specialist, psychodramatist and all around amazing therapist has shared his insights and explained that complicated title: Eye-Movement Desensitization and Reprocessing, also known as EMDR.  The following is a handout Scott put together for his clients to help explain what EMDR is and how it's done:

EMDR: Eye-Movement Desensitization and Reprocessing

Often, when something traumatic happens, it seems to get locked in the nervous system with the original picture, sounds, thoughts, feelings, etc.  Since the experience is locked there, it continues to be triggered whenever a reminder comes up. It can be the basis for a lot of discomfort and sometimes a lot of negative emotions, such as fear and helplessness that we can’t seem to control. These are really the emotions connected with the old experience that are being triggered.

EMDR therapy for PTSD in Bryn Mawr and West Chester

What is EMDR?

 Eye Movement Desensitization and Reprocessing, is a late-stage, trauma resolution method.  Developed in the late 1980's, EMDR currently has more scientific research as a treatment for trauma than any other non-pharmaceutical intervention. Based on empirical evidence as well as thousands of client and clinician testimonials, EMDR has proven an efficacious and rapid method of reprocessing traumatic material.

EMDR appears to assist in processing of traumatic information, resulting in enhanced integration - and a more adaptive perspective of the traumatic material. The utilization of EMDR has been shown to be effective with a variety of conditions including generalized and specific anxieties, panic attacks, PTSD symptoms (such as intrusive thoughts, nightmares, and flashbacks), dissociative disorders, mood disorders and other traumatic experiences. Theoretically, EMDR is about integration - bilateral hemispheric (right/left brain) integration; triune brain (brain stem, limbic system and cerebral cortex) integration; and mind/body integration, but practically, it’s about convincing the mind and body that the traumatic event is, indeed over. EMDR helps to put the past in the past, where it belongs, instead of staying stuck in it (feeling like it is happened all over again in the present-with the same thoughts, emotions and body sensations- that accompanied the event in the past).

The eye movements (or other bilateral stimulation) we use in EMDR seem to unlock the nervous system and allow your brain to process the experience. That may be what is happening in REM, or dream, sleep: The eye movements may be involved in processing the unconscious material. The important thing to remember is that it is your own brain that will be doing the healing and you are the one in charge.

How is EMDR Done?  (Parnell, 2006)

  • Establishment of Safety and Resources - Safety within the therapeutic relationship and safety within each individual EMDR session. During each EMDR session, your therapist will begin by activating your own internal resources. (S)he will guide you in an imaginal, multisensory imagery exercise designed to activate images, emotions and body sensations of safety, protection, nurture and comfort. Once these images have been activated, the actual trauma reprocessing will begin.
  • Activating the Traumatic Memory Network - The therapist will ask a series of questions regarding the traumatic memory. The purpose of these questions (or script) is to activate the entire traumatic memory network.
  • Adding Alternating Bilateral Stimulation - Once the entire traumatic memory is activated, the therapist will add alternating bilateral stimulation using:

a) buzzing in your hands by turning on the Theratapper

b) alternating auditory tones via headphones or ear buds

c) moving his/her hands back and forth, so you may visually track the movement

  • Reestablishment of Safety - regardless of whether the traumatic material was completely processed or not, the session will end at a pre-set time. Before you leave, you will be stable, embodied, oriented and calm. Depending on you and your therapist’s preferences, this may be accomplished in a variety of ways including, but not limited to re-activating your own internal resources, breathing exercises, prolonged muscle relaxation, etc.

Looking to continue EMDR therapy?

-You might begin by asking your IOP/PHP counselor for a recommended outpatient counselor who is skilled in EMDR.

-At the EMDR International Association website (EMDRIA.org) you can navigate to the “Find a Therapist” tab and search for a certified EMDR therapist in your community.

 The current treatment guidelines of the American Psychiatric Association and the International Society for Traumatic Stress Studies designate EMDR as an effective treatment for post traumatic stress. EMDR was also found effective by the U.S. Department of Veterans Affairs and Department of Defense, the United Kingdom Department of Health, the Israeli National Council for Mental Health, and many other international health and governmental agencies.

(Giacomucci 2017)(References: EMDRIA; Linda Curran; Laurel Parnell)

Scot Giacomucci, EMDR trauma and psychodrama specialist in west chester, pa.

Scott Giacomucci, MSS, LSW, CTTS, CET III is a certified trauma treatment specialist and licensed social worker in Pennsylvania. He is a graduate of Bryn Mawr College where he received his Masters in Social Service (MSS) with a concentration in clinical social work. He facilitates trauma treatment services at Mirmont Treatment Center serving a variety of populations including young adults and emergency responders (veterans, police, fire, etc..) in both individual therapy and group sessions. Scott has a gentle, non-judgmental treatment approach that honors the inherent worth of each individual. He utilizes a blend of treatment modalities including both traditional talk therapy and experiential therapy which have been research-proven as the treatment of choice for treating trauma. 

To learn more about Scott Giacomucci and the work he does, you can visit his website at: http://sgiacomucci.com/

Any comments or questions?  We'd love to hear from you!  Please comment below.  For confidential questions, email TiffanySpilove@yahoo.com.  If you need help finding an EMDR therapist, please call 610-314-8402, I'd be happy to help.

How to Find an Expert on PTSD & Trauma for Therapy on The Main Line of Philadelphia

The Main Line of Philadelphia

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is a very special place to live.  If you already live here, you know how unique this place is - if you don't live here, you are in for quite a treat.  The suburban area to the west of Philadelphia has been referred to as The Main Line because of the main train line that connects Philadelphia to all the beautiful towns built up along the train tracks: Lower Merion includes Overbrook, Merion, Bala Cynwyd, Wynnewood, Narberth, Ardmore, Bryn Mawr and Rosemont.  Further out we have Radnor, Villanova, Wayne, St. Davids, Berwyn, Paoli, Malvern, Exton and Frazier.  Each town is unique and has it’s own spin on charm.

Finding an expert trauma therapist on the Main Line of Philadelphia

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seems harder than it should be.  With Bryn Mawr's Graduate School of Social Work close by, Villanova University, Rosemont College, Saint Joseph's University, Widener, Immaculata, Cabrini, Ursinus and not to mention University of Pennsylvania, Swarthmore and LaSalle, we have so many talented therapists, social workers and counselors.  So, how do you find the therapist who knows just how to help you manage your post-traumatic stress symptoms?  How do you find the counselor you can click with and trust to guide you through an evidence-based method of healing your past traumatic memories?  Choosing a therapist is a very personal decision.  You can have three great therapists, but if you don’t feel safe with them, what’s the point?  If you are looking for a counselor, psychologist, life coach or therapist - I'd like to help you find someone who can help.

Here are some ways to search

Educate Yourself About Methods that Work for PTSD

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When you have PTSD, there are only a few ways of treating your symptoms that have been studied and proven to effectively reduce or eliminate symptoms.  Those nightmares you’ve been dealing with, the heightened startle response, hypervigilance, and avoidance of triggering situations – those are the things that get in the way of your life.  These are the issues you’ll want to be sure your therapist knows how to help you manage and heal, not just talk about.  One of the top researched methods for eliminating these symptoms is a method called Eye Movement Desensitization and Reprocessing (EMDR)

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EMDR has been studied and proven as an evidence-based treatment method.  You can learn more about EMDR and how it works here.  Here is a short explanation: when we have traumatic memories, the memories tend to get stuck on one side of the brain and our body tries to heal it by re-playing it over and over, but it stays stuck.  EMDR is a technique that stimulates each side of the body alternately while the patient processes the traumatic material.  This technique helps the brain move the traumatic memory from one side of the body through to be able to process it so it’s not stuck on a loop any longer.  You can find therapists who are trained and certified to utilize EMDR by going on the EMDRIA.org website or asking people who know therapists in the area.  Think about asking friends who have or know therapists, your doctor or someone at your school.  Therapists that come highly recommended and are known to work with PTSD through EMDR methods are a good way to make sure they have a good reputation.  

Google

Type into Google your town and the issue you are looking for help with.  For example, "Bryn Mawr and PTSD" or "Rosemont and Trauma" and see what comes up.  In the top listings that come up in your search, you will hopefully see some links to therapists that specialize in your particular need and are trained in EMDR.    

Psychology Today

What you will most likely see is a result that links to a Psychology Today profile for therapists in your area that have indicated these specialties.  Psychology Today is a great site that is most commonly used for therapists to post their profiles and for clients to find a therapist nearby.  It’s very helpful that you can refine your search by specialty.  The unfortunate thing is that therapists can indicate that we specialize in as many topics as we'd like.  Although a therapist might indicate that they specialize in PTSD, if it's really something we know a lot about, we obtain specialized training in evidence-based methods specifically for PTSD and we will often note areas we are trained in on our websites, so don’t stop with Psychology Today, make sure you read through the clinician’s website as well.

Websites

Check out the websites of potential therapists.  If you are looking for help with flashbacks and the website you are visiting talks a bunch about flashbacks, that's a great sign!  If you are looking for help with a heightened startle response and you're on a website that doesn't mention this symptom, you might want to keep looking.  

Phone consultation

Some therapists offer a free 15-minue phone consultation which is a great service and an excellent opportunity for you to interview your potential trauma therapist.  You are going to be spending a good amount of time and finances on effective therapy, it is very important that you find the right fit for you.

Here are some questions to help you navigate your phone consultation:

1.     What methods do you use to treat PTSD?

2.   How do you help your clients manage overwhelming emotions while they work on traumatic memories?

3.   What do you do to treat the symptoms versus the root of the problem?

4.   How long does it usually take before your clients start to see relief from their symptoms?

5.   How effective are the methods you use?

6.   Given my specific set of symptoms and needs, do you think you can help me and have you helped many others’ with my specific symptoms before?

 

In an ideal world, you would find a therapist who has special training and expertise in the methods that show the best results and someone who has tons of experience working with eating disorders and trauma.  Unfortunately, this is not an ideal world.  So you'll need to search a bit further.  You'll be searching for someone that you connect with, who you feel comfortable talking to, someone who will be honest with you and you'll know you can be honest with them.  

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I hope this helps you in your search for the right therapist on the Main Line of Philadelphia.  If you want some tools to help now, sign up for my newsletter to get some tips and tools for managing PTSD and eating disorders.  If you are still feeling stuck, feel free to call me at 610.314.8402 for a free 15 minute phone consultation.  I am available to listen to what's happening and help direct you to the right person.  If you are looking for help with eating disorders or PTSD, you can read more about how I can help here.

Get Proactive About Flashbacks and Intrusive Thoughts

What is PTSD? 

According to the fifth edition of the Diagnostic Statistical Manuel of Mental Disorders (DSM V), Post Traumatic Stress Disorder or PTSD is a cluster of symptoms stemming from exposure to an event that was traumatic.  In an attempt to heal, our bodies tend to re-play upsetting memories until the memory can be resolved.  PTSD can seem difficult to manage.  PTSD symptoms include things like intrusive thoughts and flashbacks.  While the key to healing PTSD requires more involved therapeutic interventions such as EMDR, there are ways to manage some of the symptoms to make life in between therapy sessions a bit easier. 

What is a Flashback?

Jane, a 28 year old abuse survivor, was out to dinner with her friends.  Suddenly, a waiter drops a tray of food and the sound carries through the restaurant.  Jane hears the clattering of dishes and silverware hitting the floor.  Her body believes she is back in the kitchen from her childhood when her parents fought and kitchenware broke.  Jane crawled under the table, and ducked her head under her arms.  When one of her friends reached out to her under the table, she flinched and apologized to her mother, reliving the childhood scene with her parents.  This is one example of what a PTSD flashback can look like.

A flashback is when a person who has experienced a traumatic event, re-experiences that event in their body.  Flashbacks can be so powerful, that the body believes that the event is happening to them in real time. 

Anticipating a Flashback

While there’s no way to be able to fully anticipate when a flashback might occur, there are some preventative measures you can take. 

Learn what your triggers are -

Scan your history with flashbacks and traumatic situations to see if you can find some themes.  In the example with Jane, she experienced trauma in the kitchen with sounds of breaking plates and glass.  You might notice that there are certain situations like restaurants, the beach, or the grocery store – that can be triggering.  There might also be objects, sounds, smells or people that can set off a flashback. 

Be Prepared -

Once you have a good idea of what your triggers are, see if there’s a way to prepare for them.  In Jane’s example – she might decide to avoid restaurants or just loud, busy ones for a while until some of her symptoms decrease.  She might sit with her back to the wall so that she can see what is happening around her in real time. 

Practice Mindfulness –

You can practice mindful awareness by checking in with yourself regularly to see what you are experiencing in your body.  Notice if any anxiety or dissociative sensations are heightened.  Some people describe their PTSD symptoms as sensations of feeling floaty, spacey, leaving their body, spacing-out, zoning out, feeling overwhelmed, high anxiety or easily startled.  If you experience any of these sensations, pay attention on a regular basis.  These sensations are warning signals that you could be easily triggered when you are in this state.  If you catch the trigger early enough, you can avoid a flashback.

What to do when you’re triggered –

Once you notice that you are in a heightened state of anxiety or dissociation, use some tools to stay in the present; in your body.   

Tools for PTSD Symptoms:

(note: don’t use any techniques or tools you find triggering)

Use the senses – taste, touch, smell, sound and sight

Drink some water slowly.  Notice the cool sensation of the glass on your lips, the water in your mouth and the sensation as it goes down your throat.

Hold an ice cube.  The cold can help you stay in your body by bringing your awareness to your hand.

Smell essential oils such as Bergamot (good for panic attacks) or Lavender (good for stress relief).

Light some incense – watch the smoke rise and coil, inhale the aroma.

Listen to music you find grounding.  Pay attention to the words, tap your feet to the rhythm. 

Play with Silly Putty or clay – notice the texture.  Pay attention to the sensation of the clay in your hands.

Distract yourself and enlist friends to help you distract –

Try to think of as many baseball teams as possible.  Take turns with friends in thinking of the names of all the teams.

Count backwards or say the alphabet backwards

Try to think of other categories such as names of movies, bands, TV shows, etc.

Ask someone else about how they’re doing

Get involved in a project like building model airplanes or re-arranging your closet.  Something tactile that also involves thought is helpful.

Read an engaging book – this uses your sight, engages the sense of touch and distracts your mind.

When you’re thinking about where to put your shoes, your brain is less likely to slip back into a trauma memory.

To learn more about PTSD treatment, contact me at TiffanySpilove@yahoo.com