A Dose of Your Own Medicine: Why Clinicians Need to Practice Mindfulness

As a therapist, you’re likely well versed in mindfulness-based therapies. You’ve probably even tried a mindfulness-based technique with a client. But when you walk out of the office, and you’ve put your therapist self aside for the evening, have you used mindfulness for your own self-healing?

Mindfulness—it’s the latest buzzword and activity that has caused a feeding frenzy of therapist and clients alike looking to make sense of a crazy, fast-paced life. In recent years, the mindfulness movement has gained so much traction that a simple google search of the term provides over 27.2 million results. Millions of dollars have been poured into research, including a $4.7 million grant that was awarded to researchers at Brown University to study whether mindfulness can help patients stick with lifestyle changes. The clinical studies on the benefits of mindfulness have been so widely accepted, that mindfulness based programs have been adapted in schools, prisons, hospitals, veterans centers, and other environments.

As a therapist, you’re likely well versed in mindfulness-based therapies. You’ve probably even tried a mindfulness-based technique with a client. But when you walk out of the office, and you’ve put your therapist self aside for the evening, do you use mindfulness for your own self-healing?

If you haven’t, you should.

Jon Kabat-Zinn, creator of Mindfulness-Based Stress Reduction, or MBSR, recognizes the extraordinary ability therapists have to love others. He knows that to do this job, you have to be filled with immense compassion to enter the areas of darkness, horror and shadows, and to be witness to the worst feelings and actions that human beings can do to each other. You enter into these spaces with your clients willingly, and with integrity, kindness, and empathy—all of the elements that are essential to healing.

This work, while rewarding, comes with a risk. It can be traumatizing and heart wrenching to enter these clouded spaces in the lives of your clients, and for that reason you need to take deep care of yourself.

Mindfulness | noun | mind·ful·ness |  \ˈmīn(d)-fəl-nəs\

The awareness that arises through paying attention, on purpose, in the present moment, non-judgmentally.

The definition, while easy to say, may just be the hardest thing for us as a person to enact. But the benefits of maintaining a mindful presence will not only transform your daily life, but it will have an enormous effect on your ability to help your clients. That’s why we’re encouraging you to take an hour of your day, and watch this message about mindfulness from Jon Kabat-Zinn. We think it’s so important that we’re providing you the CE seminar for free.

Do you practice Mindfulness?
Tell us how it’s impacted your life, your practice, or the experience of a client in the comments below.

Free CE Seminar

You Can Heal Your Heart After Grief: Honoring Infertility and Miscarriage

Affirmations are powerful tools, especially when used with mirror work. For women who have experienced infertility or miscarriage, mirror work can begin a path to finding inner peace.

There are certain things in life that we often take for granted. For example, when little girls play house with their dolls, they assume that when they grow up, they’ll be able to have a baby if they want to. They never imagine that their body’s biological clock may wind down, that they may not be able to get pregnant, or that a pregnancy might not be successful. Nor would they be able to anticipate the amount of shame and stigma that some people attach to those things. If a woman wants a biological child but isn’t able to conceive, she may feel that she isn’t fulfilling her destiny as a female, or that shes letting down her partner. She will most likely not be able to predict the personal grief that accompanies the loss of that kind of attachment, and she may subconsciously begin a bout of negative self-talk such as “I’m defective; something’s wrong with me…”

One way that a woman who has experienced the loss of infertility or a miscarriage can heal her heart is by replacing the negative self-talk with positive affirmations such as:

  • I forgive my body.
  • My body is doing everything it is destined to do.
  • I am worthy of being a mother.
  • A real mother is defined by her ability to love.

Affirmations are powerful tools, especially when used with mirror work. My co-author of You Can Heal Your Heart, Louise L. Hay, has done a beautiful job of demonstrating how to practice mirror work in the video below. If you or someone you loved has experienced the loss of a child, I encourage you to share this tool and begin a path to find inner peace.

This blog has been brought to life by PESI speaker and renowned grief and loss expert David Kessler. It features passages from his book You Can Heal Your Heart, co-authored by Louise L. Hay.

5 Tips for Public Speaking with a Stutter

If you were to ask someone what they’re afraid of, you’re likely to hear some common answers: spiders, snakes, heights, and public speaking. But for those who stutter, the fear of public speaking can be amplified by their anxiety about stuttering. Get 5 tips for helping your client get more comfortable with public speaking.

If you were to ask someone what they’re afraid of, you’re likely to hear some common answers: spiders, snakes, heights, and public speaking. But for those who stutter, the fear of public speaking can be amplified by their anxiety about stuttering. I have a unique perspective about this fear. Not only do I teach public speaking at the college level, present across the country, and work as a speech pathologist in my own private practice, but I stutter.

Here are my 5 tips for helping your clients who stutter become more comfortable with public speaking.

1. Encourage your client to pick a topic they are passionate about
When I first began public speaking, I was addressing Mothers’ Groups about language development in children. I would become so passionate about my topic that I would sometimes forget about my stuttering. Having clients pick topics that are meaningful and enjoyable for them doesn’t mean they won’t stutter, but they will have greater enjoyment in the experience of communication.

In addition, if you are working with students, you may want to encourage them to pick the topic of stuttering. One high school student told me he didn’t have to hide his stuttering anymore, and it was easier to talk because his class better understood his communication disorder after he did his class presentation on stuttering.

2. Have your client acknowledge their stuttering in the presentation
I begin presentations by saying, “I want to let you know I stutter, and I may need a minute from time to time to say certain words.” Your client can provide more details about their stuttering, depending on their comfort level.

3. Practice in the actual room where the presentation will be given
I have used this technique many times especially when doing big presentations. The most challenging and gratifying speech that I ever had to give was my father’s eulogy. The night before, I practiced in the empty church. It enabled me to face my fears of going up to the podium, check the sound of the microphone, and know where I would place my notes. On the actual day of the funeral, I felt empowered and confident because I had already been there.
Going up to the podium or in front of the classroom can be nerve-wracking, but if clients have already been there, they will feel more confident when they have to do it for “real.”

4. Role-play worst case scenario with your client
When your client shows you what they are afraid of happening on the day of the presentation, it can help you prepare by knowing what to do if the situation happens. If having a significant moment of stuttering is the fear, then have your client stutter on purpose, and show 30 seconds of the presentation in that way. If they are afraid of being laughed at, then you may role-play this situation. If they have already experienced worst case scenario, the actual presentation will feel less intimidating.

5. Have your client practice basic communication skills in addition to speech strategies for stuttering
In addition to working on speech strategies for stuttering, you should also address basic communication skills such as eye contact with the audience, vocal volume and proper inflection in the voice to emphasize key points. Practicing these skills can instill confidence and enable your clients to be a more engaging speaker.

This post has been brought to life by PESI speaker Marilee Fini, MA, CCC-SLP.

Join Marilee Fini, MA , CCC-SLP, and walk away with stuttering interventions that address the “whole person.” Through hands-on demonstrations, case studies, activities and role-play, discover effective techniques to treat the emotional and physical components of stuttering.

FLASH SALE! $99 DVD when you use promo code R16J21 at checkout!


Duty to Warn: No One Commits a Crime Without Thinking About It First

When you have a client who begins to get upset and you feel that he or she may act out in session, what do you do?

In recent years, duty to warn has been receiving increased attention following public tragedies and mass shootings such as Aurora, Colorado. We know that when a clinician is vigilant in recognizing and managing clients with violent behaviors, it can contribute to the appropriate handling of dangerous situations and minimize risk to themselves, patients, their families, coworkers, and the community as a whole.

As a frontline clinician who specializes in the treatment of personality disorders, managing clients with violent tendencies is a central concern. Some personality disorders are at a higher likelihood to harm others and put their mental health provider at risk, but not all personality disorders or those with mental illness are going to be violent and raise the “duty to warn” question.

Because the issue of duty to warn is complex, it’s important to review and understand the specific requirements for the state you practice in. And while duty to warn requirements may vary, the steps to take to protect yourself to manage and avoid in-session violence and threats are universal.

It does not matter if you are a novel or seasoned therapist, threat identifiers are not always searchlights, but often times tiny flashlights.

When the issues of in-session violence and threats do arise; are you prepared? In my book, Antisocial, Borderline, Narcissistic, & Histrionic Workbook: Treatment Strategies for Cluster B Personality Disorders (coming Fall 2015), I developed steps and strategies to keep you, your clients, and others safe. I invite you to learn about some of my personal experiences with duty to warn by watching the video below, and downloading the worksheet How to Manage and Avoid In-Session Violence and Threats.

Download the Worksheet:
How to Manage and Avoid In-Session Violence and Threats

This blog was brought to life by Daniel J. Fox, Ph.D. 

Daniel J. Fox, Ph.D. has been treating and specializing in the treatment and assessment of individuals with personality disorders for the last 14 years in the state and federal prison system, universities, and in private practice. He is a licensed psychologist in the state of Texas and has published several articles on personality, ethics, and neurofeedback. He is the author of The Clinician’s Guide to Diagnosis and Treatment of Personality Disorders. His specialty areas include personality disorders, ethics, and neurofeedback.

Your Patient has Harmed Themselves. Are You Covered?

What happens when a patient attempts to sue you? The first thing you can expect is the damage that occurs to your reputation by mere association. There are also potential fees that you may have to pay out of your own pocket, if you’re not covered. Learn more about liability insurance, and decide if it’s right for you.

As an experienced mental health professional, you know better than anyone that people can be unpredictable. This includes patients. As a professional, you might feel that there’s a need to hold your patient’s hand to keep them on the right path. However, no matter how much you support them in creating a healthy life, it’s possible that your patient may steer away from this path toward a crisis.

This is par for the course in the mental health field, but the truth doesn’t make it any easier to deal with or undo the unexpected tragedies of your patients.

When your patient who has been in your care and has trusted your advice harms themselves, are you liable? It’s a question that, although difficult to fathom, is very necessary to ask and prepare for. It’s not enough to have group or employment coverage, because, many times, the patient goes after their treating professional.

What happens when a patient attempts to sue you? The first thing you can expect is the damage that occurs to your reputation by mere association. There are also potential fees that you may have to pay out of your own pocket, if you’re not covered. We’ve read the horror stories that plague the medical industry. Your patient, referred to you for mental health care, puts you in an even more vulnerable position, especially if they can’t be trusted to care for themselves…it’s why they’ve entrusted you in the first place.

Some attorneys even specialize in the area of helping the loved ones of patients who have committed suicide to receive retribution, at the expense of the treating professional. All you have to do is Google the statistics, and it’s enough to make you want to close your doors. When you’re done looking up the alarming facts, you’ll likely agree it’s more important than ever to secure liability insurance, in case one of your patients becomes unstable. We’re here to help you protect yourself, your career, and your assets.

With the peace of mind that comes with having coverage, you can be that much more of an effective healer for your patients. It’s why you’ve chosen therapy: to derail these tragedies and to save people’s lives.

This blog was brought to life by our friends at CPH & Associates. Learn more about professional liability insurance by visiting their website.

Overcoming the Impossible with the Phone

For a person who stutters, talking on the phone can be a particularly challenging situation. Get tips, and download the free worksheet to use with your clients who stutter and struggle with the phone.

For a person who stutters, talking on the phone can be a particularly challenging situation. There’s a classic scenario of being hung up on because the listener doesn’t realize there is someone on the other end. If this continues to happen, a person who stutters loses confidence and will have others make their phone calls.
As a speech and language pathologist, I have heard countless stories from my clients about the frustration of talking on the phone. I recognize these feelings of frustration not just as a professional empathizing with my clients, but as someone who also stutters and knows first-hand the challenges of communicating on the phone.
When addressing the phone with clients, we first do practice calls where we call each other. Then we move to “real” calls where they may call a store or a restaurant. As challenging as making calls can be, answering a ringing phone may be even more challenging because it requires speaking on demand, and we can’t control or prepare for when the phone will ring.
Answering the phone has been a personal challenge of mine. I always wanted to answer my business phone with the greeting, “MLF Speech Therapy, can I help you?” But I would often struggle when saying this greeting, and I feared that potential clients would hear my stutter and not take my practice seriously. Feeling apprehensive, I submitted to my insecurities and instead answered my business phone with the greeting, “Marilee Fini.”
Throughout the years, there were brief periods where I attempted to answer with “MLF Speech Therapy,” but quickly gave up when I had a moment of stuttering or someone hung up on me. A breakthrough occurred a few months ago when I was putting a panel presentation together for the National Stuttering Association Convention called “Making Feared Situations Possible.” I realized that in order to help others overcome feared speaking situations, I also had to do it myself! I made it my goal that when the phone rang I had to proudly say, “MLF Speech Therapy” rather than avoiding it.
It didn’t matter how it came out, it just mattered that I said the words. I was working on being an “authentic communicator,” and saying what I wanted to say when I wanted to say it.
Answering the phone with a business greeting was something that I had deemed as impossible. However, when I chose to see it as “possible” and was willing to take the steps necessary to work on it, I was able to succeed. As I tell my clients, we can talk about a feared speaking situation, but true change only occurs when action is taken.

Do you have a client who struggles to answer the phone?
We have a worksheet to help. Download your free copy here.

This post has been brought to life by PESI speaker Marilee Fini, MA, CCC-SLP.

Joining Through the Truth: Therapeutic Coaching Tests Our Assumptions

You wouldn’t dream of telling your client, “You’re being such a witch to your spouse!” But maybe that’s just the thing they need to hear…

Most of us were trained to believe that we needed to be extremely careful when helping clients face the really difficult truths in their lives. Better to err on the side of going slow, creating safety, and remaining neutral than to come across as pushy or disrespectful. Nevertheless, my own experience as a couples therapist has taught me that we aren’t doing clients a favor by soft-pedaling difficult issues. The approach I’ve developed, Relational Life Therapy (RLT), is based on the premise that it’s disrespectful to clients not to let them in on the truth about what we witness regularly in our offices as they play out their relationships in front of us: the ways they deal with their partners are often self-centered, unfeeling, and counterproductive.

In some ways, the guiding principle of RLT is to be able to say to clients what we might otherwise say only to our colleagues in our supervision group. Instead of confiding, when they’re out of earshot, something like, “I can’t believe what a witch she is to him. He’s such a Caspar Milquetoast,” I believe that’s what you need to say–skillfully and respectfully–in the session with the couple.

Some would call this approach confrontational, but I think that term is misleadingly adversarial and addresses only half the process. I think the quality of directness I’m talking about is better described as joining through the truth. There are two parts to this approach: the first is to hold a mirror up to our clients to help them see themselves and their role in the dysfunctional dance of their relationship as accurately and fully as possible; the second, which is where the real nuance and clinical skill comes in, is to show them the difficult truths about themselves in a way that leaves them feeling not only that we’re on their side, but that we’re actually rooting for them.

RLT is an approach that stands somewhere between traditional psychotherapy, with its emphasis on creating a nonjudgmental, accepting, holding environment to bring about change, and the more rough-and-tumble, challenging, psychoeducational discipline of life coaching. For want of a better term, I’d call it therapeutic coaching.  It’s based on the idea that we can coach clients toward intimacy, teach them how to be more psychologically evolved, and mentor them into transforming their characters.

Taking Sides

I don’t believe that partners share 50-50 responsibility for all their issues with each other. Some couples issues are 70-30, some 90-10. One partner can have an untreated bipolar disorder or be an alcoholic rager, while the spouse’s major “contribution” is simply being there. An RLT therapist has no problem saying something like, “OK, Mr. Jones, you’re a nut. And Mrs. Jones, you’re an even bigger nut. Here’s why. . . .”

Not always, but often, a couple presents as one “latent” and one “blatant.” There’s one who’s in an enabling position, albeit perhaps angrily so, and another who’s more clearly and egregiously antirelational. If you’re sitting with a couple and thinking to yourself, “Yeah, I couldn’t be married to that person either!” you’re thinking about the blatant partner. The truth is that, many times, one partner (the fed-up latent) drags into therapy the other partner (the often clueless blatant) because the blatant is relationally insufferable–either withdrawn and giving too little, or abrasive and taking liberties.

Grandiosity and Leverage

Another way of saying that someone is blatant is that they stride through life feeling superior, looking down their nose at others, or ignoring the rules and feeling entitled. Grandiose clients bring to therapy the same privilege they bring into their living room and bedrooms–the privilege to blow up or flee. Encountering the threat of such volatility, we’re taught to go gingerly. Under the rubric of “forming an alliance,” or “gaining the client’s trust,” we learn, in essence, to replicate the traditional spousal role: we reason, we cajole, we seduce–we do everything except tell the truth and put our foot down.

As a result, most therapists get about as far with grandiose clients as traditional wives get with stubbornly entitled husbands. Therapists fear that if they push too hard, the client will explode or leave treatment–not unreasonable fears–so we play tough clients like fish, alternating between giving them enough line and reeling them in. Therapeutic coaching deals with this issue a little differently. It begins by removing the power of intimidation. Before I reach for an alliance with a difficult client, I know that I first must gather leverage if I’m to have any hope of bringing about positive change.

Leverage means that therapy must offer the grandiose client either the prospect of something he wants–a warmer, sexier wife, for example–or a buffer against negative consequences he distinctly doesn’t want–like losing his marriage. This is a necessary first step with entitled clients because grandiosity impairs one’s sensitivity to others and ability to assess negative consequences.

For more than 50 years, the mental health field has focused on helping people come up from the one-down position of shame. But we’ve done a poor job equipping therapists to help entitled clients come down from their one-up perch in life. Many current forms of couples therapy invite therapists to listen empathically, reflecting back what we hear, to be nondirective, to serve as a secure attachment figure, a safe holding environment. Such a nurture-based, facilitative therapy can work with a shame-based person because lack of empathy to oneself is central to the disorder. But the grandiose client has no problems being empathic toward himself. His missing trait is empathy toward others–and an appreciation of consequences.

Fellow Travelers

In our society, intimacy is considered a feminine characteristic, and most men react to the prospect of intimacy with all the enthusiasm of sitting through a chick flick.

We do to relationships what we often do to things deemed feminine: we idealize it in principle and devalue it in fact. Yet we’ve never wanted more from our long-term relationships. Today, couples want long walks on the beach holding hands, heart-to-heart talks, and great sex into their fifties, sixties, and beyond. However, our culture is built for production and consumption–not romance.

If we’re going to help people develop the skill set of knowing how to sustain connection, we need to know that struggle inside out from our own lives. We need to have mastered in our own intimate lives the same skills we ask our clients to use, and we need to be transparent about it. On the days my wife, Belinda, and I don’t use our tools, I often tell the couples I see, “We look just as unhappy as you do.” I believe in communicating to our clients that we’re in the mud with them–more like 12-Step sponsors than paragons of traditional therapeutic wisdom.

Joining through the Truth

In RLT, as soon as we’ve gained the leverage that sets the stage for therapeutic change, we form the therapeutic alliance by telling clients the difficult truths right out of the starting gate.

Sometimes the struggle to confront difficult truths may not come in the present, but in the past, where a particular relationship stance was learned. Professional life coaches aren’t trained to pursue family-of-origin or early childhood issues, but therapeutic coaches are. In contrast to current therapies, which focus on the traumatic influence of childhood experience, we stress identification and social learning. For example, we don’t see grandiosity as always a defense against traumatic shame, but simply a legacy from childhood. We don’t see tending to the wounded little person underneath the child’s grandiose attitudes, beliefs, and behaviors as enough to make these personal characteristics simply fall away when such vulnerability surfaces. Grandiosity must be dealt with per se: as it was learned, so it must be unlearned.

From Therapy to Therapeutic Coaching

Some clinicians resonate easily with this way of working–being themselves, telling the truth as they see it, sharing experiences they’ve had in their own lives, being direct. In fact, they may say that they’re already doing many of these things by the seat of their pants. For others, this way of working may make sense, but it requires an expressive style that’s too foreign to their temperament or clinical belief system. More than adopting any particular methodology of change, therapeutic coaching is founded on the belief that we can be far more direct and challenging to the clients who come to us than we’ve previously acknowledged. I operate with the assumption that, by and large, people are neither fragile nor stupid. If you show them how they’re getting in their own way and what behaving more skillfully looks like, they’ll be grateful. Rather than the expectation that telling tough truths will send clients out of the room screaming, I’ve seen over and over that, if done with love, grace, skill, and even an occasional dose of real wisdom, therapeutic coaching brings clients back for more.

To be sure, the approach I’m describing requires therapists to move beyond their comfort zone and step out from behind a veneer of calm neutrality. But I believe that in order to teach our clients how to be authentic and connected, we must be real with them ourselves. If our work with troubled couples is to move to a new level of effectiveness, we need to consider how well our traditional assumptions about relationship, change, and our own roles are serving us and our clients. I’ve found that the couples I see are ready to meet the challenge of examining themselves, of becoming explorers in what is, for them, uncharted territory. The question for the field of psychotherapy is whether we’re ready to meet that challenge ourselves.

Terry Real, LICSW, is an Internationally Recognized Family Therapist, Speaker and Author. A family therapist and teacher for more than 25 years, Terry is the best-selling author of I Don’t Want to Talk About It: Overcoming the Secret Legacy of Male Depression (Scribner, 1997), the straight-talking How Can I Get Through to You? Reconnecting Men and Women (Scribner, 2002), and most recently The New Rules of Marriage: What You Need to Make Love Work (Random House). Terry knows how to lead couples on a step-by-step journey to greater intimacy – and greater personal fulfillment.

This post is based on an article originally brought to life by our partner, Psychotherapy Networker.

The full article, “Joining Through the Truth: Therapeutic Coaching Tests Our Assumptions,” written by Terry Real, LICSW, appeared in the Nov/Dec 2012 issue of Psychotherapy Networker magazine.

Psychotherapy deal4