Doing TIR Online: Can I Really Treat my Trauma with Teletherapy?

 

          

You may be thinking that treating trauma with Traumatic Incident Reduction (TIR) is too intense to do with someone through a screen, and that it may not be doable. So you would rather wait till the pandemic is over, or just not do it.

Except that your life and your issues are happening now, regardless of what is going on in the outside world.

You really would rather see someone in person, in their office.  This is understandable, and it’s ok to acknowledge that this is what you want.  As with anything involving human connection, there are pros to doing TIR in person.  You meet with your facilitator in their workspace, which is a contained environment away from your daily working and living space.  You both share that physical space in the time that you are working through your distress.

But right now, there are still health risks to meeting in-person with someone outside of your home, so most practitioners and viewers are needing to prioritize safety and do sessions online.  For many of us, that’s been a sudden and significant change in how we work together.  I had always been an “old school” practitioner myself until COVID hit, and then I knew I had to adapt to this new reality. Was this going to work?  I didn’t know.

One year out, I have some good news.  Since March of 2020, I have been facilitating TIR sessions only online.  People viewing with me have reported that through our work, they have been feeling relief, less stress, and being more present in their lives, even during the pandemic.  Most of them have never met me “in person”, but they still work successfully with me.  And there are pros to online sessions. One big pro is not having to take time or effort to travel to a physical office. Also, people with mobility and/or chronic health issues can meet with facilitators with greater ease.  So yes, you can work through your issues, even treating trauma, with online sessions. You just need to do a few things to prepare for this work.

Set up a comfortable, private, distraction-free place to do your work.

The environment you choose will not just be private, but distraction-free.  So beyond just a door that closes and locks, if needed, think about what might be a distraction:  A partner or other family member working in the office next door?  Small children that could come knocking in the middle of your session?  Construction going on in the apartment next door?

You do what you can, of course, but it is important to consider how your environment might affect your ability to open up and focus on the session.  It can feel awkward to talk about conflicts and emotions you are having about your partner or other family members when they are in the room next door.  They may not be snooping on purpose, but you may still be concerned about what they hear.   And with trauma treatment, this focus is especially important. TIR sessions are often more intense and focused than “typical” talk therapy. These qualities help make it effective in relieving your symptoms, but they also make the need for a distraction-free environment more crucial.

So if this means putting a “white-noise” machine outside your door [such as a fan] or having someone else on “childcare duty” during your session, it may truly be worth it so that this cuts down on distractions. You may even feel more comfortable doing sessions from your car or a closet.   That’s fine with me, and it is likely ok with your facilitator.  The fewer distractions you have in your environment, the more you can engage and benefit from the session.

Make sure that you have a good internet connection.

I use a secure, encrypted portal for viewing.  Avoid using social media platforms like apps related to Facebook, Instagram, and such because at the time of this writing, they are generally not private or secure.  I do need to see your face, and you need to see mine.  Even if you close your eyes during your session, your face and mine need to be in visual range.

Note:  If you have visual impairment, it is still important that I can see you. A phone connection alone isn’t ideal. With TIR, a facilitator needs to be able to observe more than just your voice – they observe what is going on in your face and even your body. So please stay in visual range, at least with your face.

If something distracts you from your viewing, it’s not the end of the world. I have heard kids yell, family members knock on doors, and dogs barking. Just like with in-person sessions, a distraction may occur. You handle it as you need to and then continue the session.

Occasionally, you might lose the internet connection for whatever reason. Bad weather or a downed server can do this.  When this happens with my viewers, we just reconnect and pick up where we left off.  If the internet connection does not improve within a few minutes, it’s a good idea to reschedule the session for a later time or another day. The more stable your internet connection is (grounded, WiFi or cellular/smart phone), the fewer interruptions you will have.  Also, I ask folks to kindly park their device, whether it is an iPad, iPhone or Laptop, on a stable surface, even if it is a book or a shelf. It’s far easier to focus on you and the session if I am not getting dizzy, after all.

So things may happen.  The best approach is to prepare for things that could be an ongoing or frequent distraction from their viewing.  Dogs barking in the background don’t bother me if they don’t bother you.  A kid knocking on your door every five minutes, asking for you, is going to be more of a distraction that needs planning in the form of a sitter or responsible older person.  It’s good self-care to build your session in as your time “away”, just as though you would for a work meeting.  And please choose the helping person carefully. Someone you’ve been living with is preferable from a health standpoint, but if it needs to be someone outside your home, do what feels necessary for you and your co-habitating people to be safe these days.

Take a minute (or two, or five), to transition to your TIR space.

Once you step into your “therapeutic space”, close the door. Take a minute to just breathe deeply.

Get comfortable.

Find a good position, an easy chair, even your bed. Get a cushion if you need to.  Avoid standing, because that can get uncomfortable and distract you from your viewing, especially if you experience an intense body response. Doing a session online often means your body and head are facing in one direction more than would be the case when you are meeting with someone in-person. If you have been meeting with colleagues and friends through Zoom this past year, you already know about the eye- and body-strain that can happen. Fortunately, with TIR, you don’t have to be quite so formal as to be sitting straight up in a desk chair and  you can look anywhere you want to.

Try to designate one or two areas in your physical environment for your sessions. This can help you transition your mind and body into “TIR mode” more easily. You may even want to put up a soothing picture or object nearby to help ground you in this space.

Ok, I have my distraction-free environment. Now what?

You and your facilitator are ready for session. It usually only feels awkward in the first few minutes of the first few sessions, but that sensation will likely fade as you begin your viewing session.  My viewers and I can usually get right into the sessions pretty smoothly.

Is it really worth doing all this? Why don’t I just wait till I can go in person?

You may be tempted to hold off on doing this.  If you have a situation wherein having a private and distraction-free environment is impossible, yes, you may need to hold-off until you can see someone in person. If you are in an abusive or unsafe situation, or you don’t have a stable internet connection, online sessions may be a no-go.  But only if that is truly the case, would I recommend that.

If it is difficult but doable, then you may want to go ahead with TIR. Because you have been living with this trauma and the effects that it has on you, and you don’t have to do that anymore.  In fact, it’s part of self-care to do this work and get relief and resolution.  No matter where you do this work, whether or not there is a pandemic, your life is happening now.  When you can relieve the effects of traumatic incidents, you can live more fully in the present and participate in your life, and with the people who are important to you, in a better way than you do when you are carrying this burden around. That’s true whether you are home or out and about.

You may have heard that self-care is like filling your gas tank. If your gas tank is nearly empty, it’s hard to drive yourself where you need to go, much less anyone else.  This work helps you fill your gas tank.

So the bottom line is, yes, Traumatic Incident Reduction works, and it even works online.

You can take this step for yourself and for people you care about, right now. So I wish you well as you start this process. May your benefits be excellent!

 

 

Seven Strategies for Successful Teletherapy

There are upsides to doing therapy from your home.

Seven Strategies for Successful Teletherapy

A FEW TIPS TO MAXIMIZE YOUR SESSION

So, you are thinking about talking to a therapist. But you’re not sure.  When you think about revealing your personal feelings and emotions, it’s hard enough, because you already don’t know the person you will be talking to.  On top of that, you are meeting them through a screen. Awkward much?

I just want to tell you, I hear you.  Because when I started doing teletherapy, I felt weird about it, too.

Before the COVID-19 Pandemic, like most therapists, I was doing therapy exclusively in my physical office.  I did know people who did teletherapy, but it wasn’t the bulk of their work, and they seemed to be in the minority.  It wasn’t really a thing that most therapists I knew were doing.  And to be honest, it felt sort of strange to me.  Why talk to someone on a screen instead of in-person?

But COVID-19 changed all of that. Now, most therapists that I know do teletherapy. Since   concerns about health and safety became an issue, I have gone to doing therapy completely remotely. Like many, I had to quickly adapt, but sometimes, that’s how we learn. And I was pleasantly surprised that my clients and I adapted pretty quickly, so now, it’s become pretty normal to me.

The good news is that online therapy for individuals is showing to be just as effective as in-person therapy.  Even couples are benefitting.  Since I work exclusively with individual adults and occasionally, couples, I can’t speak to its efficacy with groups or kids.  But if you are 18 and over and thinking about therapy now, that’s a plus.

The downside is, of course, that we don’t get to see each other in person in the same physical space, and there is still something to be said about the in-person connection.  Privacy is more stable in-person. I can set up the therapy environment when you come see me

 But right now, I’m not one of them.  I foresee doing teletherapy for the rest of 2020, at least.  Even when I resume work from my physical office, I will likely keep teletherapy as an option, which will be he helpful to clients with long commutes, health issues, or physical challenges.

 

  1. A good Wifi or ethernet connection. The last thing you want is to be winking in and out of the screen while you are discussing your issues and emotions. So make sure that you have good bandwidth where you are.
  1. A laptop, tablet or smartphone. You will get the best view and largest screen on a laptop, but if you need to use these other devices, they will suffice.  The benefit of the latter two is they are more portable if you need to do therapy in a more unusual place.  More on that later…
  2.  A stable surface to place the device.  This will give your hand and body a rest, and give the therapist the ability to focus on you, without your head/body bouncing around.
  3.  Privacy. Now that many of us are doing therapy sessions from our homes, it’s a mixed bag. Some of you have plenty of space where you can be private and secure, with a door that closes and if needed, locks.  Others, not so much. It can feel awkward to discuss an issue about, say, your child, when said child is in the other room and may be able to hear you. Here are some options:

A closet.  If you really feel there is more privacy there, go for it. As long as we can see your face clearly (so you’ll need a good light), it doesn’t really matter if you are surrounded by your wardrobe or shoes. 

A white noise machine.  These can be purchased at office stores or online and can run the range of prices.  Nothing fancy is needed! Just a “fan” sound helps.  Place it outside the door of the room where you are having your session, turn it on, and you now have some sound-proofing and privacy from others hearing you, whether deliberately or accidentally. 

Your car, if you have one!  If it’s really impossible to have privacy in your home, go ahead, sit in your car.  If you really don’t have any of these options above, you can even go to a park, although that carries the risk that others nearby can hear you.

  1. Limit distractions.  If you have kids, try to make arrangements for someone to hang out with them during your therapy sessions so you can focus on YOU. Not only will your sessions feel more productive, but doing this sends kids a powerful message that you are worthy of self-care this way, too.  Turn off or mute your cellphone.
  1. Be dressed in some way. I don’t mean, super-groomed, like you are going to work or a party.  One of the benefits of being at home is that you can be casual, in pajamas or work-out clothes, so that’s fine with me. I just mean, have a shirt on and any intimate parts covered up.  
  1. Be on time. Ideally, your therapist will be on time, too.  If for some reason either of you are delayed, you can let each other know via text or phone.  That way, you get the benefit of your full hour, and neither of you has to wonder or worry that something happened to the other person.

Here are some optional things, now that we are getting into shorter days and less light:

A ringlight.  I got one on Amazon.  This is because if your only source of light is a lamp in front of your face, that’s harsh on your eyes.  The ring light is way easier on your eyes, and the one I got has three kinds of light, plus a dimmer switch, to modify the intensity.  BTW, this is a great option for any online meetings where others need to see you. 

A stand for your device.  Like I say, your therapist does need to be able to see your face fully at eye level during your session.  You can place your laptop or device on a stack of books, a tray, or even a portable stand, to do this. 

I’m not endorsing any particular brands, nor do I get any compensation for my recommendations here.  I just want to share with you things that work for me, because I want you to feel that therapy is a successful, positive experience for you, whether online or in-person.

So now that you know the basics of making teletherapy work, call me to schedule!    

*  There are some therapists who at this time are seeing people in physical office spaces for a number of reasons.  If you decide to do this, I recommend you ask about their hygiene/safety protocols.  It is then up to you to decide that you are willing to adhere to them, and whether you are comfortable with whatever health risks might by posed by seeing someone during this time.

Changes to my Website and my Practice

We’ll connect this way. And yes, it works!

And to the whole world in the last month, right?  So much has changed since my March post.  In Virginia we have been on stay-at-home orders for the past month.  It’s been challenging to adapt to this surreal period, but most of us are doing it.

The good news is, I am still here!  But with the lockdown, the definition of “here” has changed a bit.  During this time, I won’t be doing therapy at the Fairfax office. I’m doing teletherapy for all current and new clients.  This has been the case since mid-March, so at this point I’ve been seeing everyone through my online therapy platform. And you know what?  I’ve been pleasantly surprised that everyone has done an amazing job in handling this transition.  I know it’s hard for some people to wrap their heads around, the idea of doing therapy through a screen. Many of us are missing more human contact as we’ve been on lockdown. And we like having a separate space to go to, away from our work, home, etc. to be able to discuss our issues.  I get that.  But, right now, in-person is not the safest option.  I’m taking this lockdown seriously and have been pretty much on lockdown myself, save a few needed trips to the grocery store.  So in keeping with the goal of flattening the curve and lowering risk, it’s teletherapy. 

The plus side?  First of all, reduced risk of COVID-19 between us.  Secondly, you don’t have to spend time or energy commuting to see me.  Third, the research shows that one-on-one therapy is just as effective online as it is in person. And individual therapy is my specialty, so that works well.

When will I go back to seeing clients in person?  Good question. There is a lot of uncertainty around this pandemic, and I can’t be sure, but I would estimate some time in June.  The situation is evolving rapidly though, so what I can say is, I plan to be available to you via teletherapy as long as that seems to be the best option. 

More positive changes:  I have revamped my website so that it is up-to-date, and I have a Facebook Business Page

Newsletter:  I have decided to update the date of my monthly blog/newsletter to the second Tuesday of each month. I’ve found that this timing just makes more sense.  So if you already subscribe to my newsletter, please keep an eye out then.  Or, feel free to subscribe now.

And finally, I have added some videos to Facebook and my website, where I chat about your concerns and how I can help you.

To start seeing me via teletherapy:

Call me!  You just need to be 18 or over, have a laptop, smartphone/tablet with internet connection, and be in the State of Virginia to do this therapy.  (That last part is a requirement of my State Board.)  Plus a private space you can go to in your home, to do this therapy.  By the way, please don’t worry about what your space looks like to me. I get that we are mostly in our homes during all this.  The important thing to me is that you and I both show up. 

So with these changes, I’m still here. When you are ready, I’ll be here for you!


You may be on stay-at-home, but you can still get some relief.

 

Finding a therapist

Finding a good therapist

How do you find a good therapist?

Most people don’t know, if they’ve never been to see one. 

And even if you have, you might be in a different place in your life right now, with different issues, than the last time you were in therapy.

So how do you decide? Here is a brief guideline to figure it out.

 

What problem to do want to work on?

Let’s start with you. What is the main issue that you want to find a good therapist to help you with?

Are you going through a difficult life issue right now?   A rough patch in your relationship/s?

What is the main thing causing you stress? Your job, your significant other, an elderly parent or child with health needs, and you are the main caregiver/helper to this person?

One way to narrow it down is to figure out what you DON’T want.  Are you up to your ears with people giving you advice and problem-solving?  Do you just want an outside person to lend an ear to what you are going through, especially at the start? Then you probably don’t want a person who comes off as pushy or giving you yet more recommendations before hearing you out. 

Or is it the opposite? You need to make decisions, you are very anxious about something, and you really could use an objective party to listen and help you lay out your options.  In that case, you might want someone directive.

But it’s hard to figure out someone’s personality and treatment approach before you’ve even met them.  That’s where it can help to talk to people that you know have done counseling already and find out who they have seen. If it is for a similar issue, that might be a good person for you, too.  (Keep in mind some boundaries here, though. You might want to avoid seeing the same therapist that your mom, brother, or close friend has seen, especially if you are having issues with that person.) 

Having said that, another good place to look is on therapy directories online, such as Psychology Today.  You can look at the professional profiles of many therapists, as well as what insurance they take (if any), where they practice, and what is their area of interest and expertise.  This will save you a lot of legwork in trying to find someone who fits your needs.  It might be good to jot down the names of three therapists you found this way, and call them to set up an appointment with each of them, before deciding on the one for you.

Expectation management:

Keep in mind one thing:  No matter what, a therapist is there to listen to your situation and help you come to decisions that work for you.   But they will not make the decision for you. At least, they are not supposed to.  That will be up to you.

 50 warning signs of bad therapy shows a pretty complete list of what to look for and what to avoid in a therapist.  And so does 25 signs of a bad therapist: You deserve better.

Even with this, keep in mind that what works for someone else may not work for you, and vice-versa.  It doesn’t mean that one of you is right or wrong, just that you are individuals with your own needs and likes.

Another thing:  I once had a client who was looking for a marriage counselor for himself and his wife.  He had a history of substance abuse (now clean), and was having intimacy issues, along with trauma, which he was actively treating with an individual therapist.  So I referred him to an excellent therapist who works with intimacy issues.

He didn’t want to see this person because he wanted someone well-versed in couples work and sexuality, but also someone who worked with trauma and substance abuse.  I don’t think he was aware of it, but this was a pretty tall order. 

It’s understandable that you would want someone good at what they do, and it’s good to do your homework and find out if this person is well-respected and has experience in your issue. But if you find that you are passing up every therapist you come across, it could mean that, at some level, you are afraid that your problem will not be understood or handled well.

Think of looking for a doctor.  The more specialized they are, the fewer specialties you can demand of them. So if you want a cardiologist, you can narrow down what KIND of cardiology they do (adult/child, surgical/non-surgical). But it is unlikely that you will find a cardiologist who is also an orthopedist and a gastro-enterologist.  Likewise, you might find a therapist who works with teens on anxiety and does substance abuse, but they might not have too many other specialties than that.

That’s ok.  The main thing you want to focus on is, what is the BIGGEST issue for you right now?  If it is your relationship with your spouse, and you both want to see a marriage counselor, then that is the top “specialty” you need:  Someone who specializes in, and likes to do, couples’ work.   

If the next pressing issue is that one of you has trouble focusing, and that impacts your relationship, then that person may need to get screened individually, by a doctor and by an individual therapist, for any underlying conditions, like Attention-Deficit/Hyperactive Disorder 

(ADHD).  Once you have a diagnosis, they can get individual treatment for the ADHD, and then the two of you can do couples’ work around communication with someone who has some familiarity with ADHD, too, and its impact on relationships.

 

It isn’t always about their degree, but their passion.

Nowadays, a therapist should have at least a Master’s Level Degree in Counseling, Social Work, or Marriage and Family Therapy. Sometimes they will have a Doctorate (PhD, DSW, or PsyD), which are all varying levels of expertise.  Someone with a Doctorate is often able to do or has done research in their area of expertise. They can also provide extensive diagnostic testing, which a Master’s level therapist usually is not trained to do, for example. That’s important if you need your child tested for school accommodations, but maybe not so much if you are looking for talk therapy.  And definitely, any mental health professional you see should have a current, active license to practice in the state where you are seeing them.

Beyond that, you’d want someone who has an interest in your particular issue. For instance, it’s much better to get a  Masters Level clinician who has a special interest in couples, than a PhD professional who does not particularly like working with couples, if you and your spouse want help together.  If you find that therapist who is familiar with and loves working on issues related to ADHD? That person will likely give you more meaningful help than the one who is not all that into ADHD.

 

The relationship is important.

It took courage for you to come see this person, and to tell them what’s going on with you.  Did they seem to be listening to you? That’s important. Did they seem to care?  Also big.  Are you not quite sure?  That’s ok.  You also may want to give it about six sessions with someone before deciding that they are or are not for you, unless something they said or did seemed so judgmental or irrelevant to what you are working on, that you really have no desire to come back.  Even if that is the case, do you think you could tell this person how you felt when they said that?  Therapists are human, too. They might not have realized that what you said hit them that way.  And how they handle your upset will be important. Did they dismiss it, or did they at least acknowledge that you got upset? If they did the second part, well, points for them.  If not, it may be time to look for someone else. 

 

Make therapy a priority. 

I really do get it. Life is busy.  There are a million things that need doing, and sometimes it feels like coming in to talk about yourself is the one thing you want to put on the back burner.  But trust me:  Therapy is like working out. The more you stick to it, the more your chances of success and effective changes. You went to the trouble of coming, so keep it going! Come to your appointments regularly, and only cancel if you really had an emergency, which yes, does happen on occasion.   And think about it:  If you are not willing or able to prioritize therapy, how can your provider do it for you?

If you have issues that make regular sessions difficult, talk to your therapist. Perhaps you can both agree to postpone sessions until that big exam, trip, or operation is over.  Or, if you have chronic health issues or a situation that makes coming into the therapy office difficult, look for a provider who does teletherapy, which is becoming more available.   Whatever you do, most providers would prefer that you are honest about your situation than habitually miss sessions or keep cancelling. No shame, no blame. 

 

All this being said, congratulations on thinking about what you are looking for in therapist. It says a lot about you, that you are giving this some thought.  So, best of luck, and may you find a good therapist for you!