The Trap of Anxiety and Trauma

By Concentric Owner Jennifer Larson, LCPC, NCC

Driving my car in my early adult years filled me with freedom and curiosity. Didn’t matter if I was driving by myself, on city streets, highways or traversing the deserts of Arizona, I loved driving. Toggling between radio stations to find the right tune, opening up the windows to feel the fresh air hitting my face and throwing my hair around, hanging out with my thoughts, or being mesmerized by the pink and purple hues of Arizona’s sunsets were met and felt with ease, peace, and freedom. Fast forward several years later, and my experience of driving catapults me into feelings and sensations of feeling trapped and crippled by anxiety, panic attacks, and at times, dissociation.

To read the entire blog post on the Anxiety Relief Project’s website, please click here.

Let's Talk About Complex Trauma

By Concentric Counselor Jordan Perlman, LPC, NCC

I imagine many people have heard of Post-Traumatic Stress Disorder (PTSD) but not nearly as many are familiar with Complex Post-Traumatic Stress Disorder (C-PTSD) which is lesser-known and unfortunately, not yet recognized in the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-V). And while an individual with a PTSD diagnosis, which is often the result of an isolated incident, a person who experienced complex or repeated traumas requires different considerations.

But first, it’s important to understand the differences between each:

PTSD

According to the DSM-V, PTSD is diagnosed when an individual meets the following criteria that create distress or functional impairment last more than one month, which is not a result of medication, substance use, or other illness. The individual was exposed to one of the following: 

• Death or threatened death 

• Actual or threatened serious injury

• Actual or threatened sexual violence 

• Witnessing trauma

• Learning that a relative or close friend was exposed to trauma 

Indirect exposure to aversive details of the trauma (usually in the course of professional duties), the individual must have at least one intrusive symptom that causes the persistent re-experience of the trauma in the following ways:

• Nightmares

• Flashbacks

• Emotional distress after exposure to traumatic reminders

• Physical reactivity after exposure to traumatic reminders

The individual must also experience avoidance of trauma-related stimuli after trauma either by trauma-related thoughts or feelings, or trauma-related external reminders.

Two negative alterations in cognitions and mood must be present where the negative thoughts or feelings began or worsened after trauma in the following ways:

• Inability to recall key features of the trauma

• Overly negative thoughts and assumptions about oneself or the world

• Exaggerated blame of self or others for causing trauma

• Negative affect

• Decreased interest in activities

• Feeling isolated

• Difficulty experiencing positive affect

 Lastly, there must be alterations in trauma-related arousal and reactivity that began or worsened after trauma in the following ways: 

• Irritability or aggression

• Risky or destructive behavior

• Hypervigilance

• Heightened startle reaction

• Difficulty concentrating

• Difficulty sleeping

 C-PTSD

Trauma typically associated with C-PTSD tends to be long-term, where the individual is generally held in a state of captivity, physically or emotionally. In these situations, the victim under the control of the perpetrator has little or no chance to get away or escape from the danger. Some examples might include:

• Long-term domestic violence

• Long-term child physical and/or sexual abuse

• Neglect

• Organized exploitation rings

• Concentration/Prisoner-of-War Camps

• Prostitution brothels

• Recruitment into armed conflict as a child

• Sex trafficking or slave trade

• Experiencing torture

• Exposure to genocide campaigns

• Other forms of organized violence

Some might be wondering, why is this difference important then? This is because of exposure to long-term or prolonged or repeated trauma results in a broad range of symptoms that go beyond the diagnostic criteria of PTSD, a.k.a “simple” PTSD.  As such, the basic symptoms of C-PTSD are:

• Somatization (physical problems, associated pain, and functional limitations)

• Dissociation (a division of the personality into one component that attempts to function in the everyday world and another that regresses and is fixed in the trauma, spacing out, daydreaming, or feeling strong sensations of being disconnected from one self or the world)

• Affect Dysregulation (difficulty with emotions, such as experiencing and/or expressing them, alteration in impulse control, attention and consciousness

• Self-Perception (experience of their own perspective tends to be drastically different from how others perceive them)

• Interpersonal Relationships (tend to be a struggle, difficulty with engaging with others, feeling distrustful of others)

• Perception of Perpetrators (can be skewed, or longing to be loved by their abuser)

• Systems of Meaning (doubt there is any goodness in the world, outlook on life can be dark)

Further, a 2018 study by Karatzias et al. found the most important factor in the diagnosis of C-PTSD was negative cognitions about the self, characterized by a “generalized negative view about the self and one’s trauma symptoms; attachment anxiety which is defined as involving a fear of interpersonal rejection or abandonment and/or distress if one’s partner is unresponsive or unavailable; and expressive suppression, conveyed by efforts to hide, inhibit, or reduce emotional expression.”

For those who may wonder why people affected by a long-term trauma “can’t just get over it,” the answer lies in the fact that even after a person is removed from the event, their brain may be permanently affected by that intense and prolonged trauma. And since a person’s nervous system is shaped by his or her experiences, stress and trauma over time, can lead to changes in the parts of the brain that control and manage feelings and the long-term effects are found on a physical and emotional level.  

Symptoms may manifest as:

• Eating disorders

• Substance abuse

• Alcoholism

• Promiscuity

• Chronic pain

• Cardiovascular and gastrointestinal problems

• Migraines

• Rage displayed through violence, destruction of property, or theft

• Depression, denial, fear of abandonment, thoughts of suicide, anger issues

• Flashbacks, memory repression, dissociation

• Shame, guilt, focusing on wanting revenge

• Low self-esteem, panic attacks, self-loathing

• Perfectionism, blaming others instead of dealing with the situation, selective memory

• Loss of faith in humanity, distrust, isolation, inability to form close personal relationships

Special Considerations for Survivors of C-PTSD from Childhood 

Many survivors of C-PTSD also experience Attachment Disorder which is a huge consequence of individuals who suffered complex trauma as children. Attachment Disorder is the result of a person growing up with primary caregivers who were regularly dangerous. Recurring abuse and neglect habituate children living in fear and sympathetic nervous system arousal, which over time creates them an easily triggerable abandonment mélange of overwhelming fear, shame, and depression. 

Because a child’s main attachment (to their primary caregiver) helps them learn to control their emotions and thoughts, when a caregiver’s responses are in tune with a child’s needs, the child feels secure. The child then uses this relationship pattern as a practice to build coping skills.

However, children who receive prolonged confusing or inconsistent responses from their primary caregiver are prone to be fussy, have a hard time calming down, may often withdraw from others and may have frequent tantrums. Unlike adults who have more tools to understand what is happening to them, children often do not possess these skills or have the ability to separate themselves from another’s unconscionable actions. Consequently, the resulting psychological and developmental implications become complexly woven and spun into who that child believes themselves to be, thereby creating a messy web of core beliefs that are harder to untangle than the flashbacks, nightmares and other posttraumatic symptoms that may surface later. Further, these disorganized attachments and mixed messages from those who are supposed to provide love, comfort, and safety - all in the periphery of extreme trauma - can create even more unique struggles that PTSD-sufferers alone don't always face.

Treatment Considerations 

While the symptoms can be daunting and the future seems bleak for someone who appears to be suffering from C-PTSD regardless of whether an individual has been diagnosed with a trauma-related disorder or not, there is help out there and there are ways to manage and help the individual cope. 

Treatment challenges include, Survivors:

• Avoiding thinking and talking about trauma-related topics because the feelings associated with the trauma are often overwhelming

• Relying on alcohol or other substances as a way to avoid and numb feelings and thoughts related to trauma

• Engaging in self-mutilation and other forms of self-harm

• Who have been abused repeatedly are sometimes mistaken as having a “weak character” or unjustly blamed for the symptoms they experience as a result of victimization and often have comorbid disorders such as dissociative identity disorder (DID), other specified dissociative disorder (OSDD), borderline personality disorder (BPD), depressive or bipolar disorders, anxiety disorders, obsessive-compulsive disorders, eating disorders, and substance abuse

Since many trauma specialists see Attachment Disorder as one of the key symptoms of C-PTSD, a relational, individual, approach will often be most beneficial for many of these clients. For many survivors, therapy is the first opportunity to have a safe and nurturing relationship.  Therefore, the therapist must be especially skilled to create the degree of safety that is needed to build trust or risk adding to the attachment trauma. Working with these clients is essential to the development of trust and relational healing and the four key qualities are empathy, authentic vulnerability, dialogically (when two people move fluidly and interchangeable between speaking and listening) and collaborative relationship repair. This makes therapy a teamwork approach where there is mutual brainstorming and problem-solving in a respectful way implying mutuality. All of these steps will provide the client with a “good enough secure attachment” to serve as a model for other relationships. 

However, and as expected, there is no “one size fits all” approach to working with individuals who have survived trauma, but one thing is for certain: recovery from Complex PTSD requires restoration of control and power for the traumatized person. Survivors can become empowered by healing relationships which create safety, allow for remembrance and mourning, and promote reconnection with everyday life. 

If you feel as though you have experienced complex trauma, it is important to know what happened to you was not your fault. While it is undeniable trauma changes the way we experience the world, I strongly believe like a phoenix, a person who suffered from trauma can arise from the ashes, stronger than ever before. This “stronger than ever before” is also known as “Post-Traumatic Growth.” Post-Traumatic Growth identifies a shift in personal strength and worldview as a consequence of trauma. Although you can’t change it, you can change what your life looks like going forward. One step you can take towards recovery is calling to schedule an appointment with a therapist who can help guide and support you on your healing journey. 

Asking for Help - Not Waving but Drowning

By Concentric Counselor Christian Younginer, LPC, NCC

Not Waving but Drowning

By STEVIE SMITH

Nobody heard him, the dead man,   

But still he lay moaning:

I was much further out than you thought   

And not waving but drowning.

Poor chap, he always loved larking

And now he’s dead

It must have been too cold for him his heart gave way,   

They said.

Oh, no no no, it was too cold always   

(Still the dead one lay moaning)   

I was much too far out all my life   

And not waving but drowning.

I believe this poem verbalizes well a common societal pressure. That is, the need to be happy externally, even if drowning internally. As we go through our day, met with multiple “How’s it going?”, we invariably are trained to answer “fine” or “great”, without the slightest thought. The question we’re left with is: how would anyone know I’m drowning, when I always give them a friendly wave?

Asking for help can be deceptively difficult. Frequently I hear from clients that asking for help shows weakness, or is shameful, or too vulnerable. So, we strengthen our resolve, buckle down, and soldier on at the expense of our wellness and happiness. We become run down, exhausted, and deflated. Imagine a balloon trying to remain the same size, while its air slowly leaks. We receive messages from our families of origin, our employers, and consumer culture that tell us to harden. But the harder we get, the more brittle we become. Rather than naming our need for help, we’re now drowning with work, emotions, schedules, and isolation. 

Ultimately, this issue of asking for help comes down to a person’s struggle with taking care of themselves. Wellness, self-care, asking for help, boundary setting, etc all live in the same neighborhood: taking care of the self. A former supervisor of mine offered this metaphor:

You board an airplane, take your seat, and the flight attendant begins the safety protocols speech. They get to the section on the oxygen mask. They say, ‘please secure your own mask before attempting to assist anyone else.”

Why is that? Well, you can’t help anyone if you’re dead. The same concept applies here, albeit with less grim consequences. How can we expect to function, let alone help others, when we run ourselves ragged?

To return to the topic at hand, one way of taking care of the self is asking for help. Seeking therapy is a form of this. I often name the courage it takes for a client to find a therapist. As we know, it’s hard to find help for ourselves- especially for our mental health. As if the unfortunate stigma isn’t enough, busy schedules and work demands can get in the way. If therapy is two steps too far for you, there are smaller ways to open ourselves to the help of others.

We don’t have to instantly open up and adopt this idea. Rather we can take smaller steps that feel safer. For example, if we have created a default answer of “fine” when asked “how are you?” by random people, then that may have filtered into closer relationships. Those relationships where it may feel safer saying “Actually, I’m struggling.” So, what if we remove the automatic ‘fine’ from our vocabulary? Rather, when asked by a close friend or family member, “how are you?”, we take that question for what it is: an out-stretched hand to a drowning person.

 I think it is unfair to view this poem as an indictment of those who misread the author’s anguish. Rather, I believe it is a call to stop waving when we’re drowning. To let those looking out for our safety, save us. Only from this place of moaning, cold death does the author finally feel safe saying she was much too far out all of her life. If only we, the onlookers, knew this we could’ve helped.

 It is ok to feel you’re too far out. It is ok to feel like you’re drowning. There are those who want to help us, but only if we let them. When we don’t ask for help, we deny our friends and family the gift of being able to help someone they love.

Sexual Trauma, Triggers, & The 24-Hour News Cycle

By Concentric Counselor Katie Ho, LPC, NCC

You can hardly escape today’s current social and political climate - it’s on the news, in your social media, overheard at lunch, and even for therapists, themes in session. For those who have experienced trauma in their lifetime, past or ongoing, navigating topics like sexual assault can be overwhelming, scary, complicated and sometimes even powerful. How we take care of ourselves and the people around us who may be struggling with the complexity of their emotions has to be part of the larger conversation. It’s clear that avoiding or minimizing discussions on sexual violence and quieting the stories of survivors is not the path to atonement and reconciliation. But as we create space and lift up the voices of those who have suffered, we must also take inventory of what comes up in us and tend to those parts with kindness, care and nurturing.

The #MeToo movement, local and national advocacy groups and social justice organizations have been and continue to create a platform for those who have been victim to sexual harassment and assault. While the stories and accounts of these traumas seem to be daunting all of the sudden for those who have been unaware, statistics and experts have known for some time of these experiences. The National Sexual Violence Resource Center (NSVRC) estimates that 1 in 5 women will be raped in the United States in their lifetime, and that 1 in 3 women will experience some form of sexual violence. The majority of these acts are committed by acquaintances, partners or people who are known by the victim, and according to the Rape, Abuse & Incest National Network (RAINN), the majority of these events occur at or near the victim’s home. These of course are statistics, data and research gathered through reports from multidisciplinary agencies. There is undeniable value in knowing these numbers. And just as much, there is value in hearing the experiences and seeing the faces of survivors who have chosen to come forward.

As allegations and reports of sexual assault make the news, we are bombarded with information, opinions, commentary and even jokes on the matter. Survivors are subject to their own re-traumatization, which has an impact on psychological and physical health, triggered by both the details of these publicized allegations of assaults and non-believers who dismiss them.

In knowing that a trigger is a psychological stimulus that can be evoked through anything from sights, smells or sounds, it’s no wonder that the 24-hour news cycle is affecting so many people. Survivors are not alone in their strong reactions to the constant replaying and subsequent criticism, shaming or dismissing of survivor stories. Those who feel a connection or calling to the cause, whether it be through their empathic attunement or knowing a survivor, may also experience the distress and burnout that comes with the current climate.

So how do we take care? How do we balance the righteous anger and complexity of our other emotions, promote advocacy and change, all while healing and taking gentle care of ourselves? In doing this, one of the most important things to know is nothing can replace the support of others. So find someone, or a group of someones, who can help to support, validate and foster a safe environment for processing.

Find a tribe, or maybe even create one. Pay attention to your body, as our physical being can often tell us when stress is increasing and it’s time for tending and healing. Maybe that means physical exercise, movement, touch or a practice of progressive muscle relaxation (a quick YouTube search is all you need!). Set boundaries. Limit your intake of news and dialogue on the topic by knowing how much mental and emotional labor you’re able to give without overextending yourself. And if you find yourself overwhelmed, triggered or lost, use mindful grounding techniques to bring yourself back into your here and now. Feel your feet on the floor, describe and notice something around you, use your five senses to bring a consciousness into your physical environment and current moment in time and add in a quick reminder - “I am safe. I am in control. I am okay.”

Men, Loneliness, and the Substance Substitute

By Concentric Counselor Myron Nelson, LCPC

We know it is true when we take stock of our lives, although it is easier to simply ignore. We do not have the same number of friends that we used to. We definitely do not have the same number of close friends, friends we could call in an emergency. Whether it is technology taking up more of our time, a culture that promotes handling problems on your own, or some other reason, it is clear we do not connect in the same way.

Due to factors that will be explored in this blog post, half of the population is more vulnerable to the Great Friend Migration. Men, myself included, are bombarded with societal forces that encourage segregation. We are instructed to cope with problems silently, internally. Isolate yourself or be shamed. We are taught to detest emotions, push them down or aside but do not let them grow. Best to not spend time with other people if we are in an emotional state.

Consequently, our problems grow bigger, the stress becomes heavier, and the emotions continue to build up until we are neck deep. Keeping quiet and keeping it to ourselves, we fall deeper into our own thoughts. Expecting that other people do not want to be burdened with our issues. We drift apart from friends because we do not know how our problems could possibly fit into their lives.

What’s next? We turn to something that can help. Something that makes us feel better, it’s reliable, it’s dependable, it does not judge us, and it does not share our secrets. Alcohol and other drugs can become a refuge for emotional pain. They can buffer feelings of anxiety or depression and temporarily give us the mask we want to keep the facade going.

Alcohol and drugs can slowly become something we depend on but that dependency is dangerous. What starts as a solution to the problem becomes its own problem. Substances attempt to fill the void that other people used to, but they will never be enough. Substances can never talk back to us and make us feel cared for and understood. They cannot debate options with us and challenge us to be better. Substances offer complacency but relationships give us acceptance and growth. It takes courage and a leap of faith to connect with another man and share your problems but it is truest the solution.

The irony is, that we all want to lean on each other but are scared to lean first. It is society’s expectation about men and men’s expectations about society that propel this problem into an epidemic. When we let our predictions go and venture into reality, it’s clear that other men feel the same way we do and we can meet each other with compassion and caring.

Men are not inherently isolating and society is not inherently cold. Expect that other people feel the way you feel. Expect that as a man you will experience things that other men experience. Expect that others want to know about your struggles because they want to be able to lean on you too.

If you find yourself experiencing The Great Friend Migration, convincing yourself that filling your loneliness with substances is better than the alternative - opening up, reaching out, and relying on a male friend, I encourage you to stand up to your shame, choose connection, and lean it to a friend.

A Therapist's New Year's Resolution

By Concentric Owner & Counselor Jennifer Larson, LCPC, NCC

In only a few more days, 2017 will come to a close.  It will be a time to think ahead – many will ignite their New Year’s resolutions.  While I may not routinely come up with New Year’s resolutions, I do think about and write down my personal desires and goals throughout the year.  And, I have decided that I will come up with a New Year’s resolution for 2018.  Before I share my resolution, I would like to share part of my roadmap that has led me to this juncture.

As I have engaged in reflection, I found myself returning back to a perpetual theme that would emerge and re-emerge over this past year.  One particular theme is what I will name as the ‘non-self-disclosing' therapist vs. the 'self-disclosing' therapist wrestling match.  I have no idea when the sport of wrestling season begins and ends, but I can tell you this particular wrestling match has persisted season after season. And, my hope for 2018 is the self-disclosing therapist will take the lead and possibly bring the wrestling match to a close someday soon.     

Let’s start back when these 2 wrestlers first met.  Perhaps they were both first introduced way back when, before the days of graduate school as 'non-self-disclosing' me vs. 'self-disclosing' me.  In my formative years, I grappled with how much to disclose and how much not to disclose my vulnerabilities. And if I did, I chose wisely with a very select few.  Some would say this is normal as we need privacy and boundaries while others may offer a difference of opinion.  Now, let’s fast forward to when I enter into graduate school where I am confronted again with choosing and deciding on how much to disclose.  This time it is focused more on me as an emerging therapist, not me personally.  In the earlier stages of education, students learn about various theoretical orientations and the relevance and implications of non-disclosing and disclosing to one’s clients. 

Just after the start of the millennium, I recall being enthralled with the tug-of-war game that was played during a semester course on ethics.  Our instructor was instrumental in leading the charge on getting all of us graduate students to really explore how to handle ethical dilemmas that can and will mostly likely confront a professional counselor, social worker, or psychologist.  Depending on the topic, some students would sinuously form into 2 teams, tugging and vying for one end (yes, it’s okay to self-disclose to a client; yes, it’s okay to hug certain clients upon closing a session), while the other group pulled and vied in the other direction (no, it’s not okay to self-disclose and hug a client). It was one of my favorite graduate courses as our professor and the course curriculum gave us the space and freedom to think critically and to share our perspectives and beliefs.  Some topics called upon us to unequivocally unite together whereas other topics had students participating in the game of tug-of-war, and well some (ahem) left all of us pooling together in the middle, gray area -- scratching our heads saying, “It just depends, it’s not so black-and-white.”    

Does a therapist merely act as a ‘blank slate’ allowing for one to free associate more easily? Or does a therapist offer some disclosure about their experience and feelings in relation to one’s client (countertransference)?  As therapists, do we divulge some our personal, relatable experiences, such as, “I share the same fear of heights as you do – here are tools that have been helpful to me.”  To disclose or not became even further embedded post graduate school during professional training courses and consultation. And for good reason, this particular topic warrants so much attention in the world of psychotherapy.  I understand the clinical relevance and implications – I get it. 

Over the past 15 years with greater professional and personal life experiences, I have found myself continuing to think about the inquiry of the self-disclosing therapist. At times, I have put forth a tidbit of self-disclosure when I believed it to be ‘clinically appropriate’ or when it simply felt right.  The self-disclosing therapist is not uncommon for some psychotherapists, and it's probably still one of the more debated issues in the field.  Over the past year or so, the inquiry in my mind has expanded beyond the closed doors where therapist-client, supervisor-supervisee, and consultant-consultee relationships are formed, maintained and evolve.  

Questions continue to knock on my door, such as, do I as a therapist share my story (or stories) with others publicly?  Is there value in therapists who choose to open up in a more public forum?  How about us therapists taking our practice even further by exercising vulnerability and using our voice through other outlets?  Are age and credibility in the field some of the salient determinants when choosing to publicly divulge as a professional?  What is too much to self-disclose in written form? Could casting a wider net be detrimental to a therapist’s profession?

While these particular questions have lobbed around in my head for just over a year now; admittedly, they have not been all ‘heady’ taking up rent in my mind.  Sometimes (and many times), I would simply experience this feeling inside of me – near my heart or gut – nudging me to share more and to share with more people.  Stop thinking so much and just take action.  Take the leap and have faith.  Even a call to duty would emerge from within as well.  But why and for what purpose?  The answers didn’t seem readily available to me.  And then over the past few months, it all became clearer.

Earlier in 2017, I learned about On The Table and the #BreakTheSilence initiative by The Kennedy Forum.  I was immediately pulled in as I loved the mission and purpose of this initiative.  Bring people together to give people an opportunity and space to talk about mental health in effort to reduce the stigma that still hovers around and shrouds the already cocoon existence of mental health. The idea is that when more people talk about a topic – in this case mental health and addiction – a positive rippling effect can ensue. 

The more people talk about mental health…

• The easier it will be for all of us to talk about it.

• Better yet, the easier it will be for all of us to talk about it without feeling shame, crazy, or embarrassment.

• The more we will feel safe and free of judgment.

The more people talk about mental health, the more…

• People will seek out help.

• We will honor and view mental health as another facet of humanity and life, just as we do with other areas, such as our physical health.

• We will advocate for change across cultures, families, and even within the helping professional field.

• Opportunity for positive changes within the health care insurance industry.

The continual, cascading effect.  The more people talk about mental health and addiction…

• The more we will become intimate and experience love.

• The more we will be empathic and compassionate.

• The more we will be more understood and connected.

• The healthier we will all become and the more lives will be saved.

Who doesn’t want to experience these things for themselves and others? 

Concentric Counseling & Consulting hosted its first On The Table Discussion on May 16, 2017.  The turn out and experience was inspiring and moving. We even shared people’s stories, experiences and solutions for people to read in our blog.  However, the Concentric’s therapists served as hosts and guides – we were not active participants in this discussion.  No self-disclosing.  This is not a terrible thing, but the knocking on my door didn’t go away.  Should we have re-considered actively participating in this dialogue?  Sharing would mean ‘more people’ talked about mental health and addiction, right? 

There have been other initiatives and movements this year, including one of the more recent ones that started in October 2017. The #MeToo movement gained momentum and traction which has given people collective permission to break free of the shackles that have promoted and reinforced silence, inequality, sexual harassment, discrimination, and assault, shame, and for some, the cocoon existence of mental health. The #MeToo movement encouraged women to share their stories in effort to give people permission to break their silence to unite and to bring greater awareness about the prevalence of sexual misconduct.  The more people talk about their experiences and hardships, the same effects will occur as with the more people talk about mental health and addiction.  Movements like these promote the cascade effect which in turn promote movements – a positive feedback loop. 

All of these experiences along my personal roadtrip have touched and impacted me.  And, while I recognize that I am helping people, I have also recognized that choosing (more times than not) the non-self-disclosing therapist may just not be as helpful.  I believe in the importance of using one’s voice, honoring one’s experiences with integrity and respect, and I want to help become a part of the bigger picture.  I want to talk more about mental health and addiction publicly in effort to help achieve with many others a positive cascade effect.  It won’t be easy for me, that I know. Truthfully, I am not quite sure where to start, what I will disclose about and which platforms to traverse.  What I do know is I now have a clearer understanding of the persistent themes that knocked on my door.  My deeper desires and hopes for all by talking about mental health.

So, my New Year’s resolution for 2018 is for me as a therapist is to start leaning in, to become more of a self-disclosing therapist by sharing more publicly some of my own mental health challenges and triumphs.  Happy New Year Everyone! 

Your Voice Matters: Honest Discussion about Mental Health and Addiction

By Concentric Counselor Jennifer Larson, LCPC, NCC

It’s been about 3 months since Concentric Counseling & Consulting hosted its first On The Table 2017 conversation, and I am still impacted by the experience.  First let me backpedal to how I first learned about The Kennedy Forum, one of the co-sponsors of On The Table. 

It was the Fall of 2015 and I was having a conversation with my friend Caroline McAteer about various social issues and she had asked me if I heard of The Kennedy Forum.  Much to my chagrin, I had sheepishly told her that I hadn’t.  She told me about The Kennedy Forum’s mission and details of their annual meeting.  I was instantly intrigued and had to dig in.

Of the many things learned, one of them was Patrick Kennedy of The Kennedy Forum and his involvement with The Mental Health and Addiction Parity Act of 2008; he is still putting forth advocacy efforts to have The Act enforced on a national level.  I remember the buzz just before The Act went into federal law as I knew all too well the red tape and consequences people, including my own therapy clients, faced with limited mental health sessions imposed by insurance companies.

Fast forward to Spring 2017, and I learned about On The Table initiatives (co-sponsored by The Kennedy Forum and The Chicago Community Trust). Once again, I was intrigued.  On The Table initiative is about having people host open and honest conversations about mental health and addiction in effort to #BreakTheSilence and eliminate the stigma around mental illness and addiction that still greatly exists. 

As a counselor, I regularly encourage my clients to use their voice whether it is to share, increase vulnerability or intimacy, honor or advocate for oneself, and to work through the shame that often plagues people with mental illness and addiction. 

The focus of psychotherapy with my clients typically entails understanding and resolving challenges with one’s intrapsychic and interpersonal relationships (represented by inner concentric circles, hence the name Concentric) versus the larger, social systems (outer concentric circles).  Participating and joining forces with other hosts to help end the stigma associated with mental health and addiction while giving people an opportunity to use their voice fit Concentric’s mission with helping others to your their voice – but this time on a macro level.    

On May 16, 2017, the therapists at Concentric Counseling & Consulting hosted its first On The Table 2017 conversation in Millennium Park, across the street from our office.  It was an unseasonably warm and windy day, and our topic was "Your Voice Matters: Mental Health and Addiction.  Honest Discussion About Why More People Don't Seek Out Help." 

We had an incredibly diverse group of people who actively participated.  It was such an honor to hear people’s stories and ideas about why more people don’t seek out help.  So many stories and barriers were shared.  Common themes emerged and were extracted.  Follows are some of the common themes people described that either prevented them or others they know from seeking services:

• Stigma, embarrassment, and shame. Seeking help is seen as a weakness. What will my family and friends really think about me? Will I be seen as a ‘nutcase?’ Denial about having a problem or my ego getting in the way.

• Financial burden and obligations. Lacking financial resources all together. Treatment is a privilege for only those who can afford it. Lack or poor insurance coverage. All of the convoluted layers to insurance coverage.

• Lack of information and available resources on how and where to find mental health and addiction services. Example given was local university offered free counseling services to its students but was not aware of services until his senior year of college. Not knowing how to access services or where to start. Location and other barriers to gaining access to solid services.

• Cultural barriers and roadblocks, including families of certain cultures not supportive of mental health services. Experience with providers who lack cultural, gender identity, and sexual orientation competence. Religious barriers and lack of supports within religious communities.

It is a reminder to all of that us that suffering from mental illness and/or addition is hard in of itself, not to mention having to endure additional barriers that get in the way of seeking and accessing help.  Some of the solutions shared were not only to address or remove the aforementioned barriers and roadblocks, but to focus on the equity of mental and physical health. 

People remarked how it is much easier and more acceptable to talk about their physical ailments, but not their mental health.  Let’s look at people wholistically and give the mental health side the same due attention and respect.  Another solution shared was to target childhood prevention. 

One of the guests remarked in early childhood, we learn the importance of daily hygiene, such as brushing our teeth daily.  Why not introduce conversation around mental health care at an early age or make mental health education mandatory in schools.   Also, when providing education on mental illness and addiction, don’t use extreme or scare tactics, such as the “This is Your Brain” drug campaign did in the 1980s.  Guests remarked it only silences people more. Instead, provide a spectrum of information that can resonate with or speak to a variety of people across all ages and cultures.

My hope is that the information shared from our diverse group in Chicago can continue to be shared with others. And importantly, inspire all of us to participate in more active conversations about mental health and addiction whether it’s in your home, at work, in your community or as an On The Table host.  Because Your Voice Does Matter!