InSession Magazine- April 2023

Page 1

Stronger Together: Utilizing Mental Health Counselors

Across the Country

Page 7

Help my Child is a Gamer! How Parents can Support their Gamers

Whole Health

Page 38

Structured Relationship Therapy: A New Paradigm for Successful Couples


Page 13


Messaging and the Older Adult

Page 31

Self Love and Affirmations

Page 21

Cannabis and Mental Health

Page 24

Counseling Beyond the Seen

Page 44


2 | InSession- April 2023 |

Greetings FMHCA Members!

If you attended our annual conference, we hope you had a fantastic time! If you attended our Virtual Summit, we hope you enjoyed that as well

Please know FMHCA will continue to offer Live and On-Demand workshops along with regional trainings on a variety of topics throughout the rest of this year.

My focus has shifted to Florida’s current Legislative Session FMHCA has an ambitious slate of legislative agendas, and we encourage each member of FMHCA to get involved. How can you help? By donating and participating in our upcoming Legislative Days What are “Legislative Days?” It is a delegation

Join or Renew Your FMHCA Membership Today!

with our legislators in Tallahassee. If you cannot physically go to Tallahassee, you can participate in Legislative Days virtually by reaching out to your local representatives and speaking to them on behalf of our legislative agenda. Dr. Aaron Norton is the Chair of our Government Relations Committee (GRC), and he is putting together a training on how we can best communicate with our legislators Please r d hi Committee update in this issue of In Sessio

Thank you for continued membership in F


President's Column Laura

The Florida Mental Health Counselors Association (FMHCA) is a non-profit organization and chapter of the American Mental Health Counselors Association that is dedicated to meeting your needs as a Clinical Mental Health Counselors in each season of your profession through intentional and strengthbased advocacy, networking, accessible professional development, and legislative efforts


Gain access to member only discounts on NBCC approved CE events, Abenity retailers, and The FMHCA Store

Gain access to member exclusive networking events such as "Alliance"

Help shape legislature through our Government Relations Committee

Get on FMHCA's public directory for individuals seeking services across Florida & more! | InSession- April 2023 | 3


Page 7

Stronger Together: Uniting Clinical Mental health

Counselors Across the Country

Page 10

The Importance of the Call

Page 13

Structured Relationship

Therapy: A New Paradigm for Successful Couples Counseling

Page 16

FMHCA's Favorites

Page 19

FMHCA's Committee Updates

Page 21

Self-love & Affirmations

Page 24

Cannabis & Mental Health

Page 26

The Student, a feature article on Diana Huambachano, LMHC

Page 32

Negative Messaging and the Older Adult

Page 37

Around-the-Clock Listening

Page 39

Help my child is a gamer! How Parents Can Support their Gamers Whole Health

4 | InSession- April 2023 |


Page 42


Trauma Bonding

Page 45

Counseling Beyond the Seen

Page 50

Apply to be in our next issue of InSession Magazine!

InSession Magazine is created and published quarterly by The Florida Mental Health Counselors Association (FMHCA).

FMHCA is a 501(c)(3) non for profit organization and chapter of the American Mental Health Counselors Association

FMHCA is the only organization in the state of Florida that works exclusively towards meeting the needs of Licensed Mental Health Counselors in each season of their profession through intentional and strengthbased advocacy, networking, accessible professional development, and legislative efforts

Let your voice be heard by becoming a FMHCA Member today!

Click here to view FMHCA's current Bylaws


If you would like to write for InSession magazine or purchase Ad space in the next publication, please email: Naomi Rodriguez at naomi@flmhca org


Naomi Rodriguez- Editor

Victoria Siegal, LMHC- Expert Advisor


There shall be no discrimination against any individual on the basis of ethic group, race, religion, gender, sexual orientation, age, or disability.


Information in InSession Magazine does not represent an official FMHCA policy or position and the acceptance of advertising does not constitute endorsement or approval by FMHCA of any advertised service or product InSession is crafted based on article submissions received Articles are categorized between Professional Experience Articles & Professional Resource Articles

Professional Experience Articles are writer's firstperson pieces about a topic related to their experience as a mental health professional, or an opinion about a trend in the mental health counseling field

Professional Resource Articles are in-depth pieces intended to provide insights for the author's clinical colleagues on how to be more effective with a particular type of client or a client with a particular disorder, or tips for running their practice more efficiently Each article is labeled with their article type | InSession- April 2023 | 5
6 | InSession- April 2023 |

Stronger Together

Uniting clinical mental health counselors across the country

Professional Experience Article

The field of clinical mental health counseling is experiencing a surge in momentum which is contributing to various changes in legislation, increased access to services, and better treatment provision. The work provided by Clinical Mental Health Counselors (CMHCs) has never been so highly in demand as now. The global pandemic and steps towards social justice have required ongoing steps to create healing within individuals and building bridges between communities. The vast social problems and dilemmas have further placed emphasis on mental health treatment. A shift in paradigm is being experienced as the services provided by CMHCs are now viewed as crucial social tools to assist underserved communities.

The unique needs of each community and each state are passionately served by CMHCs who have devoted their lives to helping. The current bifurcation of laws from federal to state levels have caused a sense of disconnect between CMHCs in various states. With CMHCs focused on the needs of their local communities, this has caused an imbalance of national

recognition of the work of CMHCs as this can vary by state and need As such, the national work being completed by CMHCs advocating for legislative changes truly impacts all of us regardless of state. Whereas in some states, CMHCs experience push back and imposed limitations from other helping professions, the strengths and freedoms of CMHCs in other states provides ongoing evidence of the excellent clinical work that is being done (and can be done) at the national level.

Local state chapters have been a driving force in the work with the Counseling Compact As opposed to waiting for national legislation, the Counseling Compact is working to unite CMHCs like never before forcing recognition of the healing and helping work which can be overlooked in some states Furthermore, the passage of the Medicare reimbursement for CMHCs and MFTs in the Omnibus package now allows over 200,000 clinicians to serve various populations who may otherwise have limited treatment options. | InSession- April 2023 | 7

This wonderful work is truly only possible through the unity of CMHCs across states, working together to advocate for the profession With various voices, backgrounds, experiences, identities, etc. CMHCs are causing national change to help with this paradigm shift. The work done in each individual state is priceless and integral to communities. As laws continue to change, a CMHC providing treatment in Florida helps a CMHC in New York to advocate for state legislative changes to allow for diagnostic rights and privileges. Every CMHC in every state has an opportunity to contribute to this national legislation. Truly, CMHCs do not work in a vacuum. To continue this momentum, CMHCs in all states are asked to join together with their national organizations to amplify their voices in unity to help provide healing in this crucial time CMHCs are truly stronger together; and this ongoing momentum is proof of the


value that CMHCs provide Please consider joining your national organization to further this momentum

Fredrick Dombrowski is the AMHCA President and has extensive experience treating those living with co-occurring disorders since 1998 He has been a supervisor and director for multiple programs including inpatient, outpatient, and forensic treatment Currently a Department Chair at the University of Bridgeport, he is focused on experiential learning through a perspective of cultural humility and an equitable clinical care He has won several awards for his work with marginalized populations

Frequently Asked Questions from The American Mental Health Counselors Association's Code of Ethics

QIf a client refuses to sign my treatment contract, can I then provide services to that


AIn general, no. Clinical mental health counselors (CMHCs) must respect client rights,

and as stated in the AMHCA Code of Ethics (Code),

QWhen do I have the duty to warn of a threat by my client or a duty to protect against

violence that may be committed by a client?

AThe Tarasoff duty to warn and protect against serious threats of imminent violence by a

client has been adopted in various forms in state

Principle I B 7 i, a basic right of clients is “to refuse any recommended services, techniques or approaches and to be advised of the consequences of this action ”

Clients may, of course, give informed consent to treatment if they choose to do so Code section I B 2 provides excellent guidance regarding the informed consent process, and the disclosures that should be made to clients.

laws and licensing board Rules. CMHCs need to comply with their state law or licensing board Rules regarding the duty to hospitalize a client who is dangerous to others, in order to prevent threatened violence and to protect the potential victim By doing this, you comply with Code

Principle I A 2 c which contains an exception to confidentiality “for the protection of life” and provides: “CMHCs are required to comply with state statutes regarding mandated reporting ”

QWhat issues should be raised or what disclosures should be made in providing

informed consent to clients receiving telehealth?

The Consent Form for telehealth should be used in addition to your standard client A disclosure statement or form used to obtain informed consent for treatment If a client has already been in treatment with you before beginning telehealth, have the client sign the Consent Form for Telehealth, in addition to having signed your standard treatment contract The elements of informed consent for distance counseling must include any disclosures for telehealth required by your state law or by your licensing board’s rules and regulations In addition, the Consent Form should

disclose: The benefits and risks of telehealth; the confidentiality rules that apply, including a disclaimer that no guarantee can be made that electronic communication will not be compromised; the fact that written notes of treatment will be kept, just as if you were doing in-person therapy; and the fees that will be charged, which should be the same as those for face-to-face counseling Although most health insurers are covering telehealth, you should disclose that health insurance may not cover this treatment Informed consent needs to include an emergency plan in the event of a client crisis: the client should be encouraged to disclose any thought of self-harm and any history of suicide attempts or of hospital treatment for suicidal thoughts In case of an emergency, the client should sign a release authorizing an emergency contact to be involved with you; and a referral for hospital evaluation and treatment should be prepared and included in the Form A reminder Section l B 2 c states that informed consent is ongoing and needs to be reassessed throughout the counseling relationship

8 | InSession- April 2023 | | InSession- April 2023 | 9

The Importance of the Call

Professional Experience Article

The decision to seek help does not come easily for many of our clients. Maybe they are seeking help for the first time and they have no experience with mental health services. Maybe they are new to the area and are seeking a local provider to continue recovery they began elsewhere. Perhaps they have resisted help they knew they needed and now they are in crisis

In 1980 at Middle Tennessee State University, Professor Gerri Reddit instructs her students on the importance of the call. Email, texts, and tele-therapy were not a thing back then. Clients accessed services in one of two ways; they walked in or they called on the phone. Mostly, they called. Professor Reddit pointed out that the initial call is the client's first experience with getting help. Just making the call and establishing an appointment instills hope that their circumstances are about to improve. Therefore, a prompt reply and a welcoming voice is vital to keeping the client engaged

Today clients attempt access to services in many ways and often their experience is that no one answers the phone, no one replies to their text or email, or even bothers to return the call. What message does this send to the client seeking services about the mental health care system and specifically about us as individual mental health providers?

When I moved to Florida five years ago, I wanted to become familiar with the mental health resources I was opening a practice here and I wanted to know my colleagues I searched for licensed therapists in my community with whom I could meet for coffee and develop a working relationship. I emailed, phoned, and even mailed letters. A few people responded and were gracious to meet. I still have contact with them today and refer to them frequently. However, most did not. No returned call and no reply to the email or letter.

Five years later I have a steady practice and a small network of therapists to whom I can refer and consult and who also refer to me I take every call from every potential client and I reply to every email. I am not always the right provider for them, but I can help them navigate the system and find the services they need. Again and again I hear that they called multiple therapists and I am the only one who has returned their call. Why is this? I started asking this question when I would be with colleagues. Here are some of the responses I received.

"I don't have time I have a full caseload so there is no reason for me to call them " Congratulations on your success They still need help and they reached out to you The courtesy of a reply might help them stay engaged and persistent at seeking help It is a great opportunity for you to refer them to someone else who isn't full and might be able to see them.

"I don't take their insurance." Neither do I, but I do reply to let them know. Insurance systems are difficult to navigate, which is why so many providers avoid joining networks. Clients often don't understand how their insurance works and while it is not our responsibility to educate them, they are still reaching to us for help Simply explaining to the client that they can access their insurance directory online or by calling their insurance provider is an easy solution

"I don't offer the service they were seeking." The general public does not know the difference between a psychiatrist and a social worker or mental health counselor. Here is a chance to help them understand and steer them toward the right service they need.

"I'm overwhelmed. I get too many calls and emails and I can't keep up with all the work I have already." I understand. Many healthcare providers feel this way. When we become apathetic and complacent it is an indication we need to prioritize our own self care.

Everyday someone decides the time has come to seek help Return the call Reply to the email This too is what we signed up for

Steven Davidson is a

and licensed

in private practice in Broward County He is the author of Sexual Integrity: Finding the Courage to be Yourself He specializes in individual and coupl helping clients resolve sexual and relational problems He can be reached through his website at drstevendavidson com

10 | InSession- April 2023 |
Apply online today at or call us at 407-218-4800 | InSession- April 2023 | 11
12 | InSession- April 2023 |

Structured Relationship Therapy: A New Paradigm for Successful Couples Counseling

Professional Resource Article

The 3 C’s of relationship: Choice, Consent and Contract. When I work with relationships there are several different ways in which I initially engage to assess whether these three elements are in place and to what extent. It is important to understand that, until these three things are in place as explicit agreements, the likelihood of success in the healing of the relationship is significantly diminished. And often these themes exist in layers. The more complicated the relationship is, the more likely there are to be multiples of layers. One simple way to demonstrate this is to utilize the structure of the traditional wedding ceremony as an example of how we as a society have attempted to place these principles into a marriage This seems to demonstrate the intention of embracing this principle as part of the traditional sacrament or institution of marriage

In my first career I was a musician. I play guitar and sing. I am a singer first and a guitarist second. Consequently, I have never been anyone’s best man. I have had numerous friends come to me and say, “I would love to have you be my best man. But would you sing in my wedding?” So, as a professional singer, I have sung in literally thousands of weddings. Now, I do not have thousands of friends. But people would hire me to sing in their weddings While I do not necessarily believe that a marriage has to be in place as the form of relationship commitment for a couple to be successful, longitudinally, nevertheless I value the institution or sacrament of marriage very much Part of the purpose of the wedding ceremony/ritual is for everyone present to experience the process, not just the couple getting married, by vicariously re-experiencing their own coming together in

whatever form it took. At least that is how I perceive it. Consequently, even if I am hired to professionally play in the wedding of strangers, I experience the wedding as a spiritual renewal process in myself. (The reader will please keep in mind that there can be many forms of ceremony/ritual for many forms of relationships, but the basic processes, tenets or themes of commitment that I am endorsing here remain present in all of them. If not, they tend not to last. Also, the author begs the reader to please be aware that the words, “ceremony,” and “ritual,” may be used interchangeably or together.)

In the traditional wedding ceremony/ritual of two people there are many layers of choice and consent that occur in the traditional ritual. (While I am not saying that the traditional ritual, nor any specific form must occur for a couple to be successful, the marriage ceremony provides us with a process that, in a familiar way, illustrates a lot of the basic tenets of establishing the three C’s). These layers are in a sense laminated into the formation of a contract, which I will discuss a bit more going forward. The first ritual of giving consent is when the father walks the bride down the aisle. In my wedding, my father-in-law had his own family ritual that he engaged in with my wife, as he did with all his daughters, I am told In the narthex, before walking her down the aisle, he told her, “You don’t have to do this You can walk away right now, and I will cover for you I don’t care who came, or from how far away I don’t care how many people will be disappointed. I don’t care about the gifts that they bought. I don’t care about the cost of the reception. You can walk away right now, and I will cover for you. I want you to be free | InSession- April 2023 | 13

to make this decision for yourself ” While part of me might have wanted to be upset that he might be sabotaging my wedding, I would not have had her walk down that aisle any other way. So, I consider him to have done me a huge favor, and I love him for that. The father traditionally walks the bride down the aisle and up to the dais wherein the celebrant asks of the father, “Who gives this woman to be married?” (Now, truth be told, this is my least favorite part of the wedding, simply because the woman is being treated like property or chattel to be given away. Nevertheless, it is the traditional form.) In order for the wedding to continue the father must reply, “Her mother and I.” (Indicative of choice followed by consent). The father then gives the woman’s hand over to the groom and the two of them proceed up to the dais and face the celebrant (Indicative of choice followed by consent) The celebrant then asks them, “Do you come freely to be married?” If they do not answer in the affirmative, the wedding is over (Indicative of choice followed by consent) The celebrant then explains the process in opening statements and gives charges to the couple as to the seriousness of their situation. At some point shortly thereafter, the celebrant asks the couple, “Do you, bride, take this man to be your husband” And then, “Do you, groom, take this woman to be your wife?” If they do not reply with, “I do.” The wedding is over. (Indicative of choice followed by consent). Then there is the placing of the rings on the left hands, accompanied by the vows of commitment. (Indicative of choice followed by consent).

There is a relatively new ritual that has been added to weddings since I began singing in them in 1968. Over the years I have witnessed its evolution. Traditionally, two acolytes would walk up to the altar with lit tapers, and each would light one of the two candles that stood on the altar. Eventually, most churches adopted a third candle being on the altar, often provided by the couple, and, at some point during the ceremony, the couple would go up, each take one of the candles from the altar, and together light the third candle. The celebrant would explain to the congregation that this was symbolic of their two lives (or flames) being joined as one. At that point, originally they would blow out the two candles and put them back into the candleholders on the altar However, as time went by, most celebrants realized that they should keep the other two candles lit, explaining that this symbolized that, although their two lives (flames) were now blended into one, they still remained two individuals And the celebrants emphasized that just because they were married, this did not mean that they were giving up their individuality. The ritual of the two parties

engaging in this process symbolically enacted, almost as a dance would, that they were making a choice and giving consent (Indicative of choice followed by consent)

Eventually, many churches added a third vow, asking the congregation or the witnesses if they were willing to be there for this couple, support them, encourage them, help them when they were in trouble, and help them to preserve the relationship going forward. The congregation was then expected to respond, “We do.” Here is another broader layer of choice and consent. (Indicative of choice followed by consent.) And one of the last ritual statements given by the celebrant prior to introducing them as a couple, asking of the congregation, “Does anyone here have any reason why these two people should not be married? If so, speak now or forever hold your peace ” (Indicative of choice followed by consent)

All of these are pieces of the puzzle, consisting of the rituals of layers of choice and consent. They are traditionally meant to be the foundation of forming a contract of the relationship. Most people assume that the vows arethe contract. However, the vows are only a small piece of the contract. The contract between a couple has been developing since they were children, and long before they ever met each other. Most of the time couples have no idea what is in their contract Many other components of their contract were not made by the couple, but by the parents, grandparents or other ancestors of the couple, because the couple, as children, learned what a relationship is by watching their parents This is not always a good thing Just as you would not sign a contract for a loan without reading the terms of that contract, these people would really need to know the terms of the contract in order to make an informed decision as to whether to sign on, so to speak.

So it is that, many times when couples appear for relationship therapy, they have no idea what’s going wrong They almost always say that it is just “communication ”In my experience I find that couples tend to show up sometime between six and eleven years into their relationship I think this may be why people call it “the seven-year-itch ” Also, the research shows that the average divorce occurs approximately eight years into the marriage – right in the middle of that time frame. And, truth be told, approximately 50% of first marriages fail. Second marriages fail at about a 68% rate and third, and subsequent marriages fail at a 78% rate. I believe the reason for this is because they did not learn from their mistakes, because they were not aware of the terms of the contract in the first place and fail to admit that each of them was 50% of the problem (more about that

14 | InSession- April 2023 |

later) Also, when they present for therapy, they don’t realize that that they have a contract that may have never been appropriate for them, or, if it was, they have outgrown it and need a new contract. This is because the original contract was not formed by the people in the relationship. It was usually formed by their parents or families in prior generations. The template was simply handed down to them outside of everyone ' s awareness. Thus, although there is a contract that was formed, the parties involved in that contract are not aware of it. Often, their perception, or lack of perception, of the current contractual paradigm is based on the fact that they are totally unaware of the concept that the necessity of a contract for the relationship even exists. Thus, they do not know that there is a contract that needs to be fixed, nor do they have any idea what should be in that contract

This begs the question, “What is the old contract? Is it that the existing contract that now needs to be changed? Or has the couple moved from one contract to another recently?” As a result, they often do not see how hopeful the recovery of the relationship could be. And many of the terms of the initial existing contract tell them to behave in ways that


are self-destructive to the relationship Thus, we need to teach them some new relationship tools And – nobody teaches these to us in any consciously aware process as we are growing up. In this way we need to and are able to build on the strengths of the relationship and strengthen the weaknesses of the relationship.

Michael is a Past President and current Ethics Committee Chair & Parliamentarian of FMHCA He is a Licensed Mental Health Counselor, a National Certified Counselor, a Certified Clinical Mental Heath Counselor, a Certified Forensic Mental Health Evaluator, a Certified Child Custody Evaluator, a Qualified Parenting Coordinator, a Qualified Clinical Supervisor and a Certified Kink Aware Therapist & Educator

Michael has a private practice in the Florida Keys and has been working with individuals, families, couples and organizations for over 36 years You can find the latest work of Michael in his recently published book, Structured Relationship Theory: Nothing Less Would Have Sufficed


Location: WestPalmBeach

Credits: 16GeneralCEUs


Date&Time: 10August2023&11August2023(8-5bothdays)

PresentedBy: MichaelG


Register Now | InSession- April 2023 | 15

FMHCA's Favorites

Crochet Kits

Want to start a new hobby but do not know where to begin? Try out a Wobble Crochet Kit! These beginner kits include: Step-bystep video tutorial, The Woobles Easy Peasy yarn, custom-made for beginners, Unlimited help over e-mail, plus virtual crochet office hours, Plastic eyes, Stuffing, Tapestry needle, Stitch marker,crochet pattern as a PDF download

Lemon Chicken-Orzo Soup


3 tbsp olive oil

4 medium carrots, thinly sliced

3 celery stalks, cut into small pieces

2 leeks, halved lengthwise and sliced into half moons (white and light green parts only)

1/4 tsp. kosher salt, plus more to taste

1 tbsp. fresh thyme, chopped

4 wide strips lemon zest, plus cup lemon juice

2 bay leaves

4 bone-in, skin-on chicken breasts (about 3 pounds)

2 qt quarts low-sodium chicken broth

1 c orzo

1/4 c fresh dill, chopped


Heat the olive oil in a medium dutch oven over medium heat Add the carrots, celery and leeks and sprinkle with the salt Cook, stirring occasionally, until the leeks soften, about 5 minutes

Add the thyme, lemon zest, bay leaves and chicken to the pot Pour in the broth and 2 cups water Bring to a simmer and cook, uncovered, until the chicken is cooked through and tender, 20 to 25 minutes.

Remove the chicken to a cutting board and let cool slightly. Shred or cut the meat into bitesize pieces and discard the skin and bones. Return the soup to a simmer and add the orzo. Cook until the orzo is just tender, 8 to 10 minutes, returning the chicken to the pot in the last few minutes to heat through Remove the soup from the heat and discard the lemon zest and bay leaves Season with salt to taste

Stir in the lemon juice and dill


The calming fragrance of a lavender plant is thought to provide relief from stress, depression, and migraines It is also considered anti-inflammatory and has antiseptic properties. Like other plants in the mint family, lavender will repel bugs such as mosquitos, fleas, moths, and ticks.

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Pilates is a form of exercise which concentrates on strengthening the body with an emphasis on core strength This helps to improve general fitness and overall well-being Similar to Yoga, Pilates concentrates on posture, balance and flexibility It can help relieve tension in your shoulders, back and legs Having strong core muscles promotes better posture, which, in turn, can prevent or relieve the muscle tension that builds up in our day-to-day routines.

1 2 3. 4.
16 | InSession- April 2023 |

Victoria Siegal

Vickie is a Licensed Mental Health Counselor and Qualified Supervisor in the State of Florida, a Licensed Clinical Professional Counselor in the state of Idaho, a Licensed Professional Counselor in the State of Colorado, and an Expert Advisor for FMHCA's InSession Magazine

Vickie is the founder of Pegasus Counseling Services, LLC where she provides telehealth therapy Within her 10 years as a therapist, she has worked in various treatment settings with a diverse range of clientele Vickie’s specialties include working with victims of crime (domestic violence, sexual assault, stalking, homicide and human trafficking), self-esteem, shame, PTSD, grief and loss, and addiction. Vickie is also the founder of The Pegasus Academy, LLC where she provides continuing education and professional development to other mental health counselors

Get Out of Your Own Way

Self-defeating behavior is the single most common reason that people seek psychotherapy

It is a poison, preventing us from achieving the love, success and happiness we want in our lives And what really drives us crazy is feeling we have to change and not knowing how - or knowing how but being unable to stick with change Get Out of Your Own Way is an antidote - it explains why we sabotage ourselves, going back to childhood origins of various behaviors More important, it offers proven steps of action to transform behavior from self-defeating to life-enhancing With anecdotes and usable insights drawn from twenty years of psychiatric clinical practice, Dr Mark Goulston shares ideas that have helped thousands of patients overcome pain, fear, and confusion - to approach life's challenges with dignity, wisdom, courage,

Detergent Sheets

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Warmies Slippers

Warmies® Slippers are fully microwavable and gently scented with real French lavender for the ultimate comfort and relaxation Made with luxurious soft faux fur and memory foam soles, they are perfect for relieving stress and soothing tired, aching feet. Simply pop them in a microwave to provide up to an hour of soothing warmth and comfort.

Illy Coffee

100% Arabica coffee beans with a lingering sweetness and delicate notes of caramel, orange blossom and jasmine

How To Fail Podcast

How To Fail With Elizabeth Day is a podcast that celebrates the things that haven’t gone right Every week, a new interviewee explores what their failures taught them about how to succeed better

Chamomile Tea

If you ’ re feeling wired at bedtime, consider sipping a cup of chamomile tea to wind down Since chamomile tea is an herbal tea that contains no caffeine, it can be a calming beverage before bed Chamomile is in the daisy family and is widely used all over the world It’s one of the oldest documented medicinal plants with a variety of healing properties | InSession- April 2023 | 17
18 | InSession- April 2023 |

FMHCA Committee Updates

Ethics Committee

Update provided by committee chair: Michael G. Holler

As usual, the Ethics Committee continues to take questions or concerns, regarding ethics from our professional population There has been an interesting change in the presentation of these questions, as most of them have not been ethics questions, but legal questions regarding information that is in the statute (F.S. 491) and the rule (Chapter 64B4). In the past, these questions were frequently answered by the board, but they seem to have begun transferring them over to us.

This year we have developed the FMHCA Ethics Consult Form. The Ethics Policy, which was established in 2021, changed to require that ethics consults be submitted in writing to the Ethics Committee Consequently, the Ethics Committee will recommend that the ethics policy be amended to include the ethics consult form Mental Health Counselors, and Registered Interns will be required to submit this form when submitting a request for an ethics consult.

It is of note that the number of requests for ethics consults has dropped off considerably. As previously mentioned, the vast majority of the questions being posed at this time or not really ethics concerns, but statutory questions We can answer those questions quickly and affirmatively based on facts (if the answers are available clearly in the statute) However, statute is very clear most of the time, whereas ethics can be much murkier

Registered Intern & Graduate Student Committee

Provided by committee chair: Laura Peddie-Bravo

Greetings! In case you are wondering, you have not missed the first committee meeting of this year Our first meeting of 2023 is delayed due to our annual conference and virtual summit Rest assured, we will meet soon. I’m currently collecting ideas for our meetings this year. Our options are endless! We can have no main topic and simply network and connect with each other, along with addressing any questions or issues members would like to share. We can also focus on specific topics, issues, and any questions or concerns from our committee members. Last year we covered topics such as “Careers as a Licensed Mental Health Counselor,” “How To Market an Online Practice,”

“Finding Pre-Masters Placement Sites,” and much more. I also began recording our meetings last year. Our meeting days and times change each quarter, (based on committee vote), so if a

committee member cannot make the meeting, everyone has a chance to view the recordings, at their convenience. Additionally, we have a committee forum page on the FMHCA website, and any committee member is welcome to create posts in our committee forum. Examples of ideas for posts are: Helpful resources for students, interns or supervisors, questions, issues, and concerns. I am frequently asked “Who may join this committee?” This committee is open to all members of FMHCA, however it is focused on Graduate Students and Registered Interns When we have time, we also focus on the questions and concerns of Qualified Supervisors How does one join this committee? Simply contact the FMHCA office, Office@FLMHCA org, and request to join The FMHCA office will grant you access to the Committee page on our website, and you will be added to committee roster so that you may vote on meeting dates and times. Looking forward, if we have enough interest, it would be possible to split this committee in 2024 and have a separate Graduate Student Committee and Registered Mental Health Counselor Intern Committee. If you have any questions, or would like to submit your ideas for 2023 Committee meeting topics to me directly at

Government Relations Committee

Provided by committee chair: Aaron Norton

The GRC has primarily been focused on efforts to pass a bill this legislative session that would accomplish the following:

Revise F S 916 115 to include 491 board licensees among the list of health professionals who can be appointed by the court for evaluations and expert witness testimony on various mental health-related matters for criminal cases Revise F.S. 491.005(1)(c) such that registered interns in private practice are NOT required to have a licensed professional " on the premises" when providing telehealth Replace the term "registered mental health counselor intern" with "licensed associate mental health counselor" to (a) be consistent with verbiage used in most other states, and (b) reduce confusion among lawmakers, professionals, and the public, who often associate the word "intern" with college students

Thanks to the efforts of our lobbyist, Corinne Mixon, Senator Danny Burgess filed SB 700, which, in addition to the three issues above, would also add mental health counselors to the | InSession- April 2023 | 19

list of professionals whose services can be funded through the Family Empowerment Scholarship Program We are still seeing a sponsor for the House version of the bill, and we have tentatively planned our annual “Legislative Days” event for 4/11 and 4/12, at which time we will meet with legislators to promote the bill. We have also been conducting liaison work with other associations to garner support for the bill and with the 491 Board concerning the provision of gender-affirming counseling. We’ll provide additional updates as they develop.

Joining a committee is a great way to participate in FMHCA and increase your presence in our community. We have several committees that we would love you to participate in! Here is a list of all our committees, their purpose, and their chairperson.

We invite you to contribute your efforts as there are numerous opportunities for you to get involved and make a difference For more information on how to participate right away, please contact the chair committee or fill out this form.

20 | InSession- April 2023 |

Self-love & Affirmations

Professional Experience Article

Mental health and addiction therapy often contain an element of “learn to love yourself.” People will say they need to love themselves before they can love another person. A great many books, videos, and motivational resources are devoted to helping people love themselves.

What this means is that people who have spent their lives worried about how worthless and unlovable they are now spend a great deal of time in continuing to turn their attention inwards as they try to convince themselves that they are, in fact, loveable Remember Stuart Smalley doing affirmations on Saturday Night Live? He was looking into a mirror!

Well, I say “So what?” So what if you are loveable or not? So what if you are worthless or not? I say turn your attention outwards and show love to others and notice how good that

Figure out who you want to be and then live in harmony with that What qualities do the people you admire possess?

Demonstrate those qualities

When we are concerned about ourselves, we are disconnected and the people around us know When we are focused on the people we are with and being attentive to their concerns, joys, and what they are sharing, we forget about ourselves and our Connection is apparent to us and them

Take sex, for instance. If I am worried that I’m not attractive enough or expert enough or there’s something wrong with me, I won’t be really intimate or connected with my partner(s) Likewise, if I’m thinking about all the good moves I’ve got and how much I love my body since I’ve been working out and how great my last partner thought I was, then I am still not connecting with anyone else. I am probably objectifying whoever I’m with as I think of myself only in relation to how I want them to think of me.

Sure, a lot of us were wounded in childhood and grow up bringing our shame and self-loathing into our adult relationships, but “learning to love” ourselves is not the answer. Children are ego-centric – the world revolves around them and everything is their fault. Being a healthy adult is more about recognizing that we move about in a world with others who have their own feelings and beliefs and even their own selfesteem issues. While we can be attentive to them and even caring and interested, we are not the cause nor are we responsible for their issues. When I have decided what kind of person I want to be and when I bring that person into relationship, then I don’t need to be concerned with whether I love myself or not I can move through the world from a place of groundedness and allow my energy to move outwards to Connect with my partner, my friends, my students, and with the Universe

Dr Carol Clark is an educator and therapist, certified in Sex Therapy, EMDR, Addictions, and Transgender Care She is the president of Therapy Certification Training, International Institute of Clinical Sexology, and president of the International Transgender Certification Association Her books, Addict America: The Lost Connection and My Pocket Therapist: 12 Tools for Living in Connection, will help everyone to live in connection with themselves, others, and the universe

feels | InSession- April 2023 | 21


QWhat are the laws for being licensed in Florida and providing virtual services outside of the United States?

AWhat you really need to be concerned about is not the law in Florida, but the law in whatever country or jurisdiction the client is in These are the laws that will apply to you

QIf a client has an unpaid balance for services, and a request comes in from SSA for records, am I required to release them with the client in arrears with me?

AYou may not hold a client's records as ransom for unpaid fees the client owes you However, you may charge a reasonable fee for copies of the records You may also charge a separate administrative fee for completing any social

security or other insurance type forms Also, consider the fact that the law allows you to prepare and provide a summary of your treatment of a client in lieu of providing a copy of the complete record

Consider that the client may be in dire financial straits and may not have paid you because she or he is disabled, unable to work and has no income The client may be willing to work out a payment plan with you once the client is on disability and receiving payments Where the client is applying for disability, I would urge you to be charitable and assist the client as much as you can.

Mr Indest is board certified by The Florida Bar in the legal specialty of health law He is the President and Managing Partner of The Health Law Firm, based in Orlando, Florida. The information provided in this article is for educational and informational purposes only and does not constitute the provision of legal advice.

Want your question featured in the next InSession issue? Submit Here

Must be a FMHCA member to submit. Become a FMHCA member by clicking here.

FMHCA Member
Firm, George F Indest, J D , M P A , LL M
Questions answered by President and Managing Partner of The Health Law
22 | InSession- April 2023 | | InSession- April 2023 | 23


& Mental Health

Professional Experience Article

Millions of Americans struggle with Mental Health Issues. An estimated 1 in 5 Adults and 1 in 6 youth, aged 6-17 yrs. old are diagnosed with mental health conditions every year. 50% of all lifetime mental health concerns begin by age 14, and 75% by age 24. Sadly, suicide is the 2nd leading cause of death among people aged 10-34 yrs old

What is Mental Health?

Mental health includes our emotional, psychological, and social well-being. It affects how we think, feel, and act. It helps determine how we handle stress, how we relate to others, and even the choices ( both helpful and hurtful) that we make As the numbers clearly indicate, mental health is important at every stage of life, from childhood through adulthood

In recent years, a great deal of attention has been focused on

what Mental Health Practitioners have come to call “Adverse Childhood Experiences” (ACE’s). These include early childhood trauma or a history of abuse (child abuse, sexual assault, witnessing family or Community violence) and these ACE’s are highly correlated with mental health issues in adulthood.

Other contributing factors in the development of Mental Health Conditions include: Adulthood traumatic events, ongoing chronic or medical conditions (such as Cancer and Diabetes) and biological or genetic factors such as chemical imbalances or a family history of mental health challenges.

Commonly diagnosed mental health conditions include:

Anxiety and related conditions like generalized anxiety, social anxiety and PTSD. Symptoms of Anxiety and PTSD include; excessive worrying, feeling agitated, restlessness, muscle

24 | InSession- April 2023 |

tension, hyper vigilance, difficulty relaxing, sleep disturbances and panic attacks

Depression is commonly characterized by depressed mood (this is much more than feeling sad), decreased interest in previously enjoyable experiences, feelings of helplessness, hopelessness and worthlessness, changes in appetite which can lead to weight gain or loss, fatigue and sleep disturbances. Women are more likely than men to develop depression and it’s common to be diagnosed with both depression & anxiety

Bipolar can cause serious shifts in mood, energy, thinking and behavior. Someone who is bipolar can shift from one extreme to another. This condition is much more than “mood swings”, the changes in mood are so intense that they generally interfere with daily functioning and oftentimes disrupt job or school performance and even relationships. These changes can include unusually high energy (followed by periods of fatigue), erratic behavior and disrupted sleep patterns.

These issues affect much more than mental health, they commonly affect physical health as well. People with depression and other serious mental health concerns have a 40% higher risk of developing cardiovascular (heart) disease and suffer higher rates of conditions like stroke and type 2 diabetes. As we can see, mental and physical health are equally important components of overall health and well being.

Historical evidence for the use of cannabis in alleviating “suffering of the mind” is remarkably ancient Herodotus, an ancient Greek Historian, is believed by many to be the first to mention Cannabis in Western Civilization He wrote about Community members gathering in tents and placing seeds from the hemp plant upon burning stones, where the vapor emitted was used in a “grieving ritual” after a beloved member of the Community died. These records date back to 500 B.C. Additionally, Ancient Sacred text from India, described cannabis as reducing anxiety and promoting laughter.

The endocannabinoid system has been found to be a modulator of memory, anxiety and mood, with studies showing that cannabinoids interact with specific brain regions including; the cerebral cortex (responsible for memory, thinking, perceptual awareness and consciousness), the amygdala (which helps to regulate emotions) and the hippocampus (key to memory storage and recall).

With the advent of medical cannabis legalization, more focus has been placed on studying the potential benefits of cannabinoids in treating mental health conditions Medical cannabis users commonly report using Cannabis for depression, anxiety, to help manage panic reactions and for


Recent scientific studies attribute anti-anxiety, antidepressant, anti-psychotic and sedative properties to several plant derived cannabinoids and terpenoids, providing further evidence for the therapeutic use of cannabis in treating mental health related symptoms & suffering.

A 2019 review by researchers at UCLA “found that cannabinoids may hold promise as a treatment for PTSD, in particular for reducing nightmares and helping people to sleep.” Cannabis has been shown to promote “fear extinction” and “forgetting”, additional benefits to sufferers of PTSD.

A 2017 study indicated that 41% of cannabis users surveyed report replacing their usual medications in favor of cannabis, while 40% of those surveyed said that CBD was much more effective for relieving anxiety compared to other medications.

The beauty of the cannabis plant is that there are hundreds of different cannabinoids, terpenoids and flavonoids, all working together synergistically. One plant that can treat a wide array of symptoms, instead of several prescription drugs that only target one symptom at a time.

With prescription drug overdoses continuing to rise, America finds itself in the midst of an overdose epidemic. Raising awareness and excellent education are key to breaking the stigma associated with both cannabis and mental health concerns. Cannabis not only holds the potential to alleviate human suffering, it can literally save lives!


Hindocha C, Cousijn J, Rall M et al. J Dual Diagnos 2019

Khan, R., Naveed, S., Mian, N. et al. The therapeutic role of Cannabidiol in mental health: a systematic review. J Cannabis Res 2, 2 (2020)

NAMI. Mental Health By Numbers. Sept. 2019

Oswald, K. Cognitive Cannabis: The Emerging Evidence for Treating Mental Health Problems. The Pharmaceutical Journal 31 OCT 2019

Sarris, J., Sinclair, J. et. al. Medicinal cannabis for psychiatric disorders: a clinicallyfocused systematic review. BMC Psychiatry. 20: 24 (2020)

Josephine is the Founder of MMJ Knowledge, LLC, a medical cannabis education Company whose Mission is to “Inspire Hope Through Excellence in Education” Josephine is a compassionate, highly knowledgeable licensed clinical social worker who has been active both legislatively and in Florida’s clinical setting Based on her long experience in compassionate hospice care and outstanding educational skills, she illuminates the path towards health and well-being | InSession- April 2023 | 25
26 | InSession- April 2023 |

The Student

A feature on Diana Huambachano, LMHC

Diana is a Licensed Mental Health Cou owner, Executive Director of The Florid Counselors Association (FMHCA), and mother.

Diana earned her master’s degree in Clinical Mental Health Counseling from South University. Throughout her career, she has worked in various settings including child and adolescent community mental health centers, women ' s birth clinics, inpatient psychiatric facilities, substance use treatment centers, and Triple P-parenting programs. She is passionate about working with women as they transition through their life stages, from adolescence to early adulthood, career, motherhood, and beyond.

Diana volunteered at the 2014 Annual FMHCA Conference and after years of learning under Darlene Silvernail (FMHCA’s previous Executive Director), she stepped into her own role of Executive Director in 2018. She is responsible for managing the dayto-day operations of the association and the planning of FMHCA’s Annual Conference and community initiatives

Beyond her professional accomplishments, Diana is also a devoted wife (to Roberto) and mother (to Elena, Lucas, and Ava). She is known for her strong family values and her commitment to providing a nurturing and supportive home for her loved ones. Her dedication to her family, her profession, and her community have made her a respected and admired figure in the mental health field. In this feature interview, we are diving deep into Diana’s background, career advancement, and of course- unlocking the secret of how she does it all!

ith an interest. "I was always intrigued " she began "reading about it has

always been an underlying passion of mine and learning about the capacity to be aware of, control, and express one ' s emotions excited me. " It was this interest that navigated her career path.

"I had the desire to help and support others and initially I thought that meant that nursing was my path... but the passion just wasn't there." She gave herself some time to reset and discover what would drive her career-wise and that is when she discovered her interest in the brain and in helping others collided in the mental health field.

"I grew into a counselor" she stated, "it wasn't something I grew up knowing but when it lit a spark in me, I ran after it."

Keeping the spark alive

Diana has transformed her career in many ways, like a tree's limbs bursting from its trunk and heading straight up into the sky. When asked about what inspires her constant transformation, she stated that she is inspired most by strong women such as her mother.

"My transformation is due to my willingness to remain a student of life" she continues "There were plenty of things I did not know but I would never give up an opportunity because of thatI learned and figured it out." This student mentality has not only humbled Diana to learn but has also exposed her to opportunities that elevated her career to what it is today.

Meeting FMHCA Dr Darlene Silvernail, FMHCA's previous Executive Diana & Laura, FMHCA's Executive Administrator & long-time friend | InSession- April 2023 | 27
The class Diana raised her hand to volunteer

Director taught a psychology course Diana was in as a part of her undergraduate studies "She was seeking volunteers for the FMHCA Conference and I was not interested in attending since I was not even accepted into the graduate program and did not see how the conference could serve me " Diana shared. With the convincing of a friend, Diana ended up accepting the volunteer

opportunity that quickly changed everything for her.

"The energy at that conference pulled me in" Diana started, " as a student, I didn't realize how much the conference would benefit me " She went on to share that the conversations she was having, the people she was meeting, and the offers she received at that first FMHCA conference started to build the foundation for her career. "If you can network, you can grow and that's how it all started" she stated.

Returning from the conference fired up, Diana continued to volunteer at the FMHCA office for 15 hours per week She remembers saying to herself "if I am going into this field, what better position can I be in other than at the FMHCA office?"

When asked what makes her continue to stay with FMHCA all these years she stated "the team." FMHCA's team is composed of both office staff and a board of directors To Diana, the vision the team has to make the profession and organization bigger and better makes her excited and hungry for more

FMHCA Today and Tomorrow

Almost 10 years later, FMHCA has turned into a leading professional association fighting for all of Florida's Mental Health Counselors

When asked what is next for FMHCA and the future of Mental Health Counseling in Florida Diana responded, "The topic of mental health has really taken off, almost like a trend, however, FMHCA views Mental Health Awareness as a vital and continuous topic that needs to be addressed. After the pandemic, the need for Mental Health Counselors has exploded so I say what is next for FMHCA is (1) to remain a strong force in Tallahassee to ensure that our profession is protected legislatively, (2) aiding upcoming Mental Health Counselors

(students and interns) via our licensure exam scholarship and support summit (coming in July) so that they aren't 'lost' before hey even become licensed, and (3) finding out how we can support the mental health of our counselors in their own journey of healing and debriefing."

Diana goes on to express that no one else is going to do what FMHCA is doing and is willing to do so it is important to take initiative and lead the profession to benefit the state as a whole

"Meeting the needs of both clinicians and the community is what we do" Diana continues, "during the pandemic we were able to get executive orders in place within hours so that mental health services were not paused and clinicians did not have a lapse in services. It is these moments that make me proud of how far FMHCA has come, we would not have been able to meet that need without a network of leaders and loyal members "


Diana's leadership style is described as 'Transformational'. This is a style that focuses on change and how the team can be used to achieve a common goal.

"I cannot do this by myself, I have a vision but my team executes" she later states.

Pulling what she has learned as a counselor in her current leadership roles by instilling confidence in her team has aided in the success of the teams goals and has allowed new milestones to be reached. She then states, "Asking the team what they like, value, and can handle is my style because that is the only way we will get the best product."


Diana shared that her biggest challenges she has faced thus far has been balancing it all. "I am a wife, mom, and a professional" she began "I needed to set up boundaries and say ' no ' every once in awhile." With Diana's goals being so vivid to her, she had to learn how to reel herself in due to avoid overcommitting. "I get really passionate so I am still learning how to not get lost in all the roles I am in but what has worked

Diana & her husband of 8 years, Roberto. Diana's children. From left to right- Ava (2), Lucas (5), and Elena (7)
28 | InSession- April 2023 |

best for me is self-care When my cup is full I am able to then pour back into my roles and continue the mission "

A New Branch

From reading this interview we can definitely come to the conclusion that Diana is not finished.

"If you can open up my brain it is a giant vision board" she laughs, "I do not necessarily know how or when they will come to life but I see it "

So what is next for Diana? In what way will her career branch off to next? Here are her final words:

"I want to meet counselors where they are at by bringing knowledge in the form of trainings to their iPads and their cities. We are going to accomplish this through FMHCA's Annual Conference, Webinar and On-Demand Series, Regional Event Trainings, and Alliance Meetings. I want to focus on our students and interns I feel as though it is easy to get lost when

you are a student or an intern so strengthening our committees and resources for them is next on our agenda Still in regards to FMHCA, expansion of our conference has become a necessity as our membership has grown, we can expect this change in 2025.

Personally, I want to begin traveling the United States with my family. I do not want to miss out on the beauty of our country and I would like to expose myself to those new experiences. I also want to seek a Ph.D. in leadership in a non-profit organization- there is always room to grow and fine tune this skill and I have a passion for being a student!"

Diana & her mom- the first person to instill the value of higher education in her

Thank you Diana for sharing your story, expertise, and heart with us via this feature. We are lucky to have you as our leader and friend. | InSession- April 2023 | 29
-The FMHCA Office
30 | InSession- April 2023 | | InSession- April 2023 | 31

Negative Messaging and the Older Adult

Professional Resource Article

This article will explore how negative age-stereotyping affects both younger and older people, and influences the care that older people receive. We will explore how internalized beliefs in older people cause fears, self-imposed limitations and selffulfilling prophecies which may contribute to stress-related disorders and psychiatric illnesses. We also look at coping strategies, especially functional exercise paired with a therapeutic component. Finally, we discuss a possible wellness program for individuals and groups of older populations as a gateway to participation in enriching emotional and physical activities

Some Research

According to research conducted by Levy et al (2019), one in every 6 adults over the age of 60 suffers from such psychiatric conditions as generalized anxiety disorder (GAD), major depressive disorder (MDD), suicidal ideation (SI) and posttraumatic stress disorder (PTSD) Since these disorders are thought to arise concurrently with the aging process, cohorts in this population do not receive the specific attention required to alleviate suffering. These conditions may therefore remain untreated or under-treated.

Negative age-stereotyping throughout the life span contributes to internalized negative beliefs about the aging process as it highlights loss of youth along with need to hide or mask age

Negative self-perceptions of aging are promulgated through social stereotyping, which create fear of getting older in young people and cause older adults to limit themselves Younger people may feel contempt, loathing and other negative emotions towards older adults, which only adds to the dehumanizing of aging people. Younger people may see older people as superfluous, chronically sick and disabled, and dependent. These perceptions will lead younger people to

embrace youth culture, partially out of fear of the aging process for themselves.

Various studies have attempted to address negative attitudes –or cognitive ageism – towards older adults but have neglected to explore subjective experience and beliefs about aging

Although human populations are living longer courtesy of advances in medicine, persistent cognitive stereotypes foster fear of aging which trigger harsh treatment of aging people.

The stress-vulnerability model demonstrates how environmental stressors lead to higher rates of psychiatric disorders. Stereotype-embodiment theory postulates that exposure to negative stereotypes causes disorders. Age stereotypes arise within the environment and continue over time to become reinforced to such an extent that aging individuals will apply the negative messaging to their own lives

Prejudices and stigmatization cause stress-related disorders in those who are targeted. Coping strategies to mitigate deleterious effects have previously focused on how sexism and racism affect individuals. Active coping can succeed where passive coping fails.

Experimental research on the impact of negative stereotyping and the development of psychiatric illnesses demonstrate how negative age biases become environmental stressors for older people, whereas positive age-stereotyping engenders

environmental buffering. Previous longitudinal research has shown how aging individuals present with higher cortisol levels after having internalized negative age-stereotyping across a 30 year time span, with only a few studies investigating active coping skills in relation to stress caused by prejudices.

In Levy et al's study (2019), participants filled out an

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Expectations Regarding Aging (ERA) questionnaire, and were provided a list of 14 active and passive coping mechanisms from which they were asked to pick 3 strategies they more commonly utilized to deal with most disturbing events or challenges. Screenings for MDD, GAD, SI and PTSD were administered after 2 and 4 years; event-history and moderator analyses were also conducted.

Findings from this study showed that the more numerous the negative-stereotypes, the more likely participants were to develop new-onset psychiatric conditions within the 4 years post-study

When participants engaged in active coping skills, those with negative age-stereotyping experienced a reduction in the prevalence and intensity of negative psychiatric symptoms. Those participants in the positive age-stereotyping group were not as affected by active coping strategies. It is interesting to note that participants in the negative age-stereotyping category had better outcomes than those in the positive agestereotyping category, as the former used active coping and thereby experienced an empowering effect, whereas participants in the positive age-stereotyping category experienced fewer illness whether they engaged in active coping or not The authors conjectured that this second group of participants had benefited from never having been negatively impacted by harmful stereotyping and were therefore in less need of applying active coping skills.

The active coping strategies, though not tailored to directly address negative age-stereotyping, were most likely effective since active coping strategies are generalizable to various kinds of stressful situations This study has proven that psychiatric conditions diagnosed in older age are not due to the aging process itself The development of psychiatric illnesses can be predicted by investigating the deleterious effects of negative age-stereotyping Active coping strategies can mitigate the harmful effects of age bias and should be incorporated as interventions for those older people who can be at risk of developing psychiatric problems.

Expectations around decline in cognition and functionality during the aging process create self-fulfilling prophecies that manifest as poor psychological, physiological and behavioral health outcomes People 80 years and older tend to attribute compromised health to old age, demonstrating how a selfperpetuating stereotype blocks older people from actively seeking treatment and expecting it to work These older individuals believe they have lost any sense of control over their own health outcomes. In addition, the healthcare setting presupposes that aging and chronic physiological decline are

inevitable, further leaving older adults to struggle on their own with ageist stereotypes

Negative-age stereotyping, or ageism, needs to be addressed both at the societal and individual levels. This type of prejudice continues to go unchallenged in televised and social media. This complicated and multidimensional form of prejudice affects people in the workplace, in health care settings and in their interpersonal relationships

Exercise programs and involvement in sports allow older adults to bypass many conditions associated with aging, since mobility, strength and cardiovascular processes are improved through movement. Unfortunately, these active older adults, whether casually spending time in the garden or involved in purposeful exercise, still grapple with the meaning of aging in a society which has labeled aging people as superfluous

Transforming Negative Self Perceptions of Aging

Previous studies to determine whether and how negative selfperceptions of aging can be transformed into more positive perceptions through cognitive-restructuring exercises embedded within physical activity programs have demonstrated that aging stereotypes are most affected. A study by Beyer et al, (2019) addresses how cognitions and physical activity can combine to directly change self-perceptions of aging, and explores whether exercise without the psychoeducation component can yield similar results.

Functional Exercise with a Therapeutic Component

Functional exercise regimens designed to reverse physical deficits arising from sedentary aging improve mobility, balance, strength, ability to tackle activities of daily living, and quality of social functioning. When a therapeutic cognitive component is added to this type of program, significant improvements in mental health can address and remediate cognitive impairments, motivation, quality of life and physical health In this setting, people experiencing negative self-perceptions of aging (SPA) find an outlet for processing of pros and cons of the aging process This type of program encourages both those who are younger to shift their views on and behaviors towards those who have already hit aging milestones, and allows those who are already older to discover a new meaning to the passing of time.

A Study

Beyer et al's (2019) 12-week functional exercise program targeting reduction in falls for an aging population already experiencing negative SPA due to first-hand experience compared an intervention group (IG) consisting of exercise and | InSession- April 2023 | 33

cognitive restructuring targeting individual stereotypes with an exercise control group (CG)

After baseline assessments, 84 participants were invited to pick from one of several locations where they would be involved in the program; participants remained blind to which control group they were assigned. Additionally, questionnaires were administered at the beginning, the middle and at the completion of the study

The study utilized one manual for all locations and both control groups; the IG received 4 cognition interventions during the second half of exercise sessions, while the CG received commensurate activity time.

Measurement tools included the think-aloud method which prompted participants to gauge both gains and losses related to aging, with future expectations formulated through use of the AgeCog Scale. Physical performance, and mental health as measured through depression questionnaires, were also assessed at the beginning of the study.

Results demonstrated how participants evinced a beneficial increase in positive self-perceptions of aging gains along with a decrease in loss-perceptions in the period immediately following the completion of the program The study furthered other research into how to facilitate the transformation of negative attitudes towards aging into more positive beliefs and perceptions.


Though positive self-perceptions of aging declined after the termination of the program, Beyer et al (2019) postulate these effects being attributable to the programming design wherein a number of participants were not provided the chance to speak and process their own perceptual accounts. More in-depth and longer lasting psychological interventions may be required to achieve more constant positive self-perceptions of aging

Menkin et al (2022) discuss interventions designed to shift older adults' views on aging. Types of curriculae used either single sessions events or assignments spanning several weeks, and focused on increasing positive views of aging while also helping participants understand that age is not the cause of sedentary behaviors. Views of aging are malleable and benefit from interventions no matter how brief.

Brief messaging was implemented through The Reframing Aging initiative conducted in 2019 and targeting adults aged 18 through 92 years. Brief online public messages centered on anti-ageism resulted in lowered bias against aging when scored through the Implicit Attitude Test.

Menkin et al (2022) undertook a study in 2021 which avoided the pitfalls of some anti-aging messaging In general, the strategy of debunking aging myths may be counterproductive because it surreptitiously reinforces the negative myths. Extolling unrealistic achievements in aging may disappoint participants who then decide to reject all positive views on aging. Understanding the diversity that exists among older adults within their physical and emotional dimensions plays a large role in helping this population overcome negative selfperceptions of aging.

Since more research into useful and effective strategies and techniques for facilitating mental health improvement in older adults is needed, in conjunction with targeted and functional exercise programs, various organizations, medical boards and facilities, agencies, clubs, groups and mentors can promote ways for older adults to discover motivation for activities engagement.

Positive self-perceptions of aging are linked to increased desire for engagement in beneficial physical activities; when these activities become more easily available and accessible within communities, and older adults can more easily encounter communion with and support from others, healthy aging becomes a by-product of increased physical health and functional fitness. Motivation to connect with others remains consistent.

Current access to community-based healthy aging programs remains very limited. Evidence-based instructor or peer-led activity groups could be implemented in health care, residential, community center and other settings so that groups of people can meet, socialize and concentrate on the maintenance and improvement of physical functioning while also re-discovering a purpose to their developmental position in life

Health psychology should be re-tooled to require a developmental focus so that when applied to older adults, developmental needs and barriers can be included in health behavior interventions Ensuring that self-perceptions of aging are addressed within group and individual sessions can facilitate motivation to open up to possibilities for connecting with others and to gaining deeper access to age-related wisdom, the latter which may have been restrained by unrelenting negative societal messaging.

Interventions to Consider

Psychoeducation along with brief writing exercises can help older adults readjust negative self-perceptions Specificallyorganized materials which explain how negative messaging

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exists across many media platforms can guide older adults to appreciate their own strengths as they understand what has been compelling them to underrate their abilities

New findings about how older adults can rebuild and maintain strength and cognitive abilities could be included in educational packets Older adults could be able to choose a functional fitness program that has already been designed to accommodate their current abilities Performance-enhancing visualizations can be built into these functional fitness programs as an addition to strengthen positive beliefs while resolving any existing negative self-beliefs.

Fullen et al (2023) looked at programs which promote holistic wellness for older populations Individual and group coaching encouraged senior living residents to explore their unique wellness goals while also providing supportive environments for connection and interaction with peers and staff

This type of programming produced high resident satisfaction and increased sense of purpose and higher quality of life. With its 9-week sessions consisting of psychoeducation, processing of physical, spiritual, cognitive, emotional and vocational wellness, and consistent goal check-ins, the program allowed residents to encounter each other and staff within a context of mutual and collective benefit

If we conceptualize this type of programming as a motivator for participation in functional fitness routines, we may increase not only the success rate of the programming with regards to efficacy, but also the older adult's access to good mental health.


This has been a short overview of negative messaging and the older adult. Ideas to incorporate into therapeutic interventions which could help older people change the way they view themselves and their peers could include psychoeducation, narrative therapy, group processing, goal setting, and visualizations


Amano, T , & Toichi, M (2014) Effectiveness of the on-the-spot-EMDR method for the treatment of behavioral symptoms in patients with severe dementia Journal of EMDR Practice and Research, 8(2), 50-65

Beyer, A , Wolff, J K , Freiberger, E , & Wurm, S (2019) Are selfperceptions of ageing modifiable? examination of an exercise programme with vs without a self-perceptions of ageing-intervention for older adults. Psychology and Health, 34(6), 661-676.

Boulton-Lewis, G., Buys, L., Lewis, C. O., Vine, D., & Dendle, K. (2019). Aging, exercise and motivating engagement. Educational Gerontology, 45(6), 390-400.

Fullen, M. C., Smith, J. L., Clarke, P. B., Westcott, J. B., McCoy, R., & Tomlin, C. C. (2023). Holistic Wellness Coaching for Older Adults: Preliminary Evidence for a Novel Wellness Intervention in Senior Living Communities. Journal of Applied Gerontology, 42(3), 427-437.

Gordon, S (2020) Ageism and Age Discrimination in the Family: Applying an Intergenerational Critical Consciousness Approach Clinical Social Work Journal, 48(2), 169-178 https://doi org/10 1007/s10615020-00753-0

Levy, B R , Chung, P H , Slade, M D , Van Ness, P ,H , & Pietrzak, R H (2019) Active coping shields against negative aging self-stereotypes contributing to psychiatric conditions Social Science & Medicine, 228, 25 http://dx doi org/10 1016/j socscimed 2019 02 035

Markov, Č , & Yoon, Y (2021) Diversity and age stereotypes in portrayals of older adults in popular American primetime television series Ageing and Society, 41(12), 2747-2767

https://doi org/10 1017/S0144686X20000549

Menkin, J. A., Smith, J. L., & Bihary, J. G. (2022). Brief Anti-Ageism Messaging Effects on Physical Activity Motivation Among Older Adults. Journal of Applied Gerontology, 41(2), 478-485.

Ng, R., Chow, T. Y. J., & Yang, W. (2022). The impact of aging policy on societal age stereotypes and ageism. The Gerontologist, 62(4), 598-606. Sargent-Cox, K. (2017). Ageism: We are our own worst enemy. International Psychogeriatrics, 29(1), 1-8.

Scott, T. L. (2022). Aging is inevitable, nihilism is optional. International Psychogeriatrics, 34(9), 761-763

https://doi org/10 1017/S1041610222000345

Amy is a Licensed Mental Health Counselor with years of experience in inpatient and outpatient settings She works with individuals, groups, families and couples She specializes in people who are seeking help for anxiety, depression, mood, trauma, use of substances, and other issues

Amy is a EMDRIA Certified therapist and is a Certified Clinical Trauma Professional and a Certified Family Trauma Professional She is also certified in Emotional Freedom Technique, and as a life and group coach

Amy can be reached at info@gentletherapyplace com or 904-344-8320 to discuss therapeutic, coaching or consulti website is gentletherapyplace com | InSession- April 2023 | 35
36 | InSession- April 2023 |

Around-the-Clock Listening

Professional Experience Article

My daughter and I filed into line, drained and giddy from an afternoon of thrifting, where we share our love for repurposing would-be castaways When it was our turn, we greeted the cashier warmly and fell into conversation

She was tired at the end of her shift and ready to get off her feet.The uptick in her ongoing back pain was made worse by the stress of an adult son who had stopped paying his share of the rent. She was determined to set better boundaries with him. His abuse of her generosity had gone on for too many years. Seemingly unaware of the growing line behind us, she tearfully relayed that his shortcoming meant she might lose her home. She was angry, hurt, and exhausted. Thankfully, her beloved dog kept her from feeling too alone

As she bagged our final items, she heaved a deep sigh. “It felt good to get that off my chest. Thank you for listening!” Smiling, I met her gaze and offered words of comfort that bubbled up from my heart. My daughter and I waved goodbye and headed for the exit.

I turned to my daughter to resume the easy chatter that had been waylaid by our new friend, and seeing her expression, stopped short Head tilted to one side, she looked at me with curiosity. “Mom, wherever we go, people share really personal stuff with you. Why do you think that is?”

In response, I shrugged my shoulders and joked, “Occupational hazard, I suppose!” We giggled together and moved on, the matter quickly forgotten

Since, however, I have reflected more deeply on her question. As a fellow trained listener, I suspect you have similar experiences. As such, I hope my insights will benefit you.

First, empathetic listening is hard work, even if it seems to come naturally

As trained listeners, we have worked hard to perfect skills that are relatively uncommon and do not come naturally to others. We expertly ask open-ended questions, unfolding conversations instead of shutting them down. We are mindful of our posture and presentation, being careful to convey openness and create a safe, judgment-free environment. We track the movement of the conversation, asking thought-provoking follow-up questions that increase sharing. All the while, our training has equipped us to notice the sharer’s nonverbal cues those things said as well as unsaid and we skillfully integrate those messages into our overall impressions and responses

This level of expert listening is anything but passive. It is active and depleting. It is, in short, extremely hard work. And yet, it is not a skill that is easily shut off. It is one that is woven into the very fiber of our beings. We take it into our daily interactions because it reflects the value we as helpers place on fellow humans.

Empathetic listening is a rare and precious gift to those who receive it

Highly skilled, active listening communicates life-giving and often life-changing messages to its recipients: You are seen. You are heard. You have value. You have worth. You deserve to take up time and space. Your story, your pain, your struggles, your joys matter YOU matter

Is it any wonder, then, that we find ourselves being entrusted with the stories of others, even when we are “off the clock.”

Your precious skill requires mindful boundaries.

Like any precious gift, your empathetic listening warrants specialized care and boundaries. Friend, not only are you allowed to take a break you must if you are to continue productively in this line of work. Be mindful of your own personal resources and level of depletion. Are you becoming | InSession- April 2023 | 37

entangled in a weighty conversation after an exhausting day with clients? Because it is so deeply ingrained in us, we can unintentionally bring into casual interactions the expert listening that is appropriate for clients.

Take time to discern your responses, disconnect from others, and connect with you. Give yourself permission to create healthy distance so that you can go the distance.Practice the self-compassion you advocate to your clients Engage in replenishing activities that bring life to your soul Remember to listen to YOU! You, dear reader, are worth it!

Charlene is a licensed mental health counselor and life coach who specializes in helping women struggling with issues of self-worth, self-care, depression, anxiety, abuse, trauma, relationship dif loss Charlene’s passion is to help women experien inner healing that overflows into relationships and impacts future generations While providing a safe place free of criticism, she helps women unearth the beauty in their stories, embrace their value, and live a life of purpose and fulfillment

Show up to session in style

38 | InSession- April 2023 |

Help my child is a gamer!

How Parents Can Support their Gamers Whole Health

Mom just let me play for 1 more hour, please, Jeremy said. This statement become part of the daily argument between my son Jeremy and I. Jeremy, is among many other things a “Gamer”.

Like many Gamers he spends quite a bit of time playing on his PC. According to recent studies “Tweens (ages 8 to 12) spend 55 minutes per day playing computer or console games, and 34 minutes playing mobile games.” The amount of time Jeremy spends on his PC on average is about 5 hours a week. Many parents are extremely concerned about the toll this could take on their child’s mental health and for good reason

My husband and I worried however, not only about his mental health, but also his physical, social, and overall well-being, his “whole health”. We worried because we noticed several changes in Jeremy since he became a “Gamer” Our Jeremy a 13year-old, 8th grade student in NJ started his Gaming Career about 3 Years ago It began with the Nintendo switch, then PlayStation, XBOX and now PC He did have a game console as

well and often played on his XBOX, but the PC quickly became his favorite.

He no longer was interested in going to Barnes and Nobles with mom and dad to get the newest edition of Dork Diaries, Captain Underpants, and Dogman. Hanging out with his cousins seemed like more of a task then a fun time. As he continuously asked, “mom when are we going back home, my friends are waiting for me to log on my pc to play?” Friday Family movie night was out of the question, since this was the only night, he could play for a longer period time as it was not a school night. We worried we were losing Jeremy to an unknown, antisocial, sedentary world!

So, what did we did? I can first tell you this not a one size fits all. All children are different, and you will have to work as a family to find what works best.

Let me start by sharing what we tried to do that did not work for us:

Talking to him about how much we hated his new habit | InSession- April 2023 | 39

Prohibiting him from playing Forcing Jeremy to spend time with us

Trying to reason with him why gaming was bad for his health

These actions created an environment of hostility, anger, and lack of communication. It was the opposite of what we needed. We yearned desperately as a family to improve our communication skills to help Jeremy set healthy boundaries with his new interest. We quickly learned this was less about us putting our feet down as parents, giving our son ultimatums, playing the “no card”, and doing what we thought was best for Jeremy versus building what was best together.

After many failed attempts we changed our approach and found this is what did work:

First- Put yourself in your child’s/tween’s shoes! You once had a hobby, or many that you could not get enough of! Ask yourself, did your parents nagging, or yelling do anything to stop you, or did it simply make you want to play more? How did all the fighting caused by the nagging, make you feel, close to communicate or ready to talk?

Second- Listen - Instead of sharing with Jeremy the reasons why he should stop gaming, and how upset we were over the changes we noticed in him. We said: “Jeremy we are noticing you are growing and with that learning about new things and taking up hobbies. This is wonderful and we are so happy for you. Can you tell us what you like about gaming and why?” Again, just listen! We bit our tongues to whatever rebuttals formed in our minds about his new passion. We just listened. Not to answer, not to respond, but to understand our son. To acknowledge his feelings, needs, wants and help him also reflect on his new interest. Usually, any new interest can be healthy if balanced well.

Next- Allow your child the right to self-determine- We then said: “This is great Jeremy; I know it has been hard for us to understand your new hobby We just want to make sure we can help you keep enjoying all the wonderful activities you like in a balanced and healthy way How about we create a plan together? Share with us how do you think we should work out this new interest, and create a schedule that works for you?”

We fleshed out how much time he was playing every day, how much time he was dedicating to school, his studies, eating, reading, his friends, family, sleeping, and disconnecting his mind from gaming.

He shared with us, what he believed would work, things that didn’t, and what he hoped to gain from this experience

Now all of this did not happen in one conversation. It occurred

over time and slowly. We often had to prompt Jeremy, and patience was Key!! We also stopped taking away his game time, instead encouraged Jeremy to keep his own time, and would gently remind him, hey did u eat yet, or texted him over for a 10-minute break and snack. But maximized his game time to 1 hour per day on school days and 3 hours on Saturdays. Now keep in mind, every child/tween is different, and the American Academy of Pediatrics has suggested times allotted for children. We created and set times based on what we felt worked best for our tween and family.

We would say things like you are doing great at managing your time, we are so proud of you My husband created a family group chat, we affectionately labeled- The Pinks- (Pinks translated in Spanish for our last name Rosado). We shared interest, discussed family night and made sure to prompt Jeremy on what he wanted to do for family time and what time we should start.

This encouraged his participation, took into consideration his new interest and schedule We planned our social outings as a family, making sure to ask about everyone’s interest

The truth is this entire process was not at all easy. It truly required for us to think out of the box as parents. While we worked on equipping ourselves, about how gaming could potentially negatively affect Jeremy, we also developed strategies to help Jeremy build his own critical thinking skills on his newfound interest. We also became versed in the Gaming World to learn about game genres, safety measures, and the gaming community. This truly helped us to be able to speak with our son about his interest and have conversations about issues such as possible concerns with new games, e g , content/exposure to violence and nudity We were also able to just talk with our son about new games, have fun, and laugh Jeremy shared these experiences made him feel we truly cared about his interest and respected his decisions We learned that mental health involves a person’s whole health. To build and sustain our child’s mental health, we would have to learn to help him develop healthy habits, and skills he would need to use through out his whole life.

Martha received her MSW from Yeshiva University

She has more than 18 years of experience in both private and public sectors She previously served as the Service Manager in Recovery at Marjory Stoneman Douglas High School, facilitating the delivery of mental health services, and Mental Health and Social Work Consultant for the Student Services Project at the University of South Florida Currently her role is with the New Jersey Department of Veterans Affairs

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Understanding Trauma Bonding

Professional Resource Article

When we think of abusive relationships, we often focus on the physical violence that is inflicted upon the victim. However, other forms of abuse are just as damaging, if not more so. One such form is known as "trauma bonding." The common theme I have encountered as a clinician is the issue of the trauma bond a client has developed over time with their partner or one of their parents/main adult caretaker. Individuals with trauma bonds often present with post-traumatic stress disorder symptoms as a result of their partners' or parents' abusive behaviors over an extended period of time Trauma bonding occurs over this extended period within a relationship where one partner/parent exhibits repeated emotional abuse, which also can include physical abuse or threat of physical harm, towards the victim This article will focus mainly on the trauma bonding within a relationship between an individual who has unhealthy narcissistic behavior and their romantic partner.

So, what exactly is trauma bonding? Trauma bonding is a kind of psychological manipulation. Trauma bonding begins when the victim is provided with what appears to be extremely loving, caring, and attentive behavior by their partner There is a physical and a heightened emotional connection felt by the victim, causing the victim to feel a sense of security within the relationship This stage of the relationship is often called "love bombing ” Subsequently, the partner's behaviors change towards the victim when the victim is repeatedly exposed to a cycle of abuse (typically physical and/or emotional) by the partner, then followed by periods of positive connection of loving words, gestures, and displays of affection. This cycle of psychological manipulation may occur multiple times over a length of time. It is common to hear from victims that they know their partner is a good person, has great qualities, etc., as

this is the person they fell in love with at the beginning of the relationship The victims do not want to give up on their partner because they believe their partner truly does have these positive qualities that were initially displayed and if they just hold on long enough, the partner they fell in love with will reappear and all will be wonderful once again.


it trauma bonding or is it Stockholm Syndrome?

Stockholm Syndrome is the terminology often confused for trauma bonding, however, the two are not quite interchangeable The term Stockholm Syndrome is properly applied to hostage situations when danger and fear of possible loss of life were immediately present. The victims then eventually developed empathy and loyalty towards their captors. The difference between this and trauma bonding is that trauma bonding often occurs in abusive relationships or families where one’s survival or sense of self-preservation relies on their emotional connection. Trauma bonding is the result of psychological, physical, or emotional manipulation that creates an attachment to the abuser.

When someone engages in trauma bonding, they experience a range of complex emotions, including fear, confusion, guilt, shame, loyalty, and even love for their abuser. The victim begins to view their abuser as a source of protection from the world outside the relationship, leading them to feel that the abuse is worth enduring to keep the relationship intact. The result of this complex psychological manipulation is that victims often become "trapped" in their abusive relationships, feeling unable to leave even if they want to It is important to understand that the trauma bonding process is on a spectrum and every relationship will display differences in cycles of psychological manipulation

A significant component to understanding trauma bonding is the fact that dopamine and oxytocin, which are two key hormones involved in the reward system of our brains, are linked to trauma bonding Oxytocin is released when we feel close to someone, and dopamine gives us pleasure when certain activities or situations remind us of our abuser The victim may even express how they feel "addicted" to their partner as they are unable to disconnect emotionally or physically from them The physical and emotional "addiction" is felt viscerally within the limbic system. The "addiction" to the emotional and physical connection to their partner is not logical. Victims often express a desire to completely terminate their relationship with their abusive partner and not return to them due to the multiple logical reasons they identify. However, more often than not, the victims report that a complete and final termination of the relationship is very challenging for them, and the victim may

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return to their partner multiple times before a final termination is successful Increased feelings of shame and guilt by the victim are common because of the resuming of the abusive relationship.

Understanding how trauma bonds form is essential in helping victims break free from these toxic relationships Here, we will continue to explore how trauma bonds are formed and the different stages involved in forming a trauma bond with a partner who displays narcissistic characteristics

Idealization Phase

The first stage of trauma bonding is the idealization phase, where the narcissist places their partner on a pedestal, and everything seems perfect. This phase also includes what is called "love bombing".

During the idealization phase, a narcissist presents their partner with an unrealistic version of themselves The narcissist will usually make grand promises that seem too good to be true, creating false expectations of what the relationship can and will be like, often leading to disappointment down the line. This pedestal-placing display draws in the other partner, lulling them into a feeling of security as they start to believe things that aren't true about their partner or the relationship. The narcissist will use this tactic to engage in further manipulation, leading participants further into the trauma-bonding process. The love bombing that occurs within this stage is presented as a deep emotional and physical connection that may be present immediately if not quickly at the beginning of the relationship.

The Devaluation Phase

The second stage is the devaluation phase, where the narcissist starts to nitpick and find fault in their partner/victim. This can be an emotionally draining process that affects the victim's selfesteem and trustworthiness. The narcissist may also start to withdraw love and attention, leaving their partner feeling neglected The victim can then become desperate for the narcissist's love and attention, making them more vulnerable to manipulation The narcissist will continue to gain total control of the relationship by playing mind games and using guilt trips and silent treatments as a means of punishment The silent treatment behavior is often expressed by victims as one of the most difficult behaviors to receive from their partner as it causes feelings of despair and emotional pain. Human beings need attachment and connection with others. The human brain does not differentiate between emotional or physical pain. Therefore, when the silent treatment is being utilized, the victim’s feeling of pain is heightened. When there is a perception that the person’s attachment is being threatened,

anxiety increases due to this fear Anxiety is felt at a visceral

level due to the human need of connection and attachment for one’s overall survival

During this phase, the narcissist may also utilize the technique of "breadcrumbing." The narcissist provides "breadcrumbs" of attention, affection, etc to the victim, which provides the victim with a false sense of security and connection, which then encourages the relationship to continue The victim's feelings of dependency on the abuser increase during this stage, as they become more desperate for validation and approval

Discard Phase

The third stage is the discard phase, where the narcissist terminates the relationship with their partner without any explanation or warning

The discard phase is the third stage of trauma bonding within relationships with narcissists. In this phase, the person on the receiving end of the bond will be abruptly and often cruelly discarded - without reason or warning The narcissist may even use the technique of breadcrumbing, which involves sending sporadic messages or attention to keep their victim on the hook The victim then remains hopeful and is left feeling confused because they are never given a proper explanation for why they were discarded. This can create an emotional roller coaster, leaving the victim in a state of confusion and despair. While it can feel like a cruel act at the time, a better understanding of this phase can help reduce its devastating impact as people try to heal from disentangling themselves from a toxic relationship.

After the discard phase, a narcissist may engage their victim in what is called the hoovering phase The hoovering phase is where the narcissist tries to come back into their partner's life after they've been discarded. This does not occur in every relationship with a narcissist; however, it is important to be aware of this tactic in order to increase one’s awareness.

The hoovering phase is a critical part of making and maintaining the trauma bond between narcissists and their partners Here, the narcissist will use manipulative tactics to attempt to regain control over their victim's life, prompting them to reconnect despite any damage caused by previous behavior. During this stage of the cycle, emotions are often raw, and boundaries become blurred. The narcissist may try to woo their partner back with grand gestures and false promises, making them believe that this time will be different. The victim is then left feeling confused and powerless in the face of these tactics, often leading them to fall back into old patterns of behavior. The cycle can then start again, leading to an ongoing cycle of manipulation and emotional abuse. The cycle can occur | InSession- April 2023 | 43

multiple times over many years, and it is important to remember that the victim is not to blame for the cycle of abuse

From an outsider's perspective, terminating the relationship would seem an obvious response to a person being emotionally and/or physically abused. Understanding the reward system of our brains can help those who love and support the victim. Unfortunately, victims feel shame and judgment from others who do not understand the trauma bond they have developed This increases the potential of the victim isolating themselves from the outside support they are very much in need of The crucial step of recovery for the victim is achieving radical acceptance. Radical acceptance involves the understanding that the narcissist will not change. It can be confusing when the narcissist does show intermittent behaviors conducive to the belief that they have changed. However, this change is not permanent. The narcissist is unable to maintain this level of changed behavior. There is a grieving component with radical acceptance. It is encouraged that the victim acknowledges their grief to facilitate the healing process

It is important to understand the stages of trauma bonding so that an individual is able to recognize when it's happening in their own relationships. If you ' re able to identify the signs early on, you might be able to avoid getting too deep into a relationship with a narcissist or avoid getting into situations where a trauma bond may form. And if you ' ve already formed a trauma bond with someone, understanding the steps can help you start to heal and move on.

Victims of trauma bonding are encouraged to increase their self-compassion during this time. Breaking trauma bonds can often be a slow and difficult process. But it is possible to terminate an unhealthy relationship with someone you have formed a trauma bond with. Victims need to have the right

Recognizing when a trauma bond is present in your relationships can help you avoid getting into situations where one may form and actively work on breaking those that already exist. It is possible to break trauma bonds and begin to rebuild healthy and fulfilling relationships.

Ultimately, understanding why victims stay in relationships with their abusers is key to helping them break free and begin the process of healing Understanding how trauma bonds form can help those who love and support the victim to provide empathy, compassion, validation, support, and resources that will assist victims in reclaiming their lives Through ongoing education and awareness, we can provide necessary resources to those affected by abuse With a better grasp on the psychological mechanism involved in forming a trauma bond with an abuser, we can work towards breaking its power and creating lasting change for those affected by this cycle of violence.

If you or someone you know has been a victim of trauma bonding, there is help! A licensed mental health clinician can provide support, psychoeducation, and specific therapeutic interventions to aid the victim in the healing process

Renee RC Counseling in Winter Park, Florida, is a clinical qualified supervisor, clinical hypnotherapist, and an adoption competency therapist Renee is trained in EMDR and is a Master A R T therapist specializing in working complex trauma (C-PTSD), PTSD, victims of narcissistic abuse, attachment trauma, addiction, and eating disorders Renee is a public speaker and provides continuing education presentations for community events and mental health groups Renee is also a member of FMHCA and ISSTD

FMHCA 2023WEBINARSERIES Join in on one of our upcoming webinars! Topics include: ADHD, Trauma, Building a Smart Private Practice, Cultural Competency, Suicide Prevention, & More! Register Now 44 | InSession- April 2023 |

Counseling Beyond the Seen

Counseling involves a person’s mind, spirit, and body. As counselors, we are taught to ”see” the whole individual. A counselor that does not “see” all of these components of a person might be missing something for the person they are treating; therefore, getting to know the person is essential to understand all of these components However, do you need eyes to see?

Something very evident in this is that the counselor should be observant and “see” everything a client brings into the therapy session. As a mental health counselor with a visual impairment, I have felt fellow colleagues do not understand how I work with my clients. The truth is that when we are taught to be counselors, we are taught to be observant with our eyes and therefore I understand where their concerns come from because I cannot “see” how they do

Counselors are taught to “look” at nonverbal cues, for example, gestures, postures, or simply positioning within a room to gain insight into a client. As a counselor with a visual impairment, I have taught myself to find other nonverbal cues that show me how a client might be feeling or even dealing with a situation.

The tone of how a person tells their narrative, as well as the pitch of their voice can tell me a lot about how they feel or if they are uncomfortable. I have noticed that these things sometimes give me more insight than the visuals, maybe because I do not ”see” as well as most, but maybe because my ears have grown to “see” the things most counselors cannot with their eyes

When my clients realize I am visually impaired, sometimes they worry or feel uneasy. However, they have learned that it does not take good eyes to be a good clinician but empathy, compassion, dedication, and a good ear or heart. Honestly, some might even be resistant to the idea of continuing therapy because they are taught by movies, social media, and even society how a counselor ought to be, which is not visually impaired However, after discussing their fears and showing how therapy can still be done without sight, the client usually realizes that everything portrayed in media is not necessarily correct

Clients are later surprised how they cannot “hide” when they feel uncomfortable, frustrated, or uneasy with a given topic | InSession- April 2023 | 45

because I pick up on their tone of voice or their pitch and ask, “I notice your voice changed; what is on your mind?” or “what is making you feel uneasy?” or remind them that if they do not feel comfortable in talking about something they are the pilot of the counseling session, I am just the guide or the copilot, it all depends on what is it that I hear. It is tough to explain exactly how I pick out each emotion or sense the uneasiness in their voice. Sometimes even listening to how a client moves in their chair or taps their feet or hands helps too. For those, who can see, that would be easier to pick up; however, for me, it would have to be based on hearing the movement. Those that know me say it is my sixth sense. However, I say it is my fifth considering my eyes do not function as most do.

It has been rewarding to see people become more open to those that are different due to experiencing a session in my office. It has been rewarding to be a change in the world of counseling and that of people with disabilities. I enjoy truly “seeing” everyone that comes into my office and helping them grow in their healing journey.

Counselors ought to understand that our clients are diverse, and so are we Therefore, being open to counselors that are different or have different viewpoints is essential We can learn from each other if we listen to each other and grow in our profession. It does not take eyes to make a good counselor; we ought to know that. I challenge you not to view the nonverbal cues but to hear them and see if you can identify the client’s anger, frustration, or resistance.

Odalis is currently a nationally certified counselor, as well as licensed in the state of Florida She specializes in working with children and trauma survivors, which is what led her to get certified as a trauma professional (CCTP) She currently is the owner of Romero Sound Mind Counseling as well as the assistant director at Behavioral Turning Point and continues to provide services to those needing them

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