Mental Health: How to Navigate Through the Levels of Therapy Services That Are Available

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It can be somewhat overwhelming and confusing navigating through mental health treatment if you are unfamiliar with the levels of care that are available.  Whether you are a parent of a child in need of mental health services or an adult who is struggling with mental health issues, you may be unaware of where to begin.  The following guide can hopefully be a starting point for you.

Inpatient Services

Inpatient treatment is typically meant for individuals who are in need of a high level of care.  Children, adolescents, and adults who are having active suicidal thoughts may end up either admitting themselves into an inpatient facility or may be referred through a mental health professional after a psychological screening is conducted.  For example, if a child or adolescent discloses to a school counselor that they are having active suicidal thoughts and there is a psychiatric emergency, they may be referred immediately to a local hospital where a psychiatric screening will occur.  Depending on the results of the screening, it may be recommended that the child or adolescent be admitted into an inpatient facility for treatment.

What happens at an inpatient facility?

Inpatient facilities provide a variety of mental health services.  These services may include group counseling, individual counseling, family counseling, substance abuse counseling, and more.  A psychiatrist is on staff and can provide medication monitoring and a therapist is assigned to provide case management and mental health treatment.  A typical length of stay is three to seven days depending on how severe the issue is.

Partial Hospitalization Program (PHP)

A PHP is one step down from inpatient.  At a PHP, similar services are provided as at an inpatient facility.  However, treatment at a PHP program only occurs during the day, whereas at an inpatient program, beds and rooms are provided for your stay.  The hours of treatment are typically from 9-3.  During this time, mostly group counseling is conducted.  Depending on the facility, a multitude of treatment methods may be provided including DBT, CBT, etc.  A client is assigned a therapist/case manager and medication monitoring is provided if a psychiatrist is on staff.

Intensive Outpatient Program (IOP)

An IOP is one step down from a PHP.  At an IOP, services are provided a few times per week and are typically conducted during after school hours.  If treatment is being provided for an adolescent, busing is sometimes provided from schools to the program.  Mostly group counseling is provided at an IOP.  A therapist/case manager along with medication monitoring can be provided through an IOP.

Outpatient Therapy Services

Outpatient services are one step down from an IOP.  Typically, treatment is provided once per week to start and may gradually spread out over time depending on the progress of the client.  Main Street Counseling is an example of outpatient treatment.  At outpatient therapy services, a client is connected with a therapist who provides counseling services.  It may be difficult to find the right fit for you when searching for a therapist.  To learn more information and get more tips on how to find the right therapist for you, please read my blog, How to Find the Right Therapist for You & Your Family: 5 Tips for Individuals and Families New to the Process!

If you have questions or are unsure what to do, please don’t hesitate to reach out!

Look to Gratitude to Help You Cope With Loss and Depression

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“When I was a boy and I would see scary things in the news, my mother would say to me, ‘Look for the helpers. You will always find people who are helping.” – Mr. Rogers

Gratitude. What a powerful concept. This word has never been more meaningful and important than now. This global pandemic has crippled the mental health of millions of individuals and families as many have slipped into a deep depression. Panic attacks and anxiety has taken over making it nearly impossible to manage daily life. People are dealing with so much loss. They are experiencing the loss of loved ones, the loss of interpersonal relationships and affection, the loss of their employment or business, the loss of normalcy, and more. You never thought these would be things of the past. Shaking someone’s hand or giving a friend a hug when greeting them are such simple things you may have taken for granted and not thought to appreciate or be grateful for. You never know when these sorts of things will be taken from you. Now that they have been for many as you are being cautious due to the pandemic, you are grieving these losses. You are feeling sad. You are feeling anxious. You feel like your body is heavy and you are dragging each day. You are worried about the unknowns of tomorrow and when these losses will return again. This is where your mindset is. However, although you may be experiencing a good amount of loss, now is the time to be grateful as gratitude is what will be your strength to work through these moments of hardship.

Mr. Rogers indicated that his mother told him to look for the helpers in times of crisis as “You will always find people who are helping.” When you look for the helpers, you will find hope. You will recognize the good in the world. You will feel strength. This is similar to gratitude. During moments of loss and crisis, there are always things to be grateful for. 9 months ago, you may have been focusing on other things that caused stress, sadness, or anxiety as opposed to focusing on gratitude. If you knew then what you know now, you may have focused your energy a bit differently. You may have focused strongly on the moments of affection with family and friends and embraced the beauty of a large gathering or celebration when many of the people you love most were in the same room together. You may have practiced mindfulness at your favorite restaurant more regularly as you enjoyed dining indoors. Now that these things have been taken from you, your focus may be on grieving. Although it is normal and necessary to grieve, it is important to find balance between grieving and gratitude. In moments of sadness, despair and loss, find the positive. Find what to be grateful for as you never know when more things you love and value may be stripped and taken from you.

Gratitude goes hand in hand with mindfulness. To help you enhance your feelings of gratitude, focus on present moments. You may feel the loss of something that you had yesterday or be worried that you may lose something tomorrow. Just bring your attention back to the here and now. Be attentive to what you have today. To help you with this process, read our previous blog, Anxiety & the Here & Now. If you are having a difficult time finding something to be grateful for, use the list below as a starting point.

  1. Hugs and affection from your immediate family (your child, spouse, or partner)
  2. Your basic needs (i.e.: food, shelter, water)
  3. Your health
  4. Walks, hikes, playing outside
  5. Seeing and spending time with loved ones, even if it is outside or wearing a mask
  6. Doing things that bring you joy (i.e.: playing music, gardening, knitting, watching movies, exercising, watching or playing sports)
  7. Eating delicious and nutritious food
  8. Reading a good book
  9. Working from home and sleeping in for now (if you can)
  10. Being able to wear comfortable clothes if you are working from home during the pandemic
  11. Beautiful sunrises and sunsets
  12. Bicycle rides

How to Manage Your Anxiety Level & Other Mental Health Impacts From the COVID-19 Pandemic

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It has been over 5 months since we received an email from our daughter’s school indicating that education was moving from in person to virtual.  “School will be moving remotely for two weeks,” it read.  “We will reassess at that time to determine next steps,” the email continued.  At that time, communities across the country were trying to process such significant changes that were happening.  As our private practice transitioned quickly to telehealth, few realized that this can potentially be the format for mental health services for the foreseeable future.  Shortly after the pandemic began, I received a good amount of messages from clients indicating that they would like to “wait and see what happens.”  “I’ll reach back out in a week or two since I would like to continue to see you in person as opposed to online,” they said.  Little did everyone know the pandemic would linger on for several months and longer.  Now, our practice is seeing a few hundred clients per week via telehealth as so many are in need of mental health services during these challenging times.  Individuals, couples, and families are really liking the new format as it is flexible and convenient.  In addition, many insurance policies are covering telehealth sessions at 100% making mental health services much more accessible than they have been in the past.

Although the pandemic has been around for several months, people are continuing to grieve pretty hard as their feelings of loss persist.  People are going through a loss of a loved one, a loss of normalcy, a loss of life experiences like a prom, freshman year of college, weddings and birthday parties, and more.  This weighs heavily on people making day to day life more challenging to manage.  Smaller obstacles or disagreements can trigger stronger emotions of anxiety, depression, frustration or anger.  This can lead to bigger arguments and conflicts which can be damaging to relationships and families.  Additionally, individuals and families are emotionally exhausted.  Parents of young children have been going months without a break.  They have been responsible for child care, education, and entertainment all while having to work a full-time job.

Another layer that has been a large cause of anxiety for individuals and families is that big and quick decisions are needed to be made.  Should you send your child to school or daycare in September?  What changes do you need to make to the policies and procedures of your business?  How are you going to make ends meet and continue to pay for rent or your mortgage?  These are all real situations that individuals and families are being faced with today.  In addition, due to circumstances and laws constantly and quickly changing, it is making it extremely challenging to plan accordingly.  People are put in a position where they have to spend an extraordinary amount of time planning only to have to adjust their plans a few weeks later due to circumstantial changes.  For instance, school districts spent months preparing to transition back to school in September.  Many of these plans were recently shared with parents and students.  It seems that a hybrid approach combined with in-person and virtual learning is the common plan for districts.  However, due to many unknown factors, it is difficult to determine if these plans will remain once school begins in a few weeks.  Should the virus spread throughout schools, they will be forced to shut down again and go 100% virtual.  This will impact school professionals as well as working parents and students.  Little to no options are ideal making it nearly impossible to plan for.  To summarize, all of the unknown factors and having to plan to make big decisions have been crippling to many peoples’ mental health.

Impacts on Social Dynamics

For many, it is difficult to cope with change, whether it be a change of job, home, or relationship.  The pandemic has not only caused these types of changes, but also much more substantial changes specifically in societal/social norms and how people interact with one another.  This is primarily due to the fact that people are responding to the pandemic very differently from one another.  Some believe it is a hoax and choose to not wear a mask or practice social distancing while others still do not feel comfortable leaving their house.  There are also some people who find themselves somewhere in the middle.  These people leave their house, wear a mask, practice social distancing, and have become well adjusted to new social norms.  Nonetheless, many people now have a new layer of anxiety that impacts how they interact with those around them.  There is an added stress level for how people socialize.  They now have to gauge others’ comfort level with socialization and need to communicate theirs.  For example, if your friend invites you and your children over for dinner, you may not feel comfortable unless you bring your own food and if masks are worn by all.  However, when you get to your friend’s house, you find that their family isn’t wearing masks or practicing social distancing.  If your children come to the BBQ wearing masks, what do you do if your friends’ children aren’t wearing masks or being socially distant?  This can impact your stress and comfort level and potentially even your relationship with that family.  You may then choose to not stay or spend time together in the future due to these differences.

How to Cope With These Impacts

It is difficult to wrap your head around the changes around you.  As I indicated, everyone is experiencing loss during these times.  You may still be in a state of shock.  As you begin to acknowledge these changes, it can be helpful to focus on what is directly in front of you.  Rather than focusing your mind on “having things go back to normal,” try to focus on adjusting and creating a “new normal.”  This may include more outdoor activities, zoom meetings, wearing of face masks and hand sanitizer, and quarantining/COVID tests before family vacations.  Whatever the case is, create a new framework for you and your family and you will find a way to make it work.  The more times you get out and experience life within these new changes, the more comfortable you will become.

As you continue to take steps towards adjusting to your new normal, you may find it necessary to communicate with others since their new normal may be different than yours.  When making plans with others, don’t be afraid to ask questions first and share your comfort level with others.  If you are invited to a BBQ, for example, you may want to first find out how food is being shared.  You may also communicate that you are going to bring your own food if that is what you feel most comfortable doing.  Some people feel safer wearing a mask no matter what the circumstance is while others are okay not wearing a mask if they are outside and are being distant from one another.  It can be helpful to always have a mask with you as you gauge others’ comfort level.  If you are outside and they are wearing a mask, you can ask if they would feel more comfortable if you were wearing one too or you can just put it on at that point.  Otherwise, interactions and relationships can be impacted as some people have a difficult time speaking up about their emotions if they are feeling uncomfortable.

These are challenging times for everyone.  Times are constantly changing and there continues to be so many unknown factors.  As long as you are taking care of yourself and your family while also focusing on the greater good and doing your part, you are doing what you can.  Again, try to focus on now and what you can do moving forward and your feelings of anxiety will be as manageable as they can be.  If you find yourself out of control of your emotions and your decision making and relationships are being impacted, do not hesitate to reach out to us.  Many have been doing that as therapy can help ground people.  We are always here to listen.

4 More Ways to Manage Your Fear & Anxiety During the COVID-19 Pandemic

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“Worrying doesn’t take away tomorrow’s troubles, it takes away today’s peace.”

Currently, humanity is in a prolonged state of crisis.  What happens tomorrow is unknown.  People fear the unknown.  It feels unstable, unpredictable and scary.  You are acting aggressively.  You are in denial.  You feel frozen.  You are anxious and sad.  You feel alone and are missing family, friends, and loved ones.  These are all common responses when your mind believes you are in danger.  You can learn more about the anatomy of fear by reading the first part of our COVID-19 blog, 4 Ways to Manage Your Fear & Anxiety During the Corona Virus Pandemic.  You are grieving your old normalcy.  However, although the world has and will continue to change, you are still in control of yourself regardless of what your emotional experience is telling you.

To ensure your safety and the safety of those around you as well as to help slow down the spread of COVID, the government has established a set of strict rules and guidelines and are enforcing social distancing until further notice.  These vast social changes along with possible financial hardships are just the right 1-2 combo to knock the wind out of you.  For some, this may have knocked you off of your feet.  Regardless, it is up to you to regroup and get back up.  But what does it take to stand back up again?  The following 4 tips may give you the boost you need.

  1. Focus on your basic needs first.  Practice safe social distancing.  If you need to go out to buy food, wear a mask.  Wash your hands with soap and water for 20 seconds when you get home.  Learn more about how to take proper precautions by going to cdc.gov.  Make sure to still eat nutritious food throughout the day, find time to exercise, and get enough sleep at night.  To learn more about ways to maximize energy, you can read the following blogs:

4 Ways to Maximize Energy

4 Ways to Maximize Energy: Part 2

4 Ways to Maximize Energy: Part 3

4 Ways to Maximize Energy: Part 4

Symptoms of anxiety, stress, and, if you are a parent, taking care of children can be extremely draining.  Make sure to maximize your energy by focusing on your basic needs.  If you don’t maximize your energy, your days will be physically, mentally, and emotionally taxing on you.  You will be more likely to lose control of your emotions if you do not care for your basic needs.

2. Develop structure.  During the pandemic, it is easy to fall off the tracks of structure.  You may go to sleep later, wake up later, take your time getting out of bed in the morning, and skip a meal during the day.  The more you fall out of a routine, the more likely you will be impacted physically, mentally, and emotionally.  You may become more withdrawn and lose energy and motivation to do things.  Create a schedule for you and your family and make sure you keep consistency.  Try to go to sleep and wake up at the same time each day.  Continue to eat at least 3 meals per day around the same time.  Incorporate free time in your days for you and your children so you can change things up a bit.  However, the more you stick to a schedule and find structure, the more stable you will feel.

3. Shift your mindset.  When emotions deliver a message (thoughts), it doesn’t mean the message is accurate.  For example, your anxiety may have delivered a message that the pandemic won’t ever end.  If you needed to apply for unemployment and the check didn’t come yet, the emotional message may be that it won’t ever come.  Your heart will race, your breathing will be heavy, and your stress and anxiety will spill into your relationships with others.  Shift your mindset.  Don’t believe every message your emotions deliver.  Counter these messages and have a positive mindset.  Do what is in your control and what you can to help your situation as well as your family’s.  Be persistent and perseverant if necessary.  Make sure to breath as you persevere.  You will run into obstacles.  Find another way.  It is there to be found.  However, worrisome thoughts will not help you back up from being knocked down.  Positive thoughts and energy will.

4. Live for today, plan for tomorrow.  You will most likely never get this opportunity again.  The world is paused.  There is no rush to be anywhere but home with your family.  Go outside and play with your children.  Make a picnic in your backyard for you and your partner and enjoy some sunlight.  Meditate.  Practice yoga.  Learn how to paint, play a musical instrument, or another skill that will enrich your life.  There will be a time when life will be fast paced again.  That time isn’t today, tomorrow, or next week.  Enjoy it while it lasts.

Tomorrow will eventually come.  Be prepared.  Discuss a plan with your family for when regulations are loosened.  Do all of your family members have access to a mask?  What will life look like for you and your family?  What will safe socialization look like for you?  Start to think about the answers to these questions.  Don’t let the COVID pandemic cause you to freeze and do nothing.  Take action.  A solid plan will help to ease your anxiety and you will be ready for when the time comes.

4 Ways to Manage Your Child’s Anxiety, Depression, & Behaviors During the COVID-19 Pandemic

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It has been close to a month now since COVID-19 has changed society forever.  More and more people are realizing the seriousness of the pandemic, that it is not going away for the foreseeable future, and have been practicing social distancing as a result.  Initially, people were in a state of denial.  Now, anxiety and sadness has taken over as individuals and families are starting to break down emotionally.  In our last blog, 4 Ways to Manage Your Fear & Anxiety During the Corona Virus Pandemic, we discussed ways to manage anxiety during the pandemic.  In this blog, we are going to focus on 4 ways to manage children during the pandemic.

My wife and I have 4 young girls.  We have a 7 year old, a 4 year old, and two 16 month old twins.  If your family is anything like ours, it is quite challenging managing children during the pandemic, especially with no additional support (ie: grandparents, aunts, uncles, etc.).  You need to be able to maintain finances during a time when finances are limited and you need to keep up with your child’s education at home since they are not in school.  You need to do this while managing your fears and worries along with your children’s emotions.  It almost seems impossible to keep your family moving forward during these times.  However, if you take a step back and shift your mindset a bit, you will realize the silver lining of this pandemic.  We will discuss this later in the blog.  For now, here are a few ways you can help manage your children while you are at home during the pandemic.

  1. Maintain structure and keep things predictable even during unstructured times

If your child was at school, their days would be predictable for the most part.  This is because they received a schedule at the beginning of the year and their teachers mapped out expectations early (ie: classroom procedures, behavioral expectations, etc.).  They would get to class, complete a do now, turn in homework from the night before, and then sit quietly for instruction, all without prompting from the teacher.  There would be some sort of group activity followed by a classroom discussion.  Although the group activity does not require a teacher present, children remain on task because they are engaged in the assignment.  For the most part, the flow of the lesson would run smoothly, mainly because the teacher spent time prepping and planning.  Without this prep work and planning, it would be difficult to manage a classroom of children.  This is mainly due to the level of engagement.  In order to keep your children engaged, you may need to get creative and change things up a bit.  This will require daily planning and prep work.  Incorporate time in your day to do this.  Otherwise, it is likely your child will be less engaged and the days will be much less structured.  If you thought your child would sit still for an hour or two and complete their work without getting off task every couple of minutes, you probably realized by now that this is not the case.

2. Send your child outside to play and do not let them come back inside until you say it’s ok!

If you are a parent, you probably remember the times when we were children.  We would come home from school and play outside until dark when our parents called us in for dinner.  We used our imagination, got dirty, built forts, hiked in the woods, and played ball in the street.  Today, you will rarely see children doing this.  They come home from school, quickly do their homework, and then their parents drive them from one activity to the next.  There is no time for imagination or play.  This is one of the silver linings of the pandemic.  Since activities are canceled for a while, your child is now able to take advantage of time and play.  They may be resistant to going outside at first because it is new for them.  However, encourage them to create a game, build a fort, build an obstacle course, and use their imagination!  If you set the expectation that they are not allowed to come back inside until lunch or dinner (depending on the time of the day), they will adjust and start to enjoy that time.  Who knows, maybe when this pandemic ends, children’s play and use of imagination will remain.

3. Spend time and connect with your child.  

There will never be more of an opportunity to spend time and connect with your child than now.  If you have young children, get on the floor and play with them.  They will want to create a game.  Go along with it.  Color with them, create a puppet show, paint your nails, push them on the swings, or create other crafts and projects.  If you have older children, go for a short hike, ride bikes, play kickball, dodgeball or another sport, or do something else outdoors.  If your child is into video, create a stop motion or a movie.  Learn an instrument together.  Exercise together.  Find a way to help the community with your child (create masks for health care workers, donate, or deliver food to people who need it and don’t feel comfortable leaving the house).  Whatever you choose to do to spend time and connect with your child, your relationship will come out stronger when the pandemic ends.  This will also SIGNIFICANTLY help to maintain your child’s behavior as they will feel grounded and secure during these difficult times.

4. Listen & talk to your child about their feelings regarding the pandemic

The other day, my 7 year old daughter told me she feels worried about the pandemic.  She said that she is afraid that she will never get to go back to school again.  She shared that she is worried that her grandparents will die from COVID-19.  Clients who I have spoken to through telehealth the last few weeks have said the same.  Listen to your children and help them process their emotions.  Acknowledge your own fears and worrisome thoughts as well while talking to your child.  For example, it is okay to say, “I am afraid too.”  However, provide comfort and reason as well.  For instance, you may say, “There are a lot of unknown factors right now but as long as we stay home and practice social distancing, we should be safe.”  Remain calm.  Check in with your own emotions and find ways to cope.  Let your child know that you are there to listen and provide reassurance that we are in this together.  Ask your child about ways they can help others during these times.  Although there are a lot of uncertainties, your child will see and remember how you and your family dealt with crisis and the pandemic.  This teaching will be extremely valuable in their future as they will have a better understanding of how to deal with uncertain times and crisis situations.

We hope you and your family stay safe and are well.  If you need any support, please do not hesitate to reach out to us!