Heather Good, MA, LLPC
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Good Alchemy Mental Health & Wellness Blog

Al-Anon: My Version of the 12 Steps

9/28/2024

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What IS Al-Anon? Well, you've likely heard of Alcoholics Anonymous, the 12-step program that started it all... including Al-Anon, or Al-Anon Family Groups. AAFG was founded in 1951 as an international mutual aid organization for people who have been impacted by another person's alcoholism. There is Alateen, a 12-step support group for teenagers affected by someone's drinking. 

I was raised amidst Irish Catholic alcoholism on both sides of my family of origin, and began going to Al-Anon meetings 25 years ago this year (2024). It started as a support group to learn more about how growing up with my father's drinking impacted me... all I really knew at 18 was that I had some fierce "daddy issues" and I knew the drink played a part in those issues, that relationship, and what I internalized as a result. 
I went on to marry an alcoholic, and my divorce was tinged with my own variation of denial and the 'pink cloud' - it was as if I couldn't really see or register his drinking behaviors, frequency, and effects. I was a fish swimming in the water of alcoholism, it had been normalized without ever following with that right feeling. There has always been a something-is-off sense about alcoholism for me--a vague, nagging wound, a sometimes very bright lit of an epiphany I run into, and sometimes an old closet I have thoughts, feelings, and beliefs buried in. 

When I started going to meetings in my 20s, I was guarded and unsure. I had an edge about me, red-haired and angry in my own finding-her-femme way, and I think of that young queer redhead today and wish I could hold her tight. Hold her eye contact and pour time out for her, show her the tapestry of progress we've made in invisible corridors of our psyche. 

"Progress not perfection" is one of the slogans of the program. Push aside the poor writing, the cheesy language, and the patriarchal, american christian connotations that the Anonymous programs are laden with and you'll find there is a facet for you. That you belong. That you can be heard, seen, felt, understood, without the crosstalk of someone saying "I know JUST what you mean," or "When I was a kid..." or immediately relating to themselves in otherwise dismissive, self-absorbed responses.

In Al-Anon meetings, there is real respect in witnessing a person's sharing, in showing care and compassion and non-judgment in listening and holding space for their sharing, and group norms that reiterate no crosstalk, advise, or solutions from other meeting participants. You share or you don't and the meeting continues to move, with you as a part of it. It's a unique feeling, that kind of being seen--vulnerable, I think, because these are parts, feelings, experiences, and archaic beliefs within the constructs of our mind and memory have been shuttered, blocked, held fast in some deep valley of our experience. 

For many of us, the experience of being invalidated, controlled, or brainwashed by religion (Christianity in particular) in earlier life is intertwined and in fact very akin to our experience of alcoholism in the family. Unfortunately, 12 step program language and literature utilizes the pronouns he/him to refer to an externalized, monotheistic God. 

Peek into the history of recovery in the U.S., and in Alcoholics Anonymous program, and you’ll quickly find relations to the King James version of the Christian Bible. The A.A. slogans “First Things First” and “Easy Does It” were taken respectively from Matthew 6:33 and 6:34. It’s no doubt that Al-Anon Family Groups have their philosophical roots in Christianity—and that is problematic for a great many people, especially those who were raised in an oppressive household where religion and alcohol were abused or exploited in the parent/child power dynamic.
In the spirit of "progress, not perfection," I re-envisioned and wrote out the 12 steps out in my own translation, influenced by depth psychology, mindfulness-based CBT, and internal family systems. I also wrote these in the spirit of self-empowerment, mindfulness, conscientious self-reflection offered in a spiritual-not-religious light.

Heather's Revised 12 Steps for ACOAs:  

  1. Admitted that we were powerless over alcohol—that we had no control over other people’s drinking and the impacts that alcoholism/addiction had on us.

  2. Came to believe we could find support and resources greater internally and externally in our lives to help restore our sense of interpersonal safety and emotional security.

  3. Tuned into our authentic sense of self, seeking greater understanding, clarity, and intuitive knowledge.

  4. Made a fearless inventory of how we were affected by alcoholism and have perpetuated denial in our lives.

  5. Were willing to confront and analyze flaws, inner barriers, people-pleasing patterns, and limiting beliefs with self-reflection that values depth, curiosity, and compassion.

  6. Admitted to ourselves and to another trusted person the damaging experiences and corresponding attitudes/feelings/beliefs that previously were unconscious or otherwise unseen as a result of someone’s drinking.

  7. Courageously examine conditioned beliefs, behaviors, or blind spots in the psyche related to the family dynamic. Humbly acknowledged shortcomings, understanding that these shortcomings are in part a result of learning to cope with inconsistency, denial, and unmet needs.

  8. Made a list of how we have self-harmed, self-denied, and/or sabotaged ourselves, or ways in which we have harmed others (intentionally or unintentionally).

  9. Determined what healthy boundaries need to be to reflect my values, and communicate them to others (except when doing so would cause harm).

  10. Continue to act with a sense of self-awareness and self-responsibility, utilizing mindfulness, reflection, and expressive arts as therapeutic tools. 

  11. Sought, through these therapeutic tools and skills, ways to better engage with healthy personal power and feel genuine presence and peace.
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  12. Having had an awakening as the result of these steps, we try to carry this message of growth potential to others and practice these principles in our inner and outer lives.
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Top Essential Oils for Mental Health & Wellness

3/9/2024

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I often refer back to my experience as a massage therapist/bodyworker and yoga teacher. These experiences developed me just as much as any other training, degree, or employment--and took up a lot of my 20s. These lessons and insights of working with the body, and with deep respect for the mind-body connection, show up as a strength in my clinical practice with the integration of somatic techniques. One tool that I used, and continue to use in a variety of personal and professional applications, is essential oils. I wanted to write about their potency in the context of mental health and wellness for this blog post for anyone interested in learning more--without pushiness, or any kind of multi-level marketing business involvement. This is purely for sharing the benefits of essential oils and what they offer in terms of enhancing and healing our feelings and our lives. 

Natural Health Shouldn't Be a Privilege 
Whether a client is interested in lifestyle changes, or natural health tools, methods, and treatments, I begin with not assuming that things like supplements, bodywork, and nutritional supports are widely accessible. There are a number of barriers that may present for many, not the least of which being financial barriers to wellness through things that cost money, or involve a financial commitment. 

I begin with this acknowledgement, with respect and sensitivity to the limitation of means for many readers. If you do not have access to tools like the ones I mention in this blog post about essential oils, the knowledge and information can still be a benefit to you, now and in the future. I believe that plant-based medicine and health supports should be accessible to everyone who wants to explore or use them. 

No Pitch, No Pyramids
Second, this is not a post to get you to buy something, or sign up for regular orders with a pyramid kind of company like doTERRA or Young Living. While therapeutic-grade essential oils are touted as the most effective, my intention here is not to steer you to buy any particular brand of product. I hope you will find an affordable, sustainable, organic source for your oils and do your olfactory research before buying online. 
Tips for Purchasing Essential Oils

Essential Oils: Not the Only Tool, But Oh So Cool
Now, to the good stuff: the sniffing aromas of plant essences to help our brains function properly, or better. How cool is that? I've been nerding out on it for about twenty years now--and I've definitely not over how cool the chemistry of it all is. When inhaled, the essential oil's constituents can activate certain neural regions, like our limbic system (think: lizard brain behavior). That has some powerful implications when it comes to caring for ourselves when stressed, triggered, afraid, or upset. While EOs won't be the only tool you will rely on in the care and keeping of you over time, your mind and your space will benefit from you learning how essential oils can work for you and boost your sense of wellbeing in your life and home. 

To smell the sweet, mild stimulation of the scent of tangerine diffused in the air enlivens the space  with a kind of lightness and vigor. I've experienced the mood-boosting effects of citrus oils diffusing in a space, and recommend using citrus oils like grapefruit, bergamot, and lemon specifically for lifting the spirit, energizing and clearing a space, focused activities, and concentration enhancement. 

Application of EOs
I recommend diffusion, aromatherapy baths, and/or topical application if you want to use EOs to influence the mood, or for mental health benefits. Pure, organic, therapeutic grade essential oils are best.
Ways To Use Essential Oils
Pet-safe Guide to Diffusing Essential Oils
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Queen Lavender: Still Ruling
Good old lavender oil, clinically proven to be effective in lowering hypertension and anxiety, has quite an impressive resume. It consistently ranks the #1 oil for overall mental health benefits. Lavender essential oil has been found to be effective in:
  • calming anxiety without being sedating;
  • lowering adrenaline and cortisol levels in the blood, as well as lowering high blood pressure and heart rate; 
  • reducing restlessness, insomnia, agitation, and nervousness that may be connected to symptoms of anxiety; 
  • improving mood, quality of sleep;
  • interrupting the body's stress response (fight, flight, freeze, fawn); and 
  • soothing depressive symptoms and the impacts of stress and fatigue.
8 Recipes for Relaxing with Lavender Oil 

Top EOs for Mental Health & Wellness:
  • Basil Sweet Essential Oil
  • Bergamot Essential Oil
  • Clary Sage Essential Oil
  • Frankincense Essential Oil
  • Grapefruit Essential Oil
  • Helichrysum Essential Oil
  • Lavender Essential Oil
  • Lemon Essential Oil
  • Neroli Essential Oil
  • Palo Santo Essential Oil
  • Patchouli Essential Oil
  • Peppermint Essential Oil
  • Roman Chamomile Essential Oil
  • Rose Geranium Essential Oil
  • Sweet Orange Essential Oil
  • Vetiver Essential Oil
  • Ylang Ylang Essential Oil

My personal favorite oil is Palo Santo. You may have seen or used palo santo sticks to purify space. Bursera Graveolens, known as "holy wood" from South America, clears spaces as well as calms the nervous system and soothes the skin. Geranium oil and Clary Sage are fantastic for women's health and healing. Cedarwood, Patchouli, Peppermint, Ylang Ylang each have properties that boost the mood and can be soothing in treating addiction, trauma, health, healing, and grounding in their own ways. 
Palo Santo: How to Use It & Buy It Sustainably


Let Your Sniffer Be Your Guide
I encourage you to get to know essential oils over time, their personalities, profiles, benefits, and scents. Learn and experiment with them at your own pace, and let your sniffer be your guide--it won't steer you wrong in selecting what your whole self can benefit from. 

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Neurodiversity within ADHD: Theories on Diagnostic Typologies

3/6/2024

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While there is no scientific consensus regarding the existence of these distinct types of ADD (which is categorized by the DSM as ADHD with three main types), we still find it useful to discuss them as different people absolutely do experience different sorts of symptoms.

1. Classic
The three core symptoms associated with Classic ADD include inattention, hyperactivity, and impulsivity.  Classic ADD is similar to what the American Psychiatric Association describes as ADHD-combined presentation. This is the typical hyperactive/impulsive combination where the individual struggles with staying on task.
Symptoms: Inattentive, distractible, hyperactive, disorganized, and impulsive. Normal brain activity at rest; decreased brain activity during concentrated tasks.
Cause: Dopamine deficiency; decreased blood flow in prefrontal cortex and cerebellum, as well as basal ganglia, which helps produce dopamine. Brain mapping commonly reveals excessively slow brainwaves in the frontal regions of the brain, and frequently abnormal connectivity within and/or between the prefrontal cortex and parietal lobes.
Treatment: Stimulant medications, such as Ritalin, Vyvance or Concerta, or stimulating supplements, such as rhodiola, green tea, ginseng, as well as the amino acid L-tyrosine, which is a building block of dopamine; extra physical activity; fish oil that is higher in EPA than in DHA.

2. Inattentive
Patients suffering from Inattentive ADD often have difficulty with executive functioning such as organization, planning, prioritizing, time management, and self-monitoring. These individuals are easily distracted and/or lack the mental stamina for completing routine tasks that are non-preferred. They typically are not a behavioral problem since they are not hyperactive nor impulsive.
Symptoms: Short attention span, distractible, disorganized, procrastinates, may daydream and be introverted; not hyperactive or impulsive; this type impacts women as much as males.
Cause: Dopamine deficiency; low activity in the prefrontal cortex.
Treatment: Stimulant medications, such as Vyvance or Concerta, or stimulating supplements, such as amino acid L-tyrosine; high-protein, lower-carbohydrate diet; regular exercise.

3. Over-focused
In addition to the core symptoms of Classic ADD, those patients suffering from Over-focused ADD have difficulty shifting their attention from one task to the next. I
Symptoms: Core symptoms of Classic ADD, plus trouble shifting attention, going from thought-to-thought or task-to-task; getting stuck in negative thought patterns or behaviors.
Cause: Dopamine and serotonin deficiencies; over-activity in anterior cingulate gyrus, which makes flexibility difficult. In this scenario, qEEG brain mapping frequently shows the brain being stuck in excessive fast brainwaves of overstimulation, whereby the brain is also functioning in a more rigid and inflexible state.
Treatment: Supplements, such as L-tryptophan, 5-HTP (dietary supplement used as antidepressant), saffron, and inositol (naturally occurring nutrient used to boost alertness, focus, mood and mental clarity); otherwise anti-depressants Effexor, Pristique, or Cymbalta; avoid high-protein diet, which may trigger mean behavior. Neurofeedback.
4. Temporal Lobe
Individuals suffering from Temporal Lobe ADD can be over-reactive or moody, and prone to tantrums or meltdowns in childhood. This type of Temporal Lobe ADD can be associated with memory problems and difficulties in auditory processing.
Symptoms: Core symptoms of Classic ADD, as well as learning, memory, and behavioral problems, such as quick anger, aggression, and mild paranoia.
Cause: Abnormalities in the temporal lobe; decreased activity in prefrontal cortex.
Treatment: Amino acid GABA (gamma-aminobutryic acid) to calm neural activity and inhibit nerve cells from over-firing or firing erratically; magnesium to help with anxiety and irritability; anti-convulsant medications to help with mood stability; gingko or vinpocetine to help with learning and memory problems.

5. Limbic
In addition to the core symptoms of ADHD, sufferers of Limbic ADD may experience increased feelings of guilt, possible moodiness, and, in some cases,  damaged self-esteem. Limbic ADD affects a group of structures within the brain involved in our “flight” or “fight” response system, leaving the individual feeling excessively and unrealistically threatened at times by stressors. This can often mimic and/or go hand-in-hand with stress and trauma responses, or PTSD if applicable.
Symptoms: Core symptoms of Classic ADD, as well as chronic low-level sadness (not depression): moodiness, low energy, frequent feelings of helplessness or excessive guilt, and chronic low self-esteem.
Cause: Too much activity in the limbic part of the brain (the mood control center); decreased prefrontal cortex activity, whether concentrating on a task or at rest.
Treatment: Supplements DL-phenylalanine (DLPA), L-tryosine, and SAMe (s-adenosyl-methionine); anti-depressants Wellbutrin or Imipramine; exercise; fish oil and diet modifications.

6. Ring of Fire (also called “ADD Plus”)
Ring of Fire ADD is characterized by over activity in a global sense, meaning that the brain is over stimulated in multiple areas. Those suffering from Ring of Fire ADD may experience an increase in anxiety, racing thoughts, difficulty falling asleep or sleeping through the night. This person might also be emotionally over reactive and quick to anger.
Symptoms: Sensitivity to noise, light, touch; periods of mean, nasty behavior; unpredictable behavior; speaking fast; anxiety and fearfulness.
Cause: A ring of hyperactivity around the brain (the entire brain is overactive, with too much activity across the cerebral cortex and other areas).
Treatment: Stimulants alone may make symptoms worse. Begin with an elimination diet. If an allergy is suspected, neurotransmitters GABA and serotonin are boosted through supplements, such as GABA, 5-HTP, and L-tyrosine, and medication, if necessary. For medications, begin with anticonvulsants and the blood pressure drugs guanfacine and clonidine, which calm overall hyperactivity.

7. Anxious ADD
Symptoms: Core symptoms of Classic ADD, as well as being anxious and tense, having physical stress symptoms like headaches and stomachaches, predicting the worst, freezing in anxiety-provoking situations, especially if being judged.
Cause: High activity in basil ganglia (the opposite of most types of ADD, where there is low activity).
Treatment: Promote relaxation and increase dopamine and GABA levels. ADD stimulants, taken alone make patients more anxious. Begin with a range of “calming” supplements, such as L-theanine, relora, magnesium, and holy basil. Tricyclic antidepressants Imipramine or Desipramine to lower anxiety, depending on the individual. Neurofeedback to decrease symptoms of anxiety, especially to calm the prefrontal cortex.

References: The information in this list was compiled by Heather Good, a licensed professional counselor. Information was adapted from Dr. Daniel G. Amen’s book Healing ADD: The Breakthrough Program That Allows You to See and Heal the 7 Types of ADD (Penguin Group, 2013), and an article in ADDitude Magazine, The Seven Types of ADD – and How to Treat Each One.


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It's OK That You're Not OK & Megan Devine's Refuge in Grief

3/4/2024

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I honestly recommend Megan Devine's book, It's OK That You're Not OK: Meeting Grief and Loss in a Culture That Doesn't Understand, at least twice a week since I read it in graduate school. It is so widely and inevitably applicable, grounded in wisdom and rich with helpful, mindful advice ideas and practices to cope with grief, not force it away, deny or fix it. 

@refugeingrief writes, "It’s OK That You’re Not OK as "a book for grieving people, those who love them, and all those seeking to love themselves—and each other—better." ​The first weeks and months after someone you love dies are incredibly difficult territory to plumb through on your own--or even know how to do that, how to orient to the loss internally and externally. 

"Many people who have suffered a loss feel judged, dismissed, and misunderstood by a culture that wants to “solve” grief," Megan writes, “Grief no more needs a solution than love needs a solution." Megan also debunks the culturally prescribed goal of returning to a normal, “happy” life, replacing it with a far healthier middle path, one that invites us to build a life alongside grief rather than seeking to overcome it.

Some of the ground Devine's book covers include: 
  • Why typical approaches to grief don't work or feel effective
  • Challenging the myths of grief—there aren't stages, timetables, or unrealistic ideals that we presume about how grief should unfold.
  • Accepting grief as a mystery to be honored instead of a problem to solve
  • Practical guidance for managing stress, improving sleep, and decreasing anxiety without trying to “fix” the pain
  • Suggestions for how to help the people you love—with essays on developing skills, checklists, and methods of comforting others through their grieving process.

I often recommend chapter 14 in particular to friends and families of someone who is deeply struggling with grief, PTSD, depression, mental illness--many mental health conditions result in, mimic, mirror, or otherwise overlap with grief and loss. It all depends on the individual. How this chapter is written beautifully does the emotional labor of educating loved ones on how they can actively empathize, understand, and be of solid moral support when someone you love is grieving, struggling, or stuck. 
Devine's book is known as a grief book like no other, and a resource for people to heal, grow, and normalize their experience of grief. With a mindfulness based orientation, her writing and podcasts offer insights and empowering supports that tune you into, as opposed to out of, your body. I see this as a great service and support to the overarching healing process that is just as individual as grief, and often goes hand in hand with it.

Surviving Early Grief 

This graphic, created by Refuge in Grief, is titled 8 Simple Rules for Impossible Times: How to Survive Early Grief. This is an example of a free, printable, sharable resource they offer that meets a need for all of us, our loved ones, and our communities. 
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I'm grieving / Someone I know is grieving
If this applies to you, I invite you to click on the link above to visit the official Refuge in Grief website. They offer an impressive range of resources, free and available for purchase, including Devine's book, her guided grief journal, podcast, and information about the Writing your Grief courses. As a therapist, I think this is a fantastic, accessible, deeply-needed and attuned body of work that Megan Devine and her team have put together. Find her in the PBS documentary Speaking Grief, and in the new podcast, Here After with Megan Devine. For clinical training and resources for healthcare workers, learn more here.

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Trauma-Informed Care: A Model for Building Safety & Trust

3/3/2024

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According to research, individuals who have experienced trauma are at an elevated risk for substance use disorders, including abuse and dependence; mental health problems (e.g., depression and anxiety symptoms or disorders, impairment in relational/social and other major life areas, other distressing symptoms); and physical disorders and conditions, such as sleep, eating, and body dysmorphic disorders (SAMSHA, 2014). 

The National Council for Wellbeing in 2023 reported that 
70% of adults in the U.S. have experienced some type of traumatic event at least once in their lives. Single, multiple, or chronic exposures to traumatic events, as well as the emotional, cognitive, behavioral, and spiritual responses to trauma, are considered elements of trauma. Trauma can happen at any age to virtually anyone, and it can be triggered suddenly or recalled at any time. 

Welcome to trauma-informed care. Trauma-informed care acknowledges there are many ingredients prior to, during, and after traumatic experiences that can help set the stage for recovery (SAMSHA, 2014). These social-ecological impacts are complicated and unpredictable—this is something a trauma-informed provider is in touch with. Recognizing that traumatic experiences and their sequelae tie closely into behavioral health problems, clinicians and community-based programs are building a trauma-informed environment across the continuum of health care. This is what trauma-informed care is evolving into in 2024. It’s not perfect, because we are talking about a system of humans and a tricky one at that. It’s progress, information, and an increase in clarity, education, and considerations for the impacts of trauma. 

What does this mean for clients? It means you are informed of your right to inquire and pursue health care that is, in theory and practice, trauma-informed. This kind of care is designed to meet your needs as a client in a safe, collaborative, and compassionate manner. A trauma-informed provider will work to prevent practices that retraumatize people with histories of trauma who are seeking help or receiving services. It is strengths-and resiliency-based care that takes into account the contexts of your life, such as your home environment, your community, your cultural identities, and so on. The most important foundational piece is your emotional safety as a client. Your therapist and health care team should feel safe, inclusive, and foster a non-judgement, supportive environment. 

Trauma Resources
If you want to delve into supportive resources out there on the internet, there is a wealth of PTSD and trauma-specific materials and modalities to choose from. Below are a few of my favorite, most reliable recommendations when working with people who want to learn and understand as much about trauma and its impacts to them for the sake of self-study and growth. 


How to Manage Trauma Infographic

David Baldwin’s Trauma Information Pages: These Trauma Pages focus primarily on emotional trauma and traumatic stress, Post-traumatic Stress Disorder and dissociation, whether following individual traumatic experience(s) or a large-scale disaster.   

Anxiety and Depression Association of America: The ADAA is the only national, nonprofit membership organization dedicated to informing the public, healthcare professionals, and legislators that anxiety disorders are real, serious, and treatable. ADAA promotes the early diagnosis, treatment, and cure of anxiety disorders and is committed to improving the lives of the people who have them. The ADAA website provides information about the symptoms of PTSD and how it can be treated, in addition to offering a PTSD self-screening tool.


Books:
  • Trauma is Really Strange ebook/graphic novel
What is trauma? How does it change the way our brains work? And how can we overcome it? When something traumatic happens to us, we dissociate and our bodies shut down their normal processes. This unique comic explains the strange nature of trauma and how it confuses the brain and affects the body. With wonderful artwork, cat and mouse metaphors, essential scientific facts, and a healthy dose of wit, the narrator reveals how trauma resolution involves changing the body's physiology and describes techniques that can achieve this, including Trauma Releasing Exercises that allow the body to shake away tension, safely releasing deep muscular patterns of stress and trauma.  
  • The Complex PTSD Workbook: A mind-body approach to regaining emotional control and becoming whole (Schwartz  2017);
  • Healing from Hidden Abuse: A journey thorugh the stages of recovery from psychological abuse (Thomas 2017); 
  • Trauma-Sensitive Mindfulness: Practices for safe and transformative healing (Treleaven, 2018). 
  • It's OK That You're Not OK by Megan Devine. You can learn more about Megan at www.refugeingrief.com, including information on her Writing Your Grief classes, resources, and blogs for grief support. 

Reference: SAMSHA. Treatment Improvement Protocol (TIP) Series, No. 57. Center for Substance Abuse Treatment (US). Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2014.
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A Depth Psychology Couples Intake Questionnaire for Deep Diving & Reflection

3/3/2024

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Inspired by the questions posed in Goals for Couples Therapy, I blended my standard couples intake questionnaire with this and perspectives from llyn Bader & Peter Pearson of the Couples Institute. The result? A robust, if not verbose, list with a Depth orientation of questions to freewrite from, consider, and reflect on before or during couples therapy treatment. 

Your Couples Therapy Experience & Expectations
  • Have you done couples therapy together before?
  • Have you done couples therapy individually, with another partner, before?
  • Did you have a positive, neutral, or negative experience? 
  • Are there negative connotations you hold about couples therapy?
  • Why seek help now? Is there a singular problem, issue, or event that led you to decide to come to couples therapy?
  • Whose idea was it to come to therapy?
  • What do you want to get out of your sessions?
  • What are your expectations for therapy/counseling?

Your Relationship
  • How long have you been together and in what capacity?
  • If your relationship was a book or a movie, what would it be titled?
  • If your relationship was a music band or performer, what would it be?
  • What are your biggest strengths as a couple?
  • What initially attracted you to your partner?
  • What was the beginning of your relationship like and how long did this phase last?
  • What happened that first caused you to feel disillusioned with your partner? Did this lead to any changes in your relationship?
  • How long has it been since things were good between the two of you? What caused things to go downhill after that?
  • Draw a relationship timeline and point out when your relationship satisfaction changed along it from when you first got together until now.
  • Name the top three concerns that you have in your relationship with your partner (“1” being the most problematic):
  • What issues have your relationship been through in the past?
  • Do you feel on the same page as your partner in terms of what you want out of therapy?
  • Do you feel on the same page about what you envision would be a better life together?
  • How important is it to you to improve the quality of your relationship?
    (not important) 1 2 3 4 5 6 7 8 9 10 (extremely important)
  • How willing are you to make “working on this relationship” a priority in your life? (not willing) 1 2 3 4 5 6 7 8 9 10 (extremely willing)
  • Have you reflected on your respective childhood on potential origins of problematic habits?
  • What insights, if any, have you gleaned from reflecting on your childhood experiences and conditioning through your own processing so far?
  • What role have you played in contributing to the problems in your relationship; what tendencies do you have and what actions have you taken that have helped create or have added to the difficulties between you two?
  • Please make at least three suggestions as to something you could personally do to improve the relationship regardless of what your partner does:

Areas of growth potential and objectives for couples counseling:
□ Improvement of communication
□ Ability to resolve conflicts together
□ Develop/improve co-parenting skills and balance of parenting duties
□ Learn how to problem solve together
□ More intimacy (emotional)
□ More intimacy (sexual)
□ More quality time together
□ Resolution/progress with my individual issues
□ Resolution/progress with my partner’s individual issues
□ More autonomy in my relationship
□ Foster more respect/understanding between us
□ Examine and address power and control issues in relationship
□ More hobbies alone/alone time for yourself
□ More hobbies together/shared activities
□ More social contacts, time with your individual friends
□ More social contacts, shared time with friends
□ More sharing of the chores
□ Help managing household
□ Help with child(ren) behavioral issues

Stress & Coping
  • What is your current level of stress (overall)?
    (No stress) 1 2 3 4 5 6 7 8 9 10 (extremely stressed)
  • What is your current level of stress in the relationship?
    (No stress) 1 2 3 4 5 6 7 8 9 10 (extremely stressed)
  • Are you aware of your own stress response patterns?
  • What can trigger reactivity and defensiveness in you?
  • Are there any negative coping mechanisms you use (negative coping strategies, such as substance abuse, drinking/eating (too much or too little), nail biting, smoking, becoming aggressive or violent, spending money impulsively, etc.) when stressed or in conflict?
  • Please describe any significant or stressful life events that you are experiencing, such as: 
Economic problems? 
Difficulty accessing health care?
Legal issues or crime?
Discrimination? 
Cultural issues?
Transitioning (transgender)?
Family conflict?
Lack of support?
Social problems?
Educational or occupational difficulties?
Housing problems?
Eating disorder? 
Grief or bereavement?
Other:

Substance Use & Habits
  • Do either you or your partner drink alcohol or take drugs to intoxication?
    □ Yes □ No If yes for either, who, how often and what types of drugs/alcohol?
  • Please describe your current habits in each of the following areas:
Smoking:
Gambling:
Drinking:
Drug use:
Caffeine intake:
Exercise:
Eating:
Sleeping:
Fun and relaxation:
  • What are good ways you know how to cope (positive coping strategies that work for you)?

You
  • Please list any psychological or physical conditions you have been diagnosed with:
  • Have you ever been hospitalized for psychological or psychiatric reasons?
  • Medications you currently take:
  • On a scale of 1 to 10, how aware or in touch with your emotions are you
    (1=not at all and 10=extremely)? Explain the rating you give yourself.
  • How would you describe how you best receive love?
  • Please rate your current level of relationship satisfaction by circling the number that corresponds with your current feelings about the relationship:
    (extremely unsatisfied) 1 2 3 4 5 6 7 8 9 10 (extremely satisfied)
  • Do you want to be in this relationship? On a scale of 1 to 10, describe your level of commitment to your relationship (1=not at all, 10= extremely). Explain the rating you give yourself.
  • What doubts do you have around this relationship?
  • What hopes do you have for this relationship?

Sexuality
  • How satisfied are you with the frequency of your sexual activities?
    (extremely unsatisfied) 1 2 3 4 5 6 7 8 9 10 (extremely satisfied)
  • How satisfied are you with the quality of yours your sexual activities?
    (extremely unsatisfied) 1 2 3 4 5 6 7 8 9 10 (extremely satisfied)
  • Do you have sexual trauma in your personal history?
  • Is your partner aware of your sexual trauma, if applicable?
  • Are you aware of what a sexually satisfying relationship right now would feel like?
  • What don’t you like about your sexual relationship right now?
  • How has your sexual relationship changed since you were first together?
  • Do you feel comfortable talking about sex with your partner in general?
  • Do you feel comfortable talking about sex in therapy sessions?
  • Do you have concerns or areas of growth, exploration, etc., around sex, sexuality, gender identity, or expression that you want to bring to couples therapy?

Safety, Security & Connection
  • Have either you or your partner physically restrained, harmed, or injured the other person? E.g., pushed, shoved, grabbed, or slapped, etc. □ Yes □ No
    If yes for either partner, who, how often and what happened?
  • Has either of you threatened to separate/divorce as a result of the current relationship problems? □ Yes □ No. If yes, who? ____Me ___Partner ___Both of us
  • If married, have either of you consulted with a lawyer about divorce?
    □ Yes □ No If yes, who? ____Me ___Partner ___Both of us
  • Do you perceive that either you or your partner has withdrawn from the relationship?
    □ Yes □ No If yes, who? ____Me ___Partner ___Both of us
  • Have you or your partner ever emotionally or physically cheated on each other?
    □ Yes □ No □ Unsure If yes, who? ____Me ___Partner ___Both of us
  • How comfortable are you if your partner spends free time away from you?
  • Do you enjoy being involved in activities separate from you partner? What do you like to do in those situations?
  • When do you feel most content in your relationship?
  • When do you feel most unhappy or frustrated?
  • Do you know what you need to feel safe in this relationship?
  • Do you have a sense of what your partner needs to feel safe, or safer, in this relationship?
  • When you could use support or encouragement from your partner, do you get it? How?
  • When your partner wants support of encouragement from you do you feel that you give it? How?

Your Partner
  • Do you think you are fundamentally compatible with your partner? Do you know what barriers there are to compatibility, if any?
  • On a scale of 1 to 10, how much do you still love your partner(1=not at all, 10=very deeply)? Explain the rating you give yourself.
  • Are there ways that your partner is different from you that you find particularly hard to deal with, accept, or communicate?
  • How are the two or you similar and how are you different?
  • Are you aware of your partner’s fears, stress responses, and traumas?
  • How would you describe how your partner best receives love?
  • On a scale of 1 to 10, how much do you respect your partner (1=not at all, 10=very highly)?
  • What is it about your partner that creates that level of respect in you?

Communication
  • On a scale of 1 to 10, how open are you in expressing your innermost feelings, desires and thoughts to your partner (1=totally closed and 10=totally open)? Explain the rating you give yourself.
  • Are you afraid of your partners’ reactions to you opening up?
  • Does your partner listen to you in a way that feels accepted, validated, and understood?
  • Do you listen in a way that you believe conveys acceptance, validation, and understanding? 
  • What is the area or topic that it is most difficult for you to open with your partner about? Why?  

​Conflict & Resolution
  • What do you do when there is conflict between the two of you?
  • What does your partner do?
  • Are there unresolved conflicts in your relationship?
  • Do you believe these conflicts have the potential to be resolved, ultimately? Why or why not?
  • How do you want to see your relationship grow in terms of conflict resolution?
  • Does your relationship reflect a shared ability to compromise? Is one partner compromising more than the other?
  • Where/when do you struggle to work well together as a team?
  • How do you tackle new problems that come your way as a couple?
  • Do you have relationships with other people that create conflict with your partner, and if so, why?
  • What do you do when you are angry with them?
  • What does your partner do when angry with you?
  • Are you able to have healthy versus unhealthy expressions of anger or do you struggle with emotion regulation or anger?
  • What strengths and weaknesses do you have in resolving conflict?
  • What would you say are your partner’s strengths and weaknesses in resolving conflict?
  • Do you have difficulty setting and/or respecting other people's boundaries? 
  • How do you repair ruptures in your relationship (“make up”)?
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Article Review: Couples Therapy Goals

3/3/2024

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Alison LaSov, a Los Angeles-based Licensed Marriage & Family Therapist, writes in the Advekit blog post, Goals for Couples Therapy, that “couples therapy is a proven effective environment to help get a relationship back on track, out of fear patterns to love and safety.” When I first read this post, I paused for a moment and digested it, appreciating its wording, simplicity, and truth.

I honed in on the “out of fear patterns” because, in my experience, that awareness and process is invaluable to healing. Foundational. As a therapist who sees couples in my practice, I find her perspective and ideas wise, helpful, and succinctly accessible to people interested or engaged in couples therapy. In fact, I began suggesting this reading to people considering couples therapy for the first time, to prospective new couples clients who find me on a site like Psychology Today and are taking that first step to put feelers out, schedule a consult, and perhaps begin on that path of development, growth, and learning for and through their relationship.

This post is also great, recommended reading for reflecting on what goals couples have for therapy, to use the list of goals for home practice, or to deepen the therapeutic practice. To those approaching the overarching process and commitment requirements of couples therapy for the very first time, it can be daunting, vulnerable, full of questions, and moments where you don’t know what to expect. It can also be a triggering town as we face things in ourselves, life, families, and relationships that cause discomfort and emotional responses to surface.

Precisely because this is normal, and will indeed happen as part of the learning and healing process, I believe that individual therapy for each partner is vital to couples counseling really being effective. I normalize and proactively suggest that each individual in the relationship secure their own psychodynamic psychotherapist, as is most compatible with our work together, and that they put forth a willing, honest effort to do the work, whatever that individual work happens to be. I suggest weekly individual therapy with a qualified mental health counselor and weekly or twice monthly sessions for a couple not in active crisis mode.

What I ask from regular couples clients:
  1. Be on the same page as far as engaging in therapy, each be interested in therapy, and each individual be invested in and willing to grow.
  2. Be willing to show up honestly and consistently for couples therapy, at least twice per month, for sixty minute sessions.
  3. Be willing to find a suitable therapist for yourself as an individual to support and reinforce you as a person as well as the work of couples therapy and what may come up as a result of our work together (self-care).
  4. Be willing to surrender control of the dynamic, the outcome, and the session at times in order to stay curious, examine defenses, and embrance steps towards positive change.
  5. Be mindful of your contributions to the relationship, and be honest about what your areas of growth are as you become aware of them in the process of therapy.
In her piece, LaSov emphasizes the importance of being on the same page with your partner as you engage in the somewhat slow, patient, and sometimes uncomfortable process of therapy. I, too, want new clients to understand that being on the same page, mutually engaged and willing, truly is a requirement for progress to be possible, or even to begin.

Getting Started with a Couples Therapist
I’m often asked, how do you know if a couples therapist is a good fit at first? This is a very subjective determination, and a personal, private decision for each individual as well as each couple. The answer is a very general “it depends.” What you feel comfortable with as a client is unique to you, and I believe your most important tool is likely to be your intuition, your built-in feedback system in conjunction with your values and beliefs, comfort and sense of safety.

It’s important to tune into and respect your needs, feelings, and boundaries so that you can feel safe and supported without bias when you meet with a couples therapist. Some clinicians will have very specific training in modalities like Imago, or as I do in Nonviolent Communication. Some will be more structured, others more fluid in their approach. Again, finding what works with and aligns with your relationship, your goals, and your comfort level will be up to you. The bottom line is to evaluate if they’re right for you and your goals together, a determination an ethical counselor will help you in making.

This determination of fit and alignment can hopefully be achieved within the first three sessions, a time span I volunteer to my clients so they feel assured that I will suggest a referral, or perhaps an alternate modality, if I think it will better suits their needs. Couples therapists should be culturally competent, tolerant, empathic and patient while supporting you as a couple with the structure and support of therapy. Where to find a couples therapist? The most accessible online tool for zooming in on couples therapists in your area is through Psychology Today.

Deciding on Goals for Couples Therapy
“Once you’ve decided to take the plunge and go for relationship counseling,” says LaSov, “it’s important to decide on your goals … What do you want to get out of your sessions?” This question is one I ask of new couples clients as well. I want them to show me what they perceive and hope for in couples therapy, which includes long-term goals as well as what sessions are going to look and feel like for them. I also want my clients to understand that couples therapy isn’t an externalized force or protocol that is done “to” you as a couple, or to “fix” things in a number of sessions. If this is what you hope for, however, I want to know.

What do you imagine your sessions will be like, and what do you want to get from them? “Of course, you’ll be looking to gain a better understanding of your partner and yourself,” adds LaSov, but it’s important to be specific with your goals rather than just wanting to fix general relationship issues.”

Enter each session “with a shared goal of conflict resolution and the treatment of specific issues,” LaSov writes, “and both partners can work towards forging a better relationship.” What that better relationship or state of being looks like in relationship depends on who you are and a number of other factors. Knowing yourself, and having the willingness to make the ongoing, concerted, consistent effort to self-reflect and grow personally is the most vital piece of individual groundwork for the efficacy of couples counseling.

“The process calls each partner to stretch self — requiring self-study, honest self-reflection, and raw integrity to engage in feeling your feelings, becoming aware of your thoughts, and exploring how childhood wounds may impact your ability to be a good partner.”

I encourage you to stay tuned for my next post, which will be a compilation of intake questions, home practice reflections, and considerations from a depth psychology perspective for people embarking on or engaging in the often rewarding, rich journey of couples therapy!

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Transcending woo-woo

2/20/2024

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In the early 2000s, I lived in Portland, Ore., where there was plenty of woo-woo culture for a 20-something White girl to soak up. And that I did. Armed with my bicycle and the now-arcane iPod with audiobooks from Carolyn Myss downloaded for my daily commute, I was riding a new age wave in my attempt to find myself, to find insights to feed myself. In retrospect, I was probably right where I needed to be--this woo woo, so to speak, was the shape of my healing at the time. It was part of my process and my story, and the tools, symbols, and notions about how energy works within and around us served me somehow. It was safe. Safer than the Judeo-Christian model, highly fear- and guilt-based in my upbringing, that was the dominant, normative backdrop of my understanding. I was searching for anything but that. 
​
What did I find in places like the New Renaissance Bookstore on NW 23rd St, a fashionable old home turned new age consumer haven? Crystals, runes, pendulums, oils, cards, books, and singing bowls--certainly. I'd hunker down in the Tibetan Buddhist section of the house, 4 towering wooden bookshelves that felt like a shelter to me. The sense and softness, and the ease of letting go that Buddhism represented soothed me. It didn't insist on toxic positivity, on magical thinking, on human hierarchy in the order of things. It insisted on temperance, on us facing the temperance of life. That felt bold and real to me, even speaking to the parts of me that felt depressive. In all that admission of nothingness, I thought, in the stark truth of Zen Buddhism, was a deeper warmth than all the Baroque era, than what felt like the false promises and avoidant nature of Western religion. What I realize I got out of those studies, that resonance with Buddhism, is validation. A sense of acknowledgment that being imperfect is OK, that we are the sand in the wind. And to keep being. It affirmed for me that figuring things out is the nature of life, and being without a destination, so to speak, that was great comfort. Wherever you go, there you are took the pressure off my decade of soul-searching. Every stone I turned was a fair stone, and I could take my time. 

Fast forward to 2011, where I am teaching a course on Buddhism at the Rudolf Steiner High School in Ann Arbor, Mich. It was one of many electives I taught during my time teaching humanities. Was it my personal favorite? Not really--that would have to be History of Art II, a topic for another time. Putting together that course, though, was probably the smoothest process, the most organic and familiar material to me. I wonder now why so many of my former students remember this course with me more than the others, and what they recall from it. One student, we'll call him Cayden, told me at his graduation, "I'll always remember what you said about trees in that Buddhist class, that was my favorite." In the passing of roses and congratulatory background noises, I smiled and said something encouraging, gracious for his feedback. I couldn't help but wonder what I said, though, about trees. Another student came up to me after the senior play and said, "Ms. Good, your Buddhism course was the best," her Midsummer makeup glittering in the cafeteria light. "Oh, I'm glad it spoke to you--" "It did, and my senior art project is a buddha face with a mask over it that is my face." 

These students, attendees at a private school that prizes the whole self and in using and learning art as a means of being and learning, were incredible artists. I was continually amazed at their productions, at how they could jump into the cold water of creating and start swimming in a way I had never seen so many young people do at once. It inspired me to learn from them, too, to study them and use their gifts as a teacher. For example, I'd mock myself during Mythology lectures by attempting to draw out the plot on the blackboard (having zero drawing skill myself). I learned the fine art of self-deprecating humor when teaching teens. And how to incorporate self-reflection in everything we studied together. 

By the end of my short stint with teaching, I was awestruck by the students. Even the rascals had my heart. I found that my woo woo roots in Oregon served my teaching spell, and some of that magic and awe of the world came through to them, and also because of them. Was it that Buddhism is the answer, or holds some kind of ultimate truth? Not necessarily. I still wasn't joining anything organized or set on a framework that felt like spiritual sense to me as a whole. And now, I realize that was the point--the aimlessness of life is actually a feeling, a grappling, a space of being in-process. Our own journeys and pilgrimages reflected back to us. There isn't so much a simple quip or structure that can seal us in certainty, like "everything happens for a reason," because it doesn't. That urge to find and make sense for and to ourselves? That's the beauty of the individual, of being human, especially during certain life stages when it feels vital to "figure it out". 

I've still got a lot of crystals, stones, tarot cards, and books that hold pieces of me, my past, and of insight and knowledge. I hold and see them differently now, with a kind of earned self that has integrated over time, finding truth in illuminated bits and pieces along the way. I use the Tarot with less literal, externalized power than ever before; it is a tool that I consider a beautiful representation of life, and like any tool, we can get better and better at handling it with care, time, respect, and self-study. 
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    Author

    Heather earned her BA in English in 2006 and her MA in Clinical Mental Health Counseling in 2021. Between those years, she studied the mind and body through teaching yoga, craniosacral therapy, and Western astrology. She is the previous owner of Dharmaworks and currently works full-time as a psychodynamic psychotherapist.

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