Category Archives: depression

2024 Continuing Education

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This 14th year of business was a mixture of delving into some new content; reviewing the basics; and specialized training. I love the variety of sources to inspire my work–and the challenge to tailor experience with each particular client.

I went to a workshop about “divine” and “shadow” femininity and masculinity earlier this year. As a therapist and sex therapist, of course I’ve been analyzing relational and internal energies for my whole life. I see some real limits to associating energies with gender and am committed to fluidity and curiosity. At the same time, the lens of “divine” feminine and masculine is an interesting way to highlight qualities that someone of any gender can incorporate into life, with or without a partner. I’m also fascinated by the shadow aspects. While some religions may prescribe gender roles, they are silent on the shadow side–the problematic ways that gender roles hurt people. In this other framework, divine femininity relates to deep strength in vulnerability, creativity, radiance, acceptance, presence, compassion, timelessness, and flow. Toxic or shadow femininity is associated with hyper-etiquette, passive aggression, gossip, perfectionism, false humility, covert competition, and/or helplessness. Shadow (or “toxic”) masculinity, as many of us know, relates to violence, aggression, entitlement, hostility, impulsivity, bravado, and being caviler. Divine masculinity is protective, providing, initiating, activating, adventurous, focused, grounded, and direct. Anyone can have any of these traits. The shadow sides of each relates to how people cause harm and/or unconsciously sabotage themselves. This framework is one of a thousand that can help us self-assess our growth edges and practice them with ourselves and in relationships.

Another workshop I took this year was back to basics: Interpersonal Psychotherapy (IPT). It’s a comprehensive treatment theory for depression, anxiety, and trauma that involves assessing and treating 4 domains: interpersonal disputes, role transitions, grief, and interpersonal deficits. Intervention techniques include communication analysis, interpersonal inventory, role playing, assertiveness training, and building social support. I also studied an Interpersonal Process Approach book (different from IPT) with a supervisee.

For sex therapy, I attended the AASECT national convention again. This year’s workshops included:

  • The Room Nextdoor: Neural networks and Sexuality (with Emily Nagoski, author of Come As You Are and Come Together)
  • The Fight for LGBTQ Rights in an Age of Fear-Based Politics (with Representative Zooey Zephyr)
  • Black Male Sexualization (with Yamonte Cooper)
  • Intersex Narratives: Navigating Identity, Advocacy, and Sexual Health (with (Pidgeon Pagonis)
  • Navigating Intimacy with Autism
  • Reimagining Menopause and Beyond: A Journey of Empowerment and Clarity
  • Sexual and Reproductive Reality of Breeding Kinks
  • Centering Latinidad in Sex Education, Counseling, y Therapy
  • Assessing Sexual Dysfunction and Preventing Early Onset Psychosis

Additionally, I started learning how to combine two of my specialties. I took a course in combining EMDR and Ketamine-Assisted Therapy. It helped me sharpen both skill sets and develop a couple protocols for combined treatment. Both EMDR and Ketamine-Assisted therapies may help tap into unconscious material and enhance neuroplasticity. This is a treatment option for some people with depression and trauma.

I also completed my last year coordinating trainings with the Queer Affirming Therapist Guild and attended the American Academy of Psychotherapist conference (previous blog post). It’s been a great year!

Beliefs about Growth & Change

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Here are the nuts and bolts–what I think I know about change and resilience

  • The capacity to fully experience both pleasant and unpleasant experiences is key. A wide Window of Tolerance is healthy.
    • Avoidance and denial are only useful short-term survival strategies. Are you able to fully experience and express your unpleasant experiences in real time? Or the soonest appropriate time? This is what grief processing is all about. If the pain is not honored, it may be waiting in the wings to surprise you and project itself into even more situations down the road. Take your devastation seriously (yet don’t act impulsively). Acceptance and meaning develop out of emotional truth (both pleasant and unpleasant truths).
    • Less discussed is Positive Affect Tolerance. Positive affect tolerance is the ability to fully embrace pleasant experiences (love, joy, success, etc). Many folks harbor unconscious fear when a pleasant experience presents itself because they are bracing themselves from future disappointment and pain. They would rather control their experience than ride the emotional highs and lows. This emotional numbing is an understandable strategy yet ultimately limits internal and external connections.
  • Grief is a part of life. If you want to minimize the expense of therapy in your healing journey, you may want to do some serious grief journaling
  • Identify the emotional longing underneath your disappointments, frustrations, and desires. What are you truly longing for? It may not be in line with your initial words or assumptions. For example, if you’re overtly wanting sex, you might be longing to play, be cherished, or to connect. Once you clearly identify your deep emotional longing, you can generate additional approaches.
  • Congruence is vitality. Congruence means authenticity; we can be respectful without masking. Therapy may be a low-stakes opportunity to increase your genuine self-expression, a key ingredient for both autonomy and intimacy.
  • When magic happens in therapy, it’s usually around a Corrective Emotional Experience. If a client is repeating any unconscious patterns or assumptions, I do my best to respond in a way that is helpful, yet goes off-script from the pattern. Relational dynamics that are experienced earlier in life sometimes become expected, maybe even facilitated, unconsciously. The corrective emotional experience can open doors that may increase relational options outside of therapy. This kind of exploration is a huge part of what makes therapy different from other relationships, like friendships or colleagues.
  • Projections. There are a million things I could say about projections. They can wreck havoc on relationships or, if brought to awareness, can be useful in self-development. Recognizing projections can lead to healthy vulnerability and communication. Everyone makes projection errors. When we recognize projections, we can practice self-compassion and repair.
  • Inner child. Self-parenting is cheesy but real, valid, and often necessary. Neglect is gradually healed by taking the inner child seriously and responding with appropriate, consistent self-care (and community-care if you can find it). Our younger selves can be attended to in the here & now.

Ketamine-Assisted Therapy: Procedures and Safety

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After graduating from the Integrative Psychiatry Institute this May (250 hours of education), I’ll be offering ketamine-assisted psychotherapy, starting in July. I’m supporting other local therapists and their clients, offering brief treatment that augments their current work. A round of ketamine-assisted psychotherapy with me would include:

  • a consultation with you and your primary therapist
  • medical screening with a physician (referral available) who would prescribe you the Rx if indicated
  • Counseling/preparation meeting(s)
  • a 3 hour medicine meeting (the last hour we talk/process)
  • a follow up integration meeting within 2-3 days of the medicine meeting
  • consultation and referral back to the primary therapist and any additional resources
  • additional rounds if indicated

Safety:

Ketamine therapy is not for everyone. I’ve seen it effective for treatment-resistant Depression and Obsessive-Compulsive Disorder. Manic or hypomanic states, personality disorders, and/or a history of psychosis contraindicate ketamine. Ketamine involves altered states of consciousness that can increase client vulnerability and projection. There are misuses. For the safety of everyone:

  • I follow best practices in the field (from my clinical training as well as the Big Tent community and the Jules Evans substack)
  • medicine meetings are videotaped
  • I do not touch clients
  • there is no communication between client and therapist between meetings, except to schedule meetings, or in case of an extreme emergency
  • clients are welcome to bring a calm, quiet support person observe medicine meetings
  • All ketamine treatments are conjunct with psychotherapy (this is not necessarily true of IV clinics or “underground” practitioners)

I’d be happy to answer any questions! julia@juliacounseling.com

2019 Summary

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Thank you 2019! Here were the highlights!

  • attended a 40 hour EMDR training
  • hosted a panel presentation of conversion therapy survivors
  • studied the enneagram
  • obtained a Missouri counseling license (in addition to my Kansas one) & became a registered clinical supervisor
  • favorite clinical book I read this year: The Velvet Rage: Overcoming the Pain of Growing up Gay
  • studied men & depression and narcissism
  • facilitated a sex education program for adolescents
  • organized five continuing education events for therapists (Helping Transgender Clients in Transition; Becoming a Resilient Leader; Understanding LGBTQ+ in Islam and Middle East Culture; Sexual Identity, Behavior, and Fantasy with Sexual Trauma Survivors; Therapeutic Touch Practitioners–a Collaborative Resource; and Therapeutic Considerations with LBGTQ+ Active Military and Veterans)
  • joined a biweekly consultation group with 3 other professionals

Dare to Lead

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I’ve been enjoying Brene Brown’s new book Dare to Lead and decided 2019 is my Year of Leadership 🙂  I previously resisted being a leader because I’ve seen poor examples. I overlooked many positive examples of leadership. The DTL workbook helps self-assess leadership skills and is giving me courage to make more leadership contributions.

 

On Fire

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I’ve been reading Woman on Fire: 9 Elements to Wake up your Erotic Energy, Personal Power, and Sexual Intelligence. The 9 elements are: Voice, Release, Emotion, Body, Desire, Permission, Play, Home, and Fire. Amy Jo Goddard offers worksheets and exercises in each chapter to help individual women explore their sexual stories while identifying any stuck-ness, growth edges, preferred experiences, and experiments. I may refer to some of Goddard’s activities and resources as tools to bolster therapy.

Body Image and Sexuality

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Positive sexual experience can be a great way to feel gratitude for one’s own body. Unfortunately, many people’s negative body image interferes with their ability to be truly present with themselves and inhibits their pleasure. Dr. Emily Nagoski identifies some concrete practices to build self-love at the end of her TED Talk: Confidence and Joy are the Keys to a Great Sex Life. Over the last couple weeks, I have been reading her book Come as You Are.

Erotic, Non-Sexual Experience!

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I returned from another week of sex education. I took courses titled the Exceptional Sex Therapist (3 days); Resolving Trauma Through Somatic Experiencing, and Sexuality & Culture. Surprisingly, my favorite course was Introduction to Tantra. Before this course I thought Tanta was having sex for 24 hours at a time, which seemed kind of like a waste of time, honestly. I learned, instead, that tantra is a way of experiencing the eroticism in everyday life, sometimes without any specifically sexual encounters. Tantra is welcoming inter-connection while maintaining a primary connection with oneself. Eroticism bigger than sex—sensory and intellectual pleasure of many types and more of an attitude than particular events. Since March 17th, I keep going back to the 8 Principles of Tantra so I will briefly describe them here.

  • Everything is an Experiment: Beginners mind, openness to experience, observation, willingness to gather data
  • As Within, so Without: what happens in the world affects our individual experience; we need to prioritize and reset our bodies; we can offer our balance to the world
  • Tapas and Spanda: in a concrete visual form, these are the eyes in the yin and yang that reflect the healthy healthy “masculine” energy within “feminine” energy and the healthy “feminine” energy within “masculine” energy. The tapas is about patient, non-attached willpower and the spanda is about a sense of wonderment, thrill, and joy.
  • Inner Marriage: the healthy interconnection of dual, or contrasting energies within oneself. A well-integrated person is able to be consistently present in the world.
  • Multiple Realms of Consciousness: everyday waking consciousness, mythical consciousness (symbols, projections), magical consciousness (big energy, transformation), and integral consciousness (all levels of consciousness simultaneous)
  • Ascending and Descending Currents: chakras
  • Transformational Healing Power of Pleasure: this may be my favorite principle–that pleasure can heal! As a trauma therapist and human being, I know that people can get stuck in trauma, vigilance, and guardedness. True pleasure is the opposite! True pleasure can restore our bodies and clear our minds. While sometimes pleasure can invite trauma processing (for example, someone can remember a painful event while laying on the beach) it also provides a welcome, stabilizing context for healing. It’s important to differentiate impulse and addictions from pleasure.
  • Love: love, like pleasure, heals. It also connects people and connects humans to their surroundings.

 

Healing Body Memory of Trauma

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I took a recent training with Yudit Maros called “Brief, Solution-Oriented Trauma Resolution.” This training specifically focused on troubling sensations in the body that may periodically resurface after the trauma. The BSOTR protocol helps a client attend to and correct the aftershock disturbances in the nervous system and one’s negative self-identity. Here are the most basic steps:

First, the therapist helps the client identify and practice a resource state called grounding. I can guide you through a visualization exercise that depersonalizes the pain and provides more comforting imagery, which tends to regulate the nervous system. We identify and develop comfortable imagery that helps you reset. Then, I ask you to scan your life history for anything that feels pleasurable and safe. We detail key components of the experience and you practice re-experiencing the positive experience and people. Later, we scan your life history again for an unpleasant or traumatic experience. I interview about what you would have preferred to experience. Then, I facilitate your current, grounded self attending to and taking care of your younger, distressed self through a series of self-care invitations, visualizations, and self-dialogue. When it appears that you have been a loving guide to your younger self and you have nothing left unattended about the chosen difficult experience, I invite you back to the here and now of the therapy room.

If you are interested in experiencing this BSOTR process or have any questions, please let me know.

Shame Shields

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I took a webinar with Brene Brown called Shame Shields. Dr. Brown is mostly known for her research on shame, worthiness, and healthy vulnerability. Her research reveals these core tenants about shame:

  • We all have it
  • No one wants to talk about it
  • The less you talk about it, the more you have it
Shame and addiction are interlinked. Addictive behaviors are an attempt to numb, or shield the shame. However, their effectiveness is short-lived and the shame resumes.
Dr. Brown, and separately–researchers at Wellesley College Stone Center–discovered there main subtypes of these shame shields:
  • Moving away — Avoiding, leaving the room, spacing out, daydreaming, distraction
  • Moving towards — Hyper-appeasing, over-flattery, buttering up, sucking up
  • Moving against — Attacking other people, inducing shame in other people
All three shields are an attempt to deflect shame away from the person. Here’s Dr. Brown’s recommended alternatives for shame resilience:
     1) Recognize triggers
     2) Reality check messages
     3) Reach out
     4) Speaking shame
I know these four prescriptions are easier said than done so I am happy to help be a part of the process.