Category Archives: structure

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. Grief work is not about recurring thought-cycles from the past; however, it includes honoring the deep emotional truth you feel presently. 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 possibly skip the expense of therapy in your healing journey, you may want a grief processing strategy. Here’s one option and another
  • 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.
  • When magic happens in therapy, it’s usually around a Corrective Emotional Experience. If a client is repeating any unconscious patterns, assumptions, and solicitations, 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.

2022 & 2023 Continuing Education

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Here’s a quick list of my studies the last couple years…I love my job!

(My year with the Integrative Psychiatry Institute is included in prior posts, skipping it here)

SUPERVISION

  • Clinical Supervision: Ethics & Effective Practice*
  • Ethical Frameworks for Multiple (Dual) Relationships

SEXUALITY

  • Issues & Clinical Implications around BDSM/Kink and Non-Suicidal Self-Injury*
  • Sex & Consent in Contemporary Youth Culture
  • Minimizing STI Stigma with Inclusive Education
  • Building Queer Families: Conception, Emotional & Legal Issues, and Resources^
  • Sex Positivity: what it is and isn’t
  • Decolonizing Mental Health & Sexuality through Irreverent Comedy
  • Sex after Sexual Assault
  • Pelvic Floor Health and Vitality: from Pain to Pleasure*
  • Trauma-Informed Assessment of LGBTQ+ Youth^
  • Emerging Trans: Therapists’ Role in Supporting TNB Young People^
  • LGBTQ+ Older Adults: Strategies and Recommendations^
  • Non-Monogamy/Polyamory Panel^
  • Rewiring Trauma through Kink^
  • Age Play Theory
  • Gender-Affirming Letter Writing for Clinicians^
  • Play Therapy with LGBTQ+ Youth: Caring for the Child, Collaborating with the Parent^

EMDR

  • Easy Ego State Interventions*
  • EMDR & Mindfulness*

OTHER

  • Ethics of Self-Disclosure
  • Suicide Prevention
  • Grief & Bereavement in LGBTQ+ Communities^
  • Borders & Walls: Facing the Other*
  • Differential Diagnosis with DSM 5*

*Longer events, ranging from 4 hours through 4 days

^Events I volunteer organized speakers for the Queer Affirming Therapists Guild

Ketamine-Assisted Therapy: Procedures, Safety, and Science

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I graduated from the Integrative Psychiatry Institute this May! 250 hours of education in psychedelic-assisted therapy was time well-spent.

I’ll be offering ketamine-assisted psychotherapy, starting in July. In addition to treating my own clients, 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:

  • consultation with the primary therapist
  • preparation meeting(s) with the client
  • a 3 hour medicine meeting (the last hour we talk/process)
  • a follow up integration meeting (client creates a plan that applies our treatment to broader mental health concerns)
  • consultation and referral back to the primary therapist and any additional resources

Safety:

Ketamine involves altered states of consciousness that can increase client vulnerability, client or therapist projection, and risk of blurred boundaries. I heard some horror stories on the Cover Story podcast. For the safety of everyone,

  • medicine meetings are videotaped and securely stored according to HIPAA protocols
  • I’m not offering therapeutic touch. I’m trained in therapeutic touch but not offering it. We can identify several grounding substitutes
  • there is no communication between client and therapist between meetings, except to schedule meetings, or in case of an extreme emergency (this is true for non-ketamine clients as well)
  • clients are welcome to bring a calm, quiet support person observe medicine meetings

Mechanism of Action:

If you’d like to know about the science of ketamine, it’s mechanisms of action, and research studies, neuroscientist Dr. Andrew Huberman can help! https://www.hubermanlab.com/episode/ketamine-benefits-and-risks-for-depression-ptsd-and-neuroplasticity

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

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.

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.

Summer 2017 Updates

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What’s complete…

Summer semester is over. It’s always fun teaching Theories & Methods of Sexual Counseling–and a lot of work on top of a full client load. I work late hours during the summer–but getting to know the students is worth it! UMKC graduates plenty of competent, inspiring Counseling students. These interactions give me great hope and faith for the Counseling profession. Most of my work in private practice is one-on-one or with couples. It’s something special to see 20+ Counseling students apply themselves to clinical case examples.

Every year I squeeze additional information into the course. This year we fit in brief discussions of Intersex clients and Sex with Spinal Cord Injuries. We also expanded our conceptualization of “Sex Addiction” into Out-of-Control Sexual Behavior treatment.

What’s next…

I’ve organized extra time in my schedule each week for proactive research & development! Stay tuned!

How to Fall in Love (Again)

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If you’re feeling distant from a partner or loved one and want to reconnect–you may need to:

  • look at your partner with beginner’s mind
  • do the scary work of emotional vulnerability

36 Questions is structure that can help you with these common sense, yet often elusive practices. These questions were developed and tested by psychologists. The results? A pair of strangers fell in love.

Transgender Assessments

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I work with many clients who suffer from gender dysphoria. During any given week, I host several conversations regarding clients’ gender expression as related to their sense of self and well-being. There are several means, depending on the situation, to bolster client efforts in synchronizing their gender expression (cues visible to others) with their gender identity (their self-experienced gender).

Some people seek an official assessment for potential hormone referral therapy. These assessments include an intake of the client’s life history including child & adolescent development; transition goals; coping resources; and any co-occurring problems (such as depression or trauma histories). During later stages in the process, I may invite clients to bring family members into the meetings for increased social support (this part is required earlier for adolescents).

Other clients, such as gender non-conforming people, benefit from deconstructing any unhelpful gender associations & roles they internalized from developmental and social contexts. Then, therapeutic techniques such as assertiveness training help privilege their own unique identity and facilitate choices & empowerment.

Internal Family Systems

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I enjoyed a webinar with Richard Schwartz, developer of the Internal Family Systems therapy model. The IFS model grew out of other family therapy models that examined “roles” each family member inherits in reaction to each other & the family’s overall needs. The IFS model examines various “parts”, or roles, within a person, often developed within confusing family dynamics. For example, an individual is likely to develop various “protector” parts and other parts that are “exiles”–parts that express impulsive or other unwelcome behavior. In the IFS model, healing occurs as each part is attended to with curiosity and awareness. When the parts are understood, they relax and trust a well-informed leader–the “self.”

Schwartz’s IFS website: Center for Self Leadership