Category Archives: treatment theory

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!

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

  • Minimizing STI Stigma with Inclusive Education
  • Building Queer Families: Conception, Emotional & Legal Issues, and Resources^
  • Sex Positivity: what it is and isn’t
  • Issues & Clinical Implications around BDSM/Kink and Non-Suicidal Self-Injury*
  • Sex & Consent in Contemporary Youth Culture
  • 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^
  • 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 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

Defining Success

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I used to work in a university Career Services center. There, I learned that one of the toughest job interview questions was, “How do you define success?” It’s time I answer that question myself.

From my experience, productive counseling meetings incorporate three main therapeutic skills:

  • I provide concentrated attention: capacity to listen, presence, and track the main points from our prior conversations
  • I help someone expand their story: exposing & exploring additional layers
  • I offer concrete options, alternative actions, and resources

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.

Science of Trust

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I took a webinar with John Gottman of the Gottman Institute called “The Science of Trust.” Perhaps Gottman is most famous for his “four horsemen of the apocalypse” theory–that contempt, stonewalling, criticism, and defensiveness poison intimate relationships–and that the long-term success of a partnership can be calculated according to the frequency of these problematic dynamics. This particular webinar about trust explored active, healthy alternatives to repair interpersonal wounds.

Essentially, cognitively-based repairs (appeals to reason, logic, and problem-solving) aren’t as effective within intimate relationships as emotionally-based repairs. For example, empathy, self-disclosure, and investing extra attention/participation into the partnership all work at the emotional level. Emotional interventions help relax someone in distress, thereby encouraging them to make any decisions outside of duress. Within an intimate relationship, logic and “fixing” other’s problems can be experienced as dismissive, shallow, or intrusive.

Many people are not taught intimacy skills–it’s not a formal study in primary school. Some of us learn from family and community role models–other people don’t have this access or experience.

After an interpersonal or developmental trauma, a person is likely to experience hypervigilance–fight/flight responses–and/or avoidance–flight/freeze responses, even within more moderate conflicts. Effective conflict resolution within a healthy relationship requires active participation, deliberation, and transparency from all involved parties. Often, a partner can facilitate a step down the scale of hypervigilance. Gottman and others use the acronym ATTUNE to describe this stance in more detail: awareness, turning towards, tolerance, understanding, non-defensive responding, and empathy. For a great video on empathy, click here: Brene Brown on Empathy.

Does this mean everything has to be hearts, puppies, and sunshine? NO! If people interrupt their conflict or trauma processing, something like the Zeigarnik Effect is likely to happen–people will remember (often at inopportune times) experiences they haven’t ATTUNED to in a healthy relationship. If we haven’t ATTUNED to a partner’s distress, we are most likely telling a negative fictional story about our partner’s abilities.

People who avoid relational conflict have a tendency toward infidelity and and other betrayals, which likely create more (internal) conflict and avoidance.  People who address conflict also practice relaxation and co-construct viable creative solutions, over time, with additional input & information.

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

Daring Greatly

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I am currently re-reading the wonderful book Daring Greatly, by Brene Brown. If I only had a single therapeutic tool or paradigm, Dr. Brown’s work may be the one. Dr. Brown examines yucky problems like scarcity, shame, and defense mechanisms with finesse and humor. For those of you who have not seen her first viral video, here it is: vulnerability .