Happy New Year! New Year! New Me!

New Year! New Me!
F. Khristopher Blue

A lot of people are disappointment because of what happened this past election year… And I admit, I too was disappointed… Hurt, depressed, anxious, disillusioned, so much more. My team and I hit the airwaves to share our disgust via our radio program M.O.C.K. Talk Radio and POLI-TRICKS but found the more I vented the more I became upset so I ceased such activities.

These last few days I had emotional, mental, and physical breakdown… I just couldn't do anything, nothing. I think I was overwhelmed regarding this transition but I know it also has something to do with my current caseload in my mental health practice. Nonetheless… I woke up today, this morning rather, with a new outlook… I told myself you sit in that chair and I told my alter self you stand there, now it  wasn't really my alter self but it was basically to put myself in the chair as if I was the client… What would I tell my client in this position?

What goals do I hope to achieve in this coming year…?

I hope to establish a healthy lifestyle through diet, exercise, and a good sleep regimen.

I hope to use my creative energy to make impact regarding bringing awareness to issues such as mental health, homelessness, physical disabilities and illnesses etc.

I hope to have a good study regimen so I can pass my certification test for my LCAS and then start another study regimen so I can pass my NCE so I could pursue my LPC. 

I hope to establish the greatest team of all time in this mental-health realm of community support team as well as community intensive services at freedom House recovery Center much like the one I had in the past but have not had in recent years. This is our year the team is there, I have the personnel, we can do this… We will do this!

Now before I get ahead of myself… I must be very realistic in my approach they are certain behaviors that I have that have caused me problems in the past such as not sleeping enough or oversleeping, have a negative attitude and aiming it at people who have nothing to do with it... Indicating that I am the pillar of this community but not following through with"pillar" like activities... Investment in things I don't need, not invested in enough things that I do need, not spending enough time with friends and family, spending too much time thinking about clients therefore not having a balance in life. Balance is key to success… I strive to have balance in 2017 if nothing else. I plan to succeed in 2017 if nothing else. I plan on being a better person in 2017 if nothing else.

New Year... Same Mission (educate, empower, and entertain...) The journey continues with me...

Today's Quotation:

Every new year people make resolutions to change aspects of themselves they believe are negative. A majority of people revert back to how they were before and feel like failures. This year I challenge you to a new resolution. I challenge you to just be yourself.

Aisha Elderwyn

Today's Meditation:

New Year's resolutions do not necessarily have to be about changing a negative aspect of ourselves. Sure, we have flaws, and it is good to be aware of them and to work at reducing or eliminating them. But when we only look at the negative, and direct all our energies on only fixing what is wrong, we often find ourselves facing more difficulty and failure that generally leaves us no better off than we were before. Perhaps as Aisha mentions, the trick instead is to look for potential and places in our lives where we can excel.

When we spend our time focusing on things that we do well, and work hard to become even better at them, we set ourselves up for a high margin of success. And it is far easier to make positive changes in our lives when we are met with success instead of failure. Thus, with each little success we come that much closer to meaningful and lasting change.

This year, instead of looking for all the things you would like to fix in your life, focus on the things that you do well and work at getting even better at them. Just imagine the potential that you might create for yourself and the wonderful things you might accomplish. Remember, the most effective way we can strengthen our gifts is to use them to grow and further ourselves. So why not "just be yourself" this year and work on being the best version of yourself that you can be.

Today's Challenge: Resolve to change and build up a positive aspect of yourself this year.

Questions to consider:

What does it mean to you "to just be yourself?"

What are a few things you are good at? How much time do you spend developing those gifts?

What kinds of activities can you do to develop your own strengths?

For further thought:

In this new year, may you have a deep understanding of your true value and worth, an absolute faith in your unlimited potential, peace of mind in the midst of uncertainty, the confidence to let go when you need to, acceptance to replace your resistance, gratitude to open your heart, the strength to meet your challenges, great love to replace your fear, forgiveness and compassion for those who offend you, clear sight to see your best and true path, hope to dispel obscurity, the conviction to make your dreams come true, meaningful and rewarding synchronicities, dear friends who truly know and love you, a childlike trust in the benevolence of the universe, the humility to remain teachable, the wisdom to fully embrace your life exactly as it is, the understanding that every soul has its own course to follow, the discernment to recognize your own unique inner voice of truth, and the courage to learn to be still.

Janet Rebhan

COMMUNICATION SKILLS

COMMUNICATION SKILLS

The skills that promote good communication and constructive resolution of conflict are, among others: selfdisclosure, explaining, active listening, perspective taking, reframing, and brainstorming. Tests of these skills, particularly active listening and perspective taking, show that is is helpful when at least one person in a conflict makes an attempt to listen fully and understand the point of the view of the other person.

1. Self-disclosure

When you self-disclose, you reveal to the listener some aspect of how you are feeling, especially that which you might have been trying to conceal. You also share with the listener what it is that you really need, without engaging in bargaining ploys to manipulate the listener.

2. Explaining

When you explain, you provide the listener with information about aspects of the situation that you are most concerned about. Both selfdisclosure and explaining must be done without using language that is blaming or disrespectful of the other person.

3. Active listening

When you actively listen, you turn your full attention to the overall message of the speaker, as well as the details, rather than focusing on your own concerns or on counterarguments. You also provide feedback to the speaker in order to ensure that you understood the message. The feedback may involve paraphrasing what you think the speaker said, and asking questions to clarify. It should not include an evaluation of, or a counterargument to, what the other person said; rather, it should be an attempt to understand the other person’s needs and concerns as he/she sees them.

4. Perspective taking

Perspective taking is largely an internal process in which you try to understand how it might feel to be the other person in the situation. It is fostered by active listening. In other words, perspective taking is trying to understand the other person’s needs, concerns, difficulties, and pain in this situation. It is often referred to as “putting yourself in the other person’s shoes.” Perspective taking and active listening can help move the situation from an adversarial one in which your needs are pitted against the other person’s, to a collaborative one in which you are working with the other person to satisfy both sets of needs.

5. Reframing

Reframing proceeds from active listening and involves moving further away from an adversarial ‘‘me against you’’ situation toward seeing the situation as a mutual problem to be solved collaboratively. It can be initiated by such statements as ‘‘what can we do so that you get what you need which is … and I get what I need which is...?’’

6. Brainstorming

Brainstorming comes after active listening and reframing, and involves coming up with as many solutions as possible for the problem, without critiquing them at first, and then narrowing them down to come up with the solution or set of solutions that best fits everyone’s needs. Generating many solutions, quickly and without evaluation, can help with creativity, and lead to unexpected resolutions.

I Love These E-Mails, or Do I?

I Love These E-Mails, or Do I?
The Use of E-Mails in Psychotherapy and Counseling
By Ofer Zur, Ph.D.


To cite this page: Zur, O. (2008). I Love These E-Mails, or Do I?
The Use of E-Mails in Psychotherapy and Counseling. Retrieved 9/23/2008 from http://www.zurinstitute.com/e-mail_in_therapy.html.


I checked my e-mails the other day and saw that a client wanted to change his appointment for the following week. I swiftly responded affirmatively. Next I shot off an e-mail to a client asking her whether or not she could change her appointment the next Monday from 10 am to noon. Within seconds she responded with a one-word response, "Yes." A couple of months ago I discovered that I needed to be out of town the following week due to a family emergency. In one swoop I sent a single e-mail to a couple of dozen people (using Bcc not CC so their identities and e-mail addresses remain private), telling them that I would be out of town the next week, I would neither be available by phone nor by e-mail during that time, giving them names and phone numbers of my emergency back-ups, and asking them to let me know if they could make the same day and same time appointment for the week after.

Don't you like these e-mails? I do! They are simple, quick and effective. Long gone are the days where we play phone tag with clients; when we need to start the phone conversation with "How are you?" only to listen to a long winded response; hear long back-and-forth scheduling messages; get busy phone lines, get put on hold, deal with overworked, low paid, irritated receptionists or operators. These e-mails have saved us-therapists time and energy so we can focus on what is important. Many of us-therapists love the flexibility allowed in receiving and sending e-mails from our computers, Blackberrys or iPhones during working and non-working hours, from the office, living room, beach, boat, another country, or… from whenever or wherever.
Realizing how helpful e-mails can be, many therapists have started giving their e-mail addresses to their clients, including them on their business cards and posting them on our professional Websites. After all, they can save time and spare us from long, wasteful phone conversations.

Then, I woke up the other day to a short e-mail from a depressed client: "Doc, I cannot take it any longer!!!!!" I noticed it was send at 2 AM. Now what am I to do? Send an e-mail, call the patient back, call her listed emergency contact (not a good idea, it's her toxic mother), call the local crisis team or 911, or …?

Another morning, I got an e-mail from a client who was so excited about her 'break through' dream the night before, how it relates to our therapy, and apparently I was in it. Scrolling down the e-mail I noticed it was several pages long. Even though I was aware of the clinical significance of the dream, I did not have the leisure or desire to spend half an hour reading her dream that morning. She felt deeply offended and disvalued when, during the next session, she realized that I had not taken the time to read her 'break through' dream analysis.

Later on that very night, I checked my email and saw an e-mail from a client which started with: "I know we ran out of time, but there was just one more important thing I wanted to tell you." He proceeds to write an insightful e-mail, in essence extending the session by about 20 minutes. We neither have an agreement that he would pay for reading time nor would it fit within his rather tight budget.

A young woman had gotten into a fight with her best girlfriend, who is the topic of discussion during many of our sessions. She wrote: "I am so upset, can you believe that she told me ……" She went on to express her distress and rage in a long-winded e-mail. She got furious with, what she called, the "dismissive" response of "I am so sorry about the fight with your friend. Let's discuss it further when we meet this week."

Many therapists report that clients often ask them "quick" questions via "brief" e-mails, such as "My mother is coming over tonight, should I bring up with her what we discussed in our last session about my brother molesting me?" or "I met this girl, she seems perfect and I am panicked. Do you have any quick advice? We have a date later on tonight."

E-mail, like any technology, has at least two sides, if not more. Like a hammer it can be constructive and helpful or can be misused and be destructive. In our MySpace era, where social networking takes much of many people's leisure (and often non-leisure time), there is an expectation that anyone with an e-mail address is instantly available and responsive, 24/7, therapists included.

We used to check our phone messages regularly or have phone message services page us. Now we need to be on the lookout for e-mails from depressed, suicidal or homicidal, or existentially depleted or spiritually lost clients. E-mails were supposed to make our lives easier, not harder. Then come the obvious questions, what if the client committed suicide a day after she sent her "end of the rope" e-mail to me; how to deal with the disappointed client whose elaborate description of her dream went unread; or with the furious young women who felt dismissed because I did not reply with a lengthy supportive e-mail, like her best girlfriend would have done.

The main issue has become what is the proper use of e-mail in psychotherapy? To add to the complexity, there are several legal, ethical, and clinical questions that are related to e-mailing our clients.

The main question is how do we deal with clients who expect us to respond quickly and/or read lengthy and numerous e-mails between sessions? The answer lies in the communication between our clients and us. We must be clear about our parameters in regard to general use of e-mails, time, frequency, etc. While our Office Policies should attend to these issues, personal communication is likely to be much more effective in bringing clarity to the e-mail dilemma. This issue is not likely to be resolved in one conversation. With some clients who rely heavily on online social networking, it is likely to be a continuous dialogue about expectations, disappointments, and boundaries.

If you are ready to engage in dialogue and treatment via e-mail in conjunction with face-to-face therapy, state this to your clients. In this case you many need to inform them how you charge, if you do, for such e-services. Do you charge per e-mail, per minute, or other ways? I suspect that most therapists prefer to use e-mails primarily for administrative purposes and only at special times for distinct clinical purposes. In this case I would explain it verbally either in the first session or when the right time comes. Our Office Policies and Informed Consent to Treatment (see form 1 at Clinical Forms) that we give to each and every client at the beginning of therapy should have a section on policies regarding e-mails. This section should discuss issues of privacy, confidentiality, security, availability, response time, content, emergencies, etc. An example of such a paragraph is:
E-MAILS, CELL PHONES, COMPUTERS AND FAXES: It is very important to be aware that computers and e-mail and cell phone communication can be relatively easy to access by unauthorized people and hence can compromise the privacy and confidentiality of such communication. E-mails, in particular, are vulnerable to such unauthorized access due to the fact that servers have unlimited and direct access to all e-mails that go through them. Additionally, Dr. X's e-mails are not encrypted, and faxes can be sent erroneously to the wrong address. Dr. X's computers are equipped with a firewall, a virus protection and a password, and he also backs up all confidential information from his computers on to CDs on a regular basis. The CDs are stored securely off-site. Please notify Dr. X if you decide to avoid or limit, in any way, the use of any or all communication devices, such as e-mail, cell-phone or faxes. If you communicate confidential or highly private information via e-mail, Dr. X will assume that you have made an informed decision, will view it as your agreement to take the risk that such communication may be intercepted, and he will honor your desire to communicate on such matters via e-mail. Please, be aware that e-mails are part of the medical records, and do not use e-mail for emergencies. Due to computer or network problems e-mails may not be deliverable, and Dr. X may not check his e-mails daily.

There are a number of other questions that come up in relation to e-mails between therapists and clients. They include:
Are e-mails considered psychotherapy or counseling?

Yes. These e-mails, whether profound or mundane, are part of the therapeutic process and are considered part of the clinical records.

If I give my e-mail address to my clients, must I check my e-mails often?

The fact that you give your e-mail address to your clients does not obligate you to check often or even weekly. What is important is that you provide your clients with written information and verbal communication about how frequently you check your e-mail, if you respond to e-mails, and what are your general policies regarding e-mails (see details in the body of the article).

Does using e-mail make you automatically a Covered Entity by HIPAA, which means you must be HIPAA Compliant?

Different experts may give different answers to this question. In my opinion, exchanging e-mail with clients is likely to mean that you have to be HIPAA compliant, if you are not already. (Becoming HIPAA Compliant is not that hard, check our HIPAA Compliance Kit or Online HIPAA Course for CE Credits.)

What about confidentiality and privacy?

Confidentiality and privacy are applied to e-mails in the same ways that they are applied to any other verbal or written exchanges between psychotherapists and clients.

Must e-mails be encrypted?

At the present time, e-mails between therapists and clients do not need to be encrypted, as long as clients are informed about the vulnerability of e-mails being read by unauthorized people, and they elect to use e-mail. (For more details, see above note about Office Policies and the next question.)

What is an e-mail signature and what may it look like?

An e-mail signature goes at the end of the e-mail. It can be set automatically. Make sure that every e-mail to a client or patient includes an electronic signature that covers issues, such as confidentiality and security. Following is a sample of such an e-mail signature:

Notice of Confidentiality: This e-mail, and any attachments, is intended only for use by the addressee(s) and may contain privileged or confidential information. Any distribution, reading, copying or use of this communication and any attachments by anyone other than the addressee, is strictly prohibited and may be unlawful. If you have received this e-mail in error, please immediately notify me by e-mail (by replying to this message) or telephone (707-xxx-xxxx), and permanently destroy or delete the original and any copies or printouts of this e-mail and any attachments.
It is important to be aware that e-mail communication can be relatively easily accessed by unauthorized people and hence can compromise the privacy and confidentiality of such communication. E-mails, in particular, are vulnerable to such unauthorized access due to the fact that servers have unlimited and direct access to all e-mails that go through them. A non-encrypted e-mail, such as this, is even more vulnerable to unauthorized access. Please notify Dr. X if you decide to avoid or limit, in any way, the use of e-mail. Unless I hear from you otherwise, I will continue to communicate with you via e-mail when necessary or appropriate. Please do not use e-mail for emergencies. While I check my phone messages frequently during the day when I am in town, I do not always check my e-mails daily.
Name/Degree/License: xxxx
Address: xxx
Phone: xxx
E-Mail: xx
Web Site: xx

If we e-mail to clients, does it mean we are conducting tele-health or e-therapy?
If the e-mails involved are primarily dealing with administrative issues, such as scheduling, they are not likely to fall under the definition of tele-health or e-therapy. However, if they are clinically oriented (i.e., including assessment or interventions), extensive, and used routinely, they may be viewed as tele-health or e-therapy. There is not a clear line in the sand yet, differentiating between tele-health and face to face therapy, and mixing the two modes can be effective and ethical when done appropriately and competently. (For more information, see out Telehealth Online Course.)

Are these e-mails part of the clinical records, and can they be subpoenaed just like chart notes in the unfortunately not uncommon event of legal action?
Generally, e-mails between therapists and clients are considered as part of the clinical records and can be subpoenaed, just like chart notes. You may want to consider printing important e-mails and placing them in the chart, in case your computer crashes.

Guidelines To Using E-Mail With Clients

The subject and discussion about the role of e-mail in therapy is common, relatively new, unsettled, and very complex. There are a few things that therapists can do to keep clients informed, increase therapeutic effectiveness, and help protect themselves from board complaints and other liabilities.
Clarify to yourself your thoughts and feelings regarding e-mail communication with clients. What are your preferences, your limits, etc.?
If you are considering using e-mails as an adjunct to therapy, make sure you become HIPAA compliant.

Discuss the issue of e-mail communications with clients, when relevant, in the first session. Learn from them about their expectations and clarify your expectations and boundaries. Continue the dialogue as clinically and ethically necessary throughout the course of therapy.

Make sure that your office policies include a section on the use of e-mails.
If you are conducting tele-health, follow state laws, relevant codes of ethics, and have a separate informed consent, which is required in some states, such as California.

Make sure your computer has a password, virus protection, firewall, and back up system.

Make sure that each e-mail includes an electronic signature that covers issues such as confidentiality and security.



To cite this page: Zur, O. (2008). I Love These E-Mails, or Do I?
The Use of E-Mails in Psychotherapy and Counseling. Retrieved 9/23/2008 from http://www.zurinstitute.com/e-mail_in_therapy.html

Copyright © Zur Institute, LLC, 2008. All Rights Reserved. Reprinted with Permission.