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What No One Tells You About Being a Therapist

A therapist’s office is intended to be a safe, warm space that allows for others to express and process patterns of thoughts, feelings, and behaviors. It’s a place where people go to feel better. As a helping professional, I have the privilege of being part of the personal development and growth of my clients. I am deeply passionate about what I do, and I’ll be the first one to admit that I still get goosebumps whenever a client experiences an “Aha” moment. That being said, the mental health profession is not one without challenges.

According to the Philadelphia’s Department of Behavioral Health and Intellectual disAbility Services (DBHIDS), it’s estimated that about 22% of adults in the city are diagnosed with Depressive Disorder, 16% of adult Philadelphians experience frequent mental stress, and 13.8% of teens experience suicidal ideation.

To paint a clearer picture, these statistics mean that in Philadelphia 1 in 5 adults are diagnosed with depressive disorder, and 1 in 7 high school students have reported seriously considering suicide. These startling numbers are not counting the undiagnosed or unreported cases. These rates have remained consistent within recent years, with the exception of a wild increase of opioid-related deaths and ER visits for drug overdoses. With the growing severity of the opioid epidemic in the United States, an already overwhelmed system seemingly only has so much wiggle room before it breaks.

Community Behavioral Health (CBH) is a non-profit corporation contracted by the City of Philadelphia to provide mental health and substance use services to Medicaid recipients in Philadelphia County. There are about 144 Community Behavioral Health organizations in Philadelphia, and I have worked for and with many of them. Although I love the work that I do with clients, working in community agencies has created an entirely new perspective on how therapists and participants are treated among the Community Behavioral Health system….. and I think we all deserve better.

I remember learning about proper ethics and counseling techniques in my graduate program, bright eyed as I geared myself up for a future as a helper. Looking back, it seems so naive for me to have thought that it would be easy. Admittedly, I often wish I could go back to school and pay closer attention to discussions on how to avoid burnout, but sometimes it seems that in the community behavioral health field, burnout is inevitable. Although it would not have changed my choice of profession, I wish I had been more prepared for the community mental health world.

Here’s what I wish I had known:

  1. There are not enough mental health therapists in the community behavioral health system. It seems as though a major theme within the therapist community is the feeling of being overwhelmed by a bogged down system. Community Behavioral Health has an incredible amount of participants in need of mental health care and not enough wo/manpower to provide the quality of care necessary to treat severe mental health symptoms. This means that the large number of participants receiving services are divided among the limited mental health professionals that exist, meaning higher burnout rates for therapists.
  2. There is a major focus on productivity. Full time therapists are given a certain number of clinical hours that they must provide per month, typically called productivity. For example, in my organization, the month of October held 160.63 available treatment hours. I need to achieve 66% of that, meaning I needed to provide at least 106 hours of therapy to meet productivity expectations. If I don’t, I risk being written up. So when we get into the nitty-gritty of things, my work performance is not determined by the quality of therapy I provide, but by the quantity of services I provide. Where I try to validate myself, it is sometimes hard to focus on my successes with clients when I am consistently reminded of “my numbers.” It also makes it more difficult to be understanding when clients cancel, which is often framed as one less hour toward productivity.
  3. Many organizations are turning to fee-for-service. Fee-for-service is pretty self-explanatory. In fee-for-service positions, therapists only get paid for the sessions they complete. This means that if a client does not show up, the therapist will either not get paid, or will get paid a small percentage of what they would have received. Oh, and fee-for-service therapists don’t get paid for the paperwork or outreach they do…. and let me tell you, in this field there is always a lot of paperwork and outreach to do.
  4. Community behavioral health is behind. Think about all of the ethical guidelines, evidence-based practices, and sensitivity training we learned about in school. Now, try to imagine trying to implement those practices in an organization that always seems 20 years behind the present status quo. This isn’t necessarily community behavioral health’s fault. It simply takes time to roll out new methods given the amount of education and training they require.
  5. Sometimes people don’t listen. I feel like I can talk about ethical treatment and appropriate care until I’m blue in the face, and it still doesn’t feel like I am heard. I often find myself thinking of therapists as the nurses of the mental health field– we have an incredible amount of knowledge, have spent years studying the subject, and care deeply about making sure our clients are receiving proper care… and it still feels like we are spinning our wheels just to be heard and respected.

And finally, none of this would matter if we didn’t care. Professionals typically don’t join the mental health field if they don’t care about the well being of others. This makes it even more frustrating when we can see that the overall focus is not on the quality of care we provide, but instead, on the success of the business. Although I can recognize that the business aspect is important, it just does not feel right to put the needs of the business before the needs of people. Helpers feel passionately about the injustices within social systems, because we care about the outcomes of the people we work with. It can be incredibly frustrating to see the above factors as barriers to doing what we love most– helping people.

The Power of Breath

There are several actions that occur in our body without clear direction and effort from our brain. A heart beat, for example, is a powerful and- barring any serious health issues- automatic rhythm that plays a vital role in keeping our bodies alive. My brain always visualizes Osmosis Jones running around inside my body to ensure that every task is being completed without my having to consciously perform them. It makes things, like breathing, seem effortless.

Although we may be accustomed to the effortlessness of breathing, how often do we truly take a moment to mindfully connect with our breath? In meditation, attention to the breath is a method of becoming fully present. By changing breathing pattern, we can produce different states of mind, such as increasing overall energy and relaxing the body and mind. The endorphins released by the body during deep breathing also serve as a natural mood boost. These effects make deep breathing a widely used coping mechanism in managing symptoms of various mental health diagnoses.

Deep breathing does more than influence our emotional state; it can impact our physical health, as well. If you are someone who has a regular exercise/cardio routine established, you have probably realized the importance of having a close relationship with the breath. In distance running, I have learned that the more I pay attention to my breath, the more in tune I am with the rest of my body. Promoting slow, deep breaths can assist in keeping a safe pace to prevent our heart rates from climbing to dangerous BPM’s. Additionally, attention to breath can increase control and power behind movements in strength training.

As stated earlier, through deep breathing our body releases endorphins, which act as a natural pain reliever. By increasing our oxygen flow, we are also improving digestion and detoxifying our bodies through both releasing carbon dioxide and speeding up the lymphatic system. So, next time you meditate, you can visualize the release of toxins along with that negative energy that spews out with every exhale. So whether you’re stressed, overwhelmed, in physical or emotional pain, or experience a variety of physical health concerns, controlled breathing can be a step to a greater overall sense of well being.


Here are a few simple breathing exercises to get you started:

Box Breathing

This breathing technique can act as a powerful stress reliever while heightening performance and concentration.

Begin in a comfortable position. Breathe in through your nose for a count of 4 seconds. Hold your breath for a count of 4 seconds. Exhale through your mouth for a count of 4 seconds. Repeat cycle as many times as needed.

Bellows Breathing

This is a rapid breathing technique aimed toward increasing energy and alertness.

Begin in a comfortable position. Inhale and exhale rapidly through your nose while keeping your mouth shut. Breaths should be as short as possible, but equal in duration. The diaphragm should move quickly. Do this for a cycle of 15 seconds, gradually increasing time with each practice. Breath normally after each cycle.

4:7:8 Breathing

This breathing technique promotes peace and tranquility. This exercise can also be used to more easily fall asleep. It may cause one to feel slightly lightheaded.

Begin in a comfortable position, keeping your back straight. With your mouth closed, quietly inhale through your nose for a count of 4. Hold your breath for a count of 7. Exhale through your mouth, making a whooshing sound, to the count of 8. Complete cycle 3-4 times, gradually increasing the amount of cycles with continued practice.


As always, Wellness Warriors, feel free to provide feedback and share your experiences if you choose to practice these skills. My hope is that these breathing techniques empower you to love and care for your breath while harnessing the art of controlled breathing. Until next time!

Half Marathon Training: Week 4

When I decided to train for a Half Marathon, I wanted to utilize training as a way to incorporate a more stable running routine into my lifestyle. I knew that the following helped: being outside, being around people, exploring the city, exercise, listening to music, taking deep breaths. With running, I could do all of these things at the same time. These simple pleasures coupled with the influx of endorphins are a major component of what keeps my brain from feeling like sluggish mush buried under 10 feet of black goop.

I failed to estimate the challenges of caring for sore muscles, using intense mental energy, attending to detail to avoid injury, REMEMBERING TO STRETCH. But the Buddha said if there is pleasure there must be pain, and so here we are- completing Week 4 of Half Marathon Training, noticing the pain, but focusing on the pleasure… and adding in some hard hitting speed and strength training to really squash that Week 3 plateau before heading into some serious recovery work.

Here’s what Week 4 looked like:

  • Sunday: Run 7 miles
  • Monday: Yoga
  • Tuesday: Stairs (a mile distance)
  • Wednesday: Arm Strength Training
  • Thursday: Yoga
  • Friday: Sprints
  • Saturday: REST

My most intense workouts for the week were stairs and sprints. I join many city residents at the Philadelphia Museum of Art, channeling my inner underdog to mindlessly run up and down the Rocky Steps.

These are the rear Art Museum steps

I usually do about 11-15 rounds of the steps, which usually equals about a mile of stairs. As for sprints, this cardio addition is just a way to increase overall pace. Similar to the speed workout in Week 3, Sprints include alternating between running and sprinting from block to block until I reach my distance goal.

Lesson of the Week: Acknowledge the pain, but focus on the pleasure. I love running for the improvements in mood that I have experience since adding regular exercise into my routine. I have been so thrilled with feeling both physically and mentally healthier that I sometimes fight the urge to push myself too far. Remembering that a major part of training for a half marathon is avoiding injury so I can actually do the half marathon has been the key for me to monitor my pain and take extra care of my body.

Which leads me to my question for the runners out there in Wellness Warrior World: What is your key to avoiding injury?

How to Stay Motivated

My dad always says, “Find something that puts a fire in your belly.” Teenage Me would often roll my eyes, turn up the volume on my latest self-burned punk/emo mix CD and let Travis Barker’s drum beats muffle the unappreciated wise words of my father. As an adult, I can finally understand the sentiment of embracing motivation and passion while pursuing goals. I can also recognize a possibly unintentional deeper meaning here- if left without fuel, fires burn out.

Establishing a goal is the easy part. Hard work comes with actually following through with the steps required to achieve that goal. Maintaining motivation can be difficult, and I always say that building motivation is somewhat of a catch-22. The best way to increase motivation is to just do it (insert Nike symbol here). We feed motivation by reflecting on how we feel as we complete steps toward a goal. Even if the motivation begins as a small flame, we can turn it into a bonfire. Here are some tips for building and maintaining motivation while working toward goals:

  1. Remind yourself of your goals.
    • Write your goals down and display them in a place you look at often. Make sure they are specific and detailed to better organize steps necessary. Take away the “Oh, right, I forgot I wanted to do that” moment and shoot directly for goal achievement. Goals can be easily pushed to the side and forgotten about if we don’t make a point to keep them in our focus.
  2. Discover the WHY.
    • Any task has a number of good reasons behind it. Even small things can be analyzed to find something good. Consider washing dishes. We don’t complete the task for no reason- we complete the dishes in order to have a greater sense of cleanliness and organization (and it helps keep little pestering pests away, but that’s a different blog post). It’s all helpful in creating an image of the bigger picture we are striving for.
  3. Partialize your goals.
    • If we view our goals as one large chunk, it can become overwhelming and cause a person to shut down or give up. By breaking goals down into smaller pieces, we can more easily set targets and obtain a greater sense of achievement. Additionally, developing a deadline for each step can be crucial in maintaining momentum.
  4. Acknowledge your achievements.
    • Track your progress and celebrate benchmarks along the way. Congratulate yourself when you have completing a smaller chunk of the overall goal. Acknowledging progress made toward your goal can propel you forward to the next step.
  5. Be flexible.
    • I have said this so many times that I feel like it should be my new tag line, but: BE GENTLE WITH YOURSELF. If something is not working, be flexible and try it a different way. If you find yourself frustrated, stressed, or overwhelmed, be flexible enough with your deadlines that you can allow yourself a moment to step away and regroup. Achieving a goal looks differently for every person. Don’t just find a process, find YOUR process.

What helps you stay motivated?

Do You Even Gram?

Follow me on Instagram at @the.wellnesswarrior to get a little snapshot of my day-to-day life.

Here are some examples of what you’ll see:

My food experimentation

Me being active

My travels

My feelings turned into cartoons

My face

Urban exploration

My DIY projects

Positivity

Half Marathon Training: Week 3

I finally understand the beauty of running in the rain.

Come one, come all! Have you been running around your city jamming out to an “Emo Forever” Spotify Playlist and letting Gerard Way fuel your mind and your legs as the miles pile on? If not, you probably don’t know the struggle resisting the urge to play air guitar on a 6 mile run, as to maintain good form. Week 3 came hard and fast, and my biggest struggle this week was navigating through the frustrations and fears of plateauing.

Week 3 was a true challenge in attempting to balance pushing myself enough to reach my goals, but not hard enough to cause injury or burn out. There was a new focus on both my mind and body. My brain said, “Push yourself harder or you’ll never be ready in time,” while my body urged me to avoid pushing my lungs into a pace they weren’t ready for. My muscles felt ready, but every time I attempted a faster pace, my body felt overheated and I quickly ran out of breath and steam. I realized I needed to decrease my pace, which definitely solved the issue!

With that in mind, here’s Week 3:

  • Sunday: Run 6 miles
  • Monday: Yoga/Walk
  • Tuesday: Run 3 miles
  • Wednesday: Plyometrics
  • Thursday: Yoga/Stretch
  • Friday: Speed Work
  • Saturday: REST

I enjoy speed work in a variety of ways. For speed, others recommend hill repeats, plyometrics, etc., but in the city it can be difficult to find a good easily accessible hill. Instead, I might find a good, long set of stairs or a ramp. My typical go-to is a quick run workout. For a run workout, I will walk for a block, run for a block, and sprint for a block, and repeat this until I’ve hit whatever the distance goal I’ve set for myself. This week I learned that my body is in good shape, but my cardio needs work- hence the frustration.

Lesson of the Week: Go at your own pace. In the weeks before, I put pace goals on each run workout. From here on, I am just going to focus on completing the miles at whatever pace my body allows. I want to put more emphasis on how I feel physically instead of focusing on the pressure of not feeling fast enough- I’m out there, I’m running, I’m working to achieve a goal. If that’s not good enough, I don’t know what is.

Digging up the Roots of Depression

Anyone can experience sadness, grief, and despair (assuming one has the emotional capacity), but not everyone will experience depression. Depression is characterized by loss of interest, lack of pleasure, changes in appetite or sleep, irritability, low energy, decreased mood, among other symptoms that can have a severe impact on daily life. Try to picture being a slug with no hope and no desire to do anything- that’s depression. It’s like trying to run against the current… while underwater… and someone forgot to give you a scuba tank so you could breathe. Depression is as abundant as the common cold, and it is one of the most common mental disorders in the United States. Although previously believed to stem from chemical imbalance, we now know that root of depression lies among a variety of risk factors, including physiological, environmental, emotional, and situational circumstances.

Physiological factors may include genetics, diet, hormonal imbalances, or chronic illness. Both of my parents were diagnosed with clinical depression at some point in their lives. In my own case, an extensive family history of depression put me more at risk for developing depression myself (I like to call it The Double Whammy). So, while this encouraged me to learn some skills early to manage depression, I didn’t quite understand what it would actually feel like to be- in the words of a client- “cuckoo-nuts,” until it got severe enough that I couldn’t work through it on my own. In some cases, poor diet or hormonal imbalances can relate to decreased energy or mood, influencing depressive symptoms. In my case, this was a chicken-or-the-egg scenario. I’d feel depressed and lose my appetite, have candy or chips or nothing for dinner, and then feel MORE depressed because I was eating like garbage. Often, individuals with chronic illnesses, sleep disorders, or other health concerns experience depressive symptoms, as well, particularly if these conditions cause challenges completing daily tasks and living a fulfilling life.

Depressive symptoms may also be affected by environmental factors. For example, if someone lives in a stressful or chaotic environment, that person may be more likely to experience depression. My own depressive symptoms heightened after moving to the suburbs. Living in a house that I could not afford, working two jobs, and living far from my friends created financial stress, lack of self care, and isolation. I found myself hiding in my room with debilitating anxiety at the thought of coming out of my cave and engaging with my manipulative roommate and her bro-in-denial boyfriend- which often meant navigating my way through stale marijuana smoke and Patron. And don’t get me wrong, I am far from prude, but this wasn’t the lifestyle I wanted or expected when I moved. My inability to cope with feeling stuck in an unhappy and unfulfilling environment was a major factor in my depression spiraling. Additionally, environmental factors may affect those living in a setting with increased violence, domestic disturbance, or crime.

Individuals who experience low self esteem, pessimism, or have a history of physical or emotional trauma may be more susceptible to symptoms of depression. This can be more apparent in people who lack coping skills or positive outlets for emotions. I used to have a saying: “Turn your sadness into anger, and lock it up in a box.” Now, picture me screaming this from the tallest rooftop: THIS WAS NOT HELPFUL. It took a LONG time to realize that feelings are normal and okay, and pretending it does not exist does not mean a feeling goes away. It just means that it’ll eventually come up more bubbly and more aggressive than before, like an exploding pressure cooker, or manifest in symptoms of depression or anxiety. And so, my new saying is: “Listen to yourself.” We experience emotions for a reason, and, whether they are accurate or not, they all deserve to be respected and acknowledged.

Last, but certainly not least, feeling sad is not the same as experiencing depression. Let me say it again: feeling sad is not the same as experiencing depression. However, if you are a human you have probably encountered a situation that has caused you intense grief- and if you haven’t, give me some of those unicorn-and-rainbow sunglasses you’re wearing. Life transitions can be complex. Death of a loved one, issues in work or school, relationship problems, financial issues, moving- these are all situations that can cause one to feel stressed, overwhelmed, distraught. These are some of the situations that I deem the “Big Bad Sad-Makers.” Major life changes can affect daily routine, cause anxiety, and manifest symptoms of depression. If emotions that come from these situations cause disruption in your ability to engage in daily life, it’s something to look at more closely.

While these are common roots of depression, they are surely not the only ones, and many individuals experience more than one of these risk factors for depression. Take me for example- all four of these things joined up to make me a tiny burrito of sadness! From the time I was in college, factors have been coming in and out of my life to cause disruptions in mood, and the one thing that encouraged me most in dealing with my depression was learning about my depression. Everyone has a different experience with mental health, and if I can offer you one piece of advice in tackling your own mental health concern, it is to learn about it. It’s like Voldemort- Harry had to learn about Voldemort’s history, strengths, and weaknesses before he could defeat him. Yes, I just turned Mental Health into a Harry Potter reference… and I think it’s my proudest moment of the day.

Thanks to @depression-patriciajordan.com for inspiring me to write this. It’s not a simple answer, but it’s an answer none-the-less.