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!

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.

101 Coping Skills for Depression

  1. Identify potential triggers
  2. Identify your emotions
  3. Take a walk
  4. Call a friend
  5. Practice deep breathing
  6. Meditate for 5-10 minutes
  7. Draw a cartoon
  8. Write 5 things you love about yourself
  9. Stretch for 10 minutes
  10. Go for a run
  11. Play with a pet
  12. Make a playlist of feel good songs
  13. Listen to your feel good songs
  14. Dance
  15. Paint a representation of your emotions
  16. Make a collage using old magazines
  17. Practice handstands
  18. Do 10 push ups
  19. Go for a bike ride
  20. Clean your apartment
  21. Take a shower
  22. Put on your favorite outfit
  23. Style your hair
  24. Read a book
  25. Take a drive
  26. Take photographs
  27. Stay hydrated
  28. Go window shopping
  29. Socialize with someone
  30. Avoid judging your emotions
  31. Create a simple to do list and complete at least 3 things
  32. Cook a healthy meal
  33. Practice yoga poses
  34. Make jewelry
  35. Look at your rock collection
  36. Paint your nails
  37. Put on a face mask
  38. Play with makeup
  39. Video chat a loved one
  40. Free write in a journal
  41. Let yourself cry
  42. Go somewhere very public
  43. Bake
  44. Drink tea or hot chocolate
  45. Look up recipes
  46. Rearrange your apartment
  47. Watch stand up comedy
  48. Practice positive self talk
  49. Use a stress ball
  50. Make slime
  51. Go for a hike
  52. Sit under a tree and read
  53. Spend time in nature
  54. Sit by a river and listen to the water
  55. Read poetry
  56. Look at art
  57. Put a puzzle together
  58. Water your plants
  59. Write a poem
  60. Play ukulele
  61. Make a list of long term goals
  62. Watch America’s Funniest Home Videos
  63. Identify 10 positive thoughts
  64. Write a gratitude list
  65. Read inspirational quotes
  66. Write a song
  67. Get enough sleep
  68. Use essential oils
  69. Take a bubble bath
  70. Plan an activity
  71. Look outside mindfully
  72. Go outside
  73. Crochet a scarf
  74. Listen to a podcast
  75. Play a board game with a friend
  76. Plan outfits for the week
  77. Sing
  78. Practice visualization
  79. Watch a movie
  80. Meal prep
  81. Challenge any negative thinking
  82. Color a picture
  83. Get a massage
  84. Get your nails done
  85. Make worry stones
  86. Go rock picking
  87. Use progressive muscle relaxation
  88. Engage in problem solving
  89. Watch videos of funny children
  90. Write a letter to yourself
  91. Play a sport
  92. Make extra time for yourself
  93. Use lavender room spray
  94. Identify your strengths
  95. Do a body scan
  96. Look at old pictures
  97. Learn a new craft
  98. Spend time with a family member
  99. Volunteer
  100. Light a candle
  101. Explore somewhere you’ve never been

I Quit Social Media and This is What Happened

The power of social media can be an amazing tool. Through the click of a button, we can share ideas, connect with friends and family, and facilitate political change. Although it’s a useful tool, it can also be a dangerous one. Excessive social media use can lead to addictive behaviors, increased mental health concerns, and challenges in time management. It may be important to explore the role that social media plays in our lives to better determine the purpose it serves. After noticing myself grow increasingly frustrated with social media, I decided to take a break. I deactivated all of my social accounts. This is what happened:

1. I stopped comparing myself to others.

  • People only post the best parts of themselves on social media. Realistically, I know this, but that didn’t stop me from noticing the feeling I got seeing other people’s perceived happy lives flash on my screen consistently (getting married, growing families, buying homes). It seemed impossible to not feel behind. After deactivating my accounts, the invisible clock stopped ticking. I could more easily focus on accomplishing my goals without putting unnecessary pressure on myself. 

2. I lived in the moment.

  • The most significant change I noticed was that I spent less time posting about what I was doing and became more engaged in what I was doing. I no longer had to show that I was having fun, but I could simply focus on doing just that: having fun. I engaged more with others, stopped using my phone as a distracting crutch in uncomfortable situations, and felt more connected to my surroundings.

3. I put my phone down.

  • If there is one thing I already knew before starting this project it’s this: social media can be a gigantic waste of time if one allows it. And I allowed it. Oh, boy did I allow it. Being unable to fill my spare time with Facebook scrolling, deep diving profiles, and the like allowed me to fill my time with more productive tasks. I redecorated my apartment, read books, listened to more music, and procrastinated WAY less.

4. I connected with others in a more genuine way.

  • In therapy, I made my own connection between socialization and my mood. I am a person who really benefits from quality time spent with others. It’s my love language, if you will. I realized how distant social media had made me feel from my loved ones—like I was watching their lives scroll by from the outside.  By taking social media out of the equation, I found more effective ways to keep in touch with my loved ones. With my friends and family, I stayed connected through phone, text, or in person, and I felt growth in my relationships that I largely contribute to taking a more active role in maintaining them.

5. I embraced my authentic self.

  • I have always been the weird drama kid with tie-dye shirts, lime green jeans, and Chucks thrown together into what I used to call “fashion.” I have never been the person who cared for others’ opinions and have always prided myself on marching to the beat of my own drum, but somewhere I got lost. As I grew older, I started focusing more on how I was perceived by others, and it took doing this experiment to notice that social media played a significant role in that. I am already someone who puts a ton of pressure on myself, and by comparing myself to others on the internet, that pressure grew even bigger. After putting my phone down, I stopped caring. It made it SO easy to focus on myself, my hobbies, and my goals. 

It has been about two months since I have logged into my Facebook account, and I don’t see myself scrolling in the near future. Of course, social media can be a great tool and resource for staying connected to others, and I can only speak from my experience in learning that social media impacts my life in a way that is not always so great. If anything, this experiment has taught me to be more mindful of how I am spending my time, and I encourage others to examine what aspects of their daily routine may not be serving the best purpose. Have any Wellness Warriors out there eliminated anything in their lives that turned out to me more hurtful than helpful? Let’s talk about it in the comments below!

How to Overcome Regression Toward Goals

Picture this: It’s been a months-long streak of hitting wellness goals. You go to sleep at a normal time and sleep well, embrace a healthy diet that a few years ago you would have scoffed at, and actually find yourself LOVING engaging in regular exercise. And then, boom—you go on vacation, your car gets totaled by a deer, stress builds. Routine goes out the window, and it feels like all of the progress that was made is quickly crawling away from the fires that have engulfed your once safe little nest. 

The thing about fires is that they go out eventually. The flames may burn us, but we can avoid the spiral of negativity and douse the fire with water and positivity until we are left to lick our wounds and move forward. Most of us know how difficult it can be to get back on track when life happens.

Here are 5 powerful strategies to moving forward after hardship attempts to derail progress.

  1. Identify the root of the backslide
  • Before we can find a way back, we need to identify what contributed to our slide in the first place. This can include increased stress from life changes, self-defeating mindsets and behaviors, illness or injury, challenging or more frequent life events, and/or challenges in time management. For example, my car recently got totaled. Working out daily was impossible when I needed to spend my free time looking at cars, talking to my insurance, taking my car to various inspection sites. Attending to my car had to become my priority, given that I commute to work by driving.

2. Try a different approach

  • Maybe while you were exploring the root of the backslide, you discovered some real barriers to working toward goals. Maybe you’ve been planning to exercise in the mornings, but can’t go to sleep early enough? Maybe you’re finding difficulty keeping up with a healthy diet due to limited variety of fresh foods at the grocery story you go to. Achieving goals may require some changes in approach, and that’s okay! Methods are going to look different for everyone. It’s all about finding what works best for you and using that to your advantage.

3. Create a schedule

  • I love schedules. I mean it— I LOVE them. Nothing makes me feel more organized than having a plan—even if it’s just loosely followed. My Sunday routine includes sitting down and planning the week—exercises I want to focus on, meals I want to eat, self care activities I want to do, and other tasks or errands that need to be completed. I create a schedule based on what my week looks like and then try my best to stick with it—but life happens, so I’m always gentle and understanding if my schedule changes in small various ways as the week goes on.

4. Find accountability

  • Studies show that the more people that know about your goal, the more likely you are to work toward it. Working toward holding yourself accountable is monumental in achieving goals, but better yet, finding other people who can hold you accountable creates a whole new layer of support in actually doing what you say you’re going to do.

5. Be gentle with yourself

  • Imagine me shouting the following from the tallest rooftop: Embracing positivity toward self and challenges can make or break the ability to overcome obstacles. Understand that backslides happen. Working toward a goal will not always be a forward motion—sometimes it feels like two steps forward, one step back. Negativity and frustration toward self or circumstances can cause one to shut down and can be a deterrent to finding motivation to work through failure. If needed, go back to the basics until you start to feel your groove again.

As Wellness Warriors, it’s important to put more emphasis on the sense of accomplishment we have when achieving a goal and decrease the focus we may put on barriers. We can choose to interpret hardships as an opportunity to utilize healthy coping skills and celebrate our strength, resiliency, and power. 

Happy Tuesday, Wellness Warriors! Here’s to hoping that the schedule I have outlined for myself allows me the ability to port more consistently now that my car fiasco is resolved!

Fighting Gloom with Gratitude

Have you ever had one of those weeks where it feels like the universe is everything but on your side? A beautiful vacation in Michigan with my family was followed by a series of unfortunate events. I was about 20 minutes into my trip back to Philadelphia when a small deer attempted a dance with my car, resulting in the car doctor’s diagnosis of “most likely totaled.”

After scrambling to find a way back to Philadelphia, my brother graciously lent me his car. I drove home, left for a 6 mile run with a friend, and that was it. I ran home through a rain storm with the challenging moments of the week behind me, or so I thought.

I arrived back to work the next day, fresh faced and ready to roll, to be greeted by 31 voicemails and 53 emails. As I dug through, I learned of a series of client crises that had occurred while I was gone (one client suicidal, another in crisis, another arrested). I dealt with them with stride, taking things one step at a time. When the day was done I felt stressed and slightly overwhelmed but satisfied with the job that I had done.

As I parked my brother’s car that night, I let out a sigh of relief. Even through the heavy rainstorm I could see the light at the end of the tunnel, which for me, included a quick dinner and some HEAVY relaxation time. The next morning I was ready to do it all over again: work, relax, repeat. I soon found myself standing in soon parking spot… where my brother’s car used to be. I looked around, noticing all of the street cleaning signs that read “VIOLATORS WILL BE TOWED.”

I felt my anxiety rising, hands shaking, talking to myself as I looked up the phone number for the City of Philadelphia while simultaneously texting my brother to get his license plate number, etc. I began walking back to my apartment when I saw it: the silver Dodge Dart that so beautifully stared at me from across the street where the tow company had relocated it. I repeated another, though stronger, sigh of relief as I clicked the unlock button to ensure that this was, in fact, my brother’s car.

On the way to work, I found my mind racing with the “What will be next?” thoughts. “Bad things always happen in threes,” I irrationally told myself. “I wonder what horrible thing will happen next.” I was able to catch myself by acknowledging that, although these events were unfortunate, they could have been so much worse. The more rational side of my decided that this is the perfect day for a gratitude list. So here is what I am grateful for:

  • I was not injured at all in the accident with the deer
  • I was close enough from my mom’s house that my dad and brother were able to come get me after the accident
  • My car is still able to be driven (regardless of the lack of reliability for the three hour trip back to the city)
  • My brother’s car was simply moved down the street and not to an impound lot, where I would have had to pay multiple hundreds of dollars to get it released
  • My brother-in-law offered to go car shopping with me if the insurance company agrees that my car is totaled
  • My supervisor is incredibly laid back and empathetic to my situation in needing an extra day of vacation to tend my car
  • I have delightful coworkers who helped to address the crisis situations at work while I was on vacation and supported me as I worked to follow up after my return
  • I have incredibly supportive people in my life in general, friends, family, etc. I could not have gotten through these events without being able to lean on them for guidance

Last but not least, I am grateful for this platform through which I can openly evaluate my negative thinking and reframe into more positive thoughts. I want to thank those who have engaged through follows or comments. I love the feedback. While on vacation, I did a lot of planning for this site that I hope to work on while life calms down. This blog helps hold me accountable, because if I am not being a Wellness Warrior myself, then how am I able to encourage others to be?