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.

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?

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.

10 Morning Hacks for the Non-Morning Person

I didn’t get the nickname “Little Bear” in college for no reason. In the morning it takes me about 1 hour, 1 cup of coffee, 1 giant plate of breakfast, and a whole lot of self-encouragement to start feeling like a human. In fact, I love my mother, but my biggest complaint about her parenting was that she talked to me in the morning- the horror!

Now, don’t get me wrong. I love the idea of being a morning person, and I actually find myself enjoying the quiet mornings to myself if I have a day off. It’s the pressure of having a schedule to keep that causes me to roll out of bed with my hair a mess and grunt to myself as I struggle to don my big girl garb and start the day. There just never seems to be enough time in the morning, and no matter how hard I try, I still find myself consistently running 5 minutes late. One might think that I could simply wake up earlier, but your girl loves her sleep. Therefore, I can offer these helpful tips that might help- excuse my French- unfuck your morning as well as they did mine.

  1. Pick out your clothes.
    • I tend to take this tip to the extreme. Every week as I am putting away my laundry, I put together my outfits for the entire week (or more if I’m feeling extra adventurous). This way, I can just pull something ready-to-wear from my closet. I’m not suggesting that anyone take things to that extreme, but it is a huge time saver to have an outfit prepared. I also notice that I always feel better if I’m wearing something I like, and I rarely create an outfit I like if I save the task for the busy morning.
  2. Prep your lunch.
    • I like to make this part of my nightly routine. Before I go to sleep, I’ll my lunchbox together, so I can just grab it out of the refrigerator before I leave in the morning. Not only does this save time in the morning, but it also gives me time to make sure I’m packing a healthy and well balanced lunch.
  3. Have a routine.
    • Part of making the morning easier is not thinking-just doing. Having a good routine in place can save time, increase productivity, and increase a sense of accomplishment. For those like me who used to forget her lunch, office keys, etc. at least once a week, it can help to ensure you’re not skipping over any important morning tasks.
  4. Say it with me: SLEEP WITH YOUR PHONE AWAY FROM YOUR BED.
    • There is truly not much to say here that I haven’t said already. If you want to catch up on my reasons behind religiously adopting this hack, you can read all about it here!
  5. Stretch in bed.
    • The hardest part of the morning for me is peeling myself away from my cuddly cat/sleeping buddy and unraveling my cozy blanket burrito. After doing research on stretches that can be done in bed, I found that not only did this satisfy my desire to stay in bed longer, but it helped my body feel more awake and motivated to get my morning routine going strong.
  6. Make your bed.
    • It may seem small, but making your bed can set the mood for the entire day. Starting off with completing a task can lead to a sense of accomplishment that can only snowball into a bigger form of motivation. Coming home to a tidy area can also decrease any residual stress from the work day.
  7. Save scrolling for later.
    • Anyone who has read my previous posts already know my view of social media and cell phones- if you allow it, your electronic device can be a giant waste of time. So, save the scrolling for later and minimize anything that might distract you from a productive morning. The memes will still be there after you’re all dressed and ready to start the day with, hopefully, time to spare.
  8. Look forward to food.
    • Okay, this one might me more tailored to me, but it works. I find it way easier to crawl out of bed if I know I’ve planned a breakfast I can look forward to. (Even better, I’ll meal prep it, so I can go straight to the rewarding part).
  9. Make your morning more enjoyable.
    • It may seem like common sense, but it’s easy to lose ourselves in the rush of getting ready for the day. We can’t forget about our needs. Whether it’s yoga, a morning walk, or reading a chapter, take a little bit of time and engage in an activity that will make your morning feel like yours! It doesn’t even have to be the same activity each day.
  10. Listen to music.
    • I. Love. Music. In my 28 years of existence, nothing has been able to captivate me as much as music. It has been, and probably always will be, a huge part of my life (but that’s a post for a different day). For me, and maybe for some of you also, there’s no better way to wake up the body than to start by waking up the soul.

Although weekday mornings are a struggle, I am really focusing on making them effective and productive. It simply makes me happier and more energetic when I feel good about my mornings. I am always trying to make Rise and Shine Time easier and less hectic, and I always love to hear feedback and start a conversation. What are some of your go-to morning hacks?

Half Marathon Training: Week 2

Happy Monday, Warriors! Wow, did Week 2 really present some challenges that served as some pretty important reminders. Sunday rolled through just as I was coming out of a great, but busy, week. I completed all of my training days from Week 1 with complete success and felt prideful as I rewarded myself with a “Tourist Weekend.” While I love living in Philadelphia, I don’t often get time to partake in the famous attractions. Every so often (usually if a family member or friend is visiting), I allow myself to act as a tourist for an entire weekend and explore the hot staples of the city tourist-style (Though, you will never catch me riding a Segway).

Fueled by residual motivation from Week 1, I created an intense training plan for the week that included longer runs and harder speed training workouts. During my first run of the week, I made it half way to my distance goal when my entire body felt exhausted, and every fiber of my being felt one step away from a becoming real life example of a dramatization in a Life Alert commercial. As I slowed to a walk, I reflected on the prior week of nonstop movement and recreation. I remembered my top goal in beginning my overall wellness journey: GIVE YOUR BODY WHAT IT’S ASKING FOR. It was a not-so-gentle reminder to listen to my body, and my body needed some good old TLC (both physically and audibly, because come on– who can’t get down with a little No Scrubs blaring on a Sunday night???). With that in mind, I walked the remainder of my distance goal, went home, ripped up my plan, and spent the week going off script, tailoring each activity to what I felt that my body needed on a day-to-day basis.

Here is what it looked like:

  • Sunday: Run 3 miles, walk 1-2 miles. (I made this a mindful walk, meaning that I put my phone on airplane mode and listened to no music, taking in my environment and focusing on my experience).
  • Monday: Strength Training: Arms, Stretch
  • Tuesday: Run 1 mile at an easy pace, run 1 mile at race pace, walk 1 mile, run 1 mile at an easy pace
  • Wednesday: Yoga
  • Thursday: Strength Training: Abs and Back
  • Friday: Strength Training: Legs, Stretch
  • Saturday: REST

Lesson of the Week: Listen to your body. Training doesn’t have to mean pushing yourself to the point of exhaustion or injury. If your body is craving something slow and easy, give it just that. If your body is buzzing with energy, use it as fuel for harder workouts. I ran and worked out at a lesser intensity and still ended the week feeling stronger.

It’s your turn, peeps: How did you listen to your body this week?

Wins of the Week

The burst of energy I woke up with this morning and the happy sunshine streaming through my office window can only mean one thing– It’s Friday! This week has been a rough mental health week, and although I am well aware of the triggers it can always feel like a slow crawl back to stability. That being said, if there is ever a week to focus on my Wins, this would be the one!

  • I finished a book. If anyone reading this has been struggled with any sort of mental health issue, you may know that concentration may be a huge challenge. As someone who read the last Harry Potter book in just over a day, part of me is heartbroken to say that it had been well over a year since I had been able to read an entire a book. It took about a month to finish this book by breaking down reading into smaller chunks of time, but I felt a sense of accomplishment.
  • I was able to delegate responsibility at work. At my organization, I manage a caseload of about 55 clients. I typically schedule 38-40 hours of individual therapy sessions per week, attend 5-7 meetings monthly, facilitate a group twice monthly that consists of 15 additional clients, and somehow squeeze in time for paperwork and outreach calls in between. Needless to say, all of my days are incredibly busy. I spoke to my supervisor about feeling overwhelmed and we agreed that it would be best to hand my group off to someone else who has a less established caseload to maintain. With my group facilitating nearing its end, I can already feel a little relief.
  • I didn’t feel like a bad employee for delegating. Typically, admitting that I do not have the energy to perform well at a task would lead me to believe that I’m bad at my job. I learned how to catch these thoughts in therapy, but this time I didn’t even need to catch myself because I didn’t have the thought. That’s progress, folks!
  • I painted for the first time in about 10 years. I used to paint all the time, more of a hobby than a coping skill. I was always a perfectionist when it came to creativity, but when I picked up a paint brush this week, I simply focused on playing with color however I was inspired to. I definitely felt rewarded and mindful and just…. emotionally better!

Honestly, to a certain extent, I’m just thankful for making it through the week without completely spontaneously combusting.

Now turning to you, Warriors! What have been your biggest wins of the week?

Why I Stopped Sleeping With My Phone Next to my Bed

Sometimes our cell phones seem like an extension of ourselves. They are useful little boxes that remember our appointments, stay in contact with our friends, and share our memories with the touch of a button. It can be difficult to think of cell phones as what they are: a tool. So, I decided that if I don’t feel the need to sleep with a hammer next to my bed, I don’t feel the need to keep my cell phone there either. Here’s why:

Late night cell phone use can lead to lack of sleep.

We’ve all been there: we turn the lights off, settle into our blankets… and then scroll in Instagram for the next hour instead of closing our eyes for some well-deserved snoozing. Further than that, using cell phones in the dark can more intensely expose our eyes to blue lights, potentially causing damage in vision or interfere with our ability to fall asleep.

We are not yet aware of potential health risks.

While there has not been research that proves cell phone use causes cancer, we do know that cell phones emit small amounts of electromagnetic radiation, which can lead to tumor growth. However, since they are such small amounts, cell phones are safe to handle for individuals who are not more vulnerable to radiation. This being said, clear links between cell phone use and health risks are not yet clear—which makes me want to be more safe than sorry.

I wake up more easily in the morning.

I am not a morning person. In fact, I have been known to set my alarm early just to hit snooze for the next hour. A few months ago, I started sleeping with my phone across the room from my bed, and I initially felt resentful that this little music-making pile of metal was dragging my lazy bones out of bed on the first ring. It slowly became much easier to wake up in the morning at the first chime of my alarm.

My mind is clearer as I’m drifting off to dream world.

Incorporating an hour of phone-free time before bed each night has helped me make the space to check in with myself. Having the opportunity to read, journal, or simply reflect has allowed me the space to get any leftover thoughts from the day out of my head before putting my head onto the pillow.

Disconnecting from my phone on a regular basis has allowed me to use my time effectively. Although, I still find myself frustrated sometimes that I have to crawl out of bed to get the loud noises to stop. Overall, I’ve felt positive in my decision to start sleeping disconnected with my phone—and it seems that my brain and body are thankful, too!