Welcoming Elise Clerkin

Welcoming Elise Clerkin

I am thrilled to welcome Dr. Elise Clerkin to the Wellness Path Therapy team! Elise brings with her a wealth of experiences as a scientist practitioner, including working as a staff psychologist at the University of Virginia and as an associate professor at Miami University. Elise is an empathetic, authentic, well-trained therapist. She has a deep understanding of the science underlying human behavior, and an unusually strong capacity to perspective take. With clinical work grounded in behavioral and cognitive therapies, Elise is committed to helping her clients pursue their values, develop meaningful lives, and minimize suffering. 

To learn more about Elise and her approach to therapy, please visit her bio and request a free consultation. 

Anxious about therapy? Me too, and I’m a therapist!

Anxious about therapy? Me too, and I’m a therapist!

Recently I was meeting a potential new client for the first time. They told me that they felt anxious about meeting with a therapist to consider counseling. In the course of our discussion, I revealed that I often feel anxious too when I begin therapy with a new client! In full disclosure, my anxiety feels manageable, which I know is not the case for everyone; my anxiety neither causes me distress nor gets in the way of my work. However, whether you are a client or a therapist, anxiety can be normal and helpful to reflect upon.

Why do clients feel anxious about therapy?

As a therapist, I attribute my anxiety to how important I view the beginning relationship. I want to make a good connection with someone new, and I have a strong desire to start doing our work together effectively. Each person is unique, and I know I will need to work hard to accurately understand their needs. For myself, these are good goals and my anxiety helps motivate me toward them.

On the client side, there are many additional possible sources of anxiety about therapy. Let’s name some of them:

  • Meeting a stranger (the therapist). For most of us, but especially folks who struggle with social anxiety, the situation of meeting a stranger may induce anxiety regardless of whether it is a therapist or someone else. You may feel nervous about whether your therapist will like you, judge you, or have a good impression of you. Please remember that good therapy is all about forming a strong connection and collaborating on your goals; your therapist is truly there to understand and empathize with you, and has received significant training to make this happen. If there is a mismatch, it isn’t your fault; it may just not be a good fit! Which brings us to…
  • Worrying about whether the therapist will be a good fit. If you decide to seek counseling, it is important for your therapist to fit what you are looking for. Seeking the right match for pursuing your mental health goals can be anxiety-provoking! The first therapist you meet won’t always be the best fit, and it is fine to honestly communicate your hesitations. Many therapists offer free consultations for exactly this purpose.
  • Discussing private, difficult topics. You may worry about being judged or whether information will stay private. Therapy is a strange place in some ways. There probably aren’t many places where you can talk as freely about mental health struggles, sex, relationship complexities, and other topics. As a result, breaching private or ‘taboo’ subjects may feel uncomfortable. Please be assured that therapists inhabit this space every day. We not only are used to discussing these topics non-judgmentally and confidentially, we encourage open, genuine discussion for the sake of your well-being.
  • Acknowledging to yourself that you need support. Change is hard, and sometimes the first step of a journey possesses outsized meaning. It may be nerve-wrecking to contact a therapist if such an action marks a commitment to move in a new direction.
  • Uncertainty. A lack of information about the future is often a trigger for anxiety. A new therapist and perhaps the process of therapy itself may be uncertain to you at the start. Again, anxiety is an expected reaction to uncertainty! For excessive anxiety, one of the skills you may work on in therapy is better tolerating the uncertainties of life.
  • Worry that therapy “won’t work.” Sometimes despite your hard work in therapy, it is possible that an initial course won’t reach your goals. This possibility can make you feel hopeless, but remember that doing therapy is like riding a bike. You often have to try and fall off several times before you learn how to ride. Just like you wouldn’t expect to ride a bike perfectly on your first attempt, shifting mental health patterns takes practice and time.

These sources of anxiety are not exhaustive, but some of the ones I most commonly hear from clients. It may be helpful to notice how each source of anxiety is about something important. In other words, these concerns didn’t arise from nowhere – they reflect valid needs, even if the amount of anxiety can sometimes become excessive.

Signs of anxiety about therapy

In addition to standard physical, thinking, and behavior-based symptoms of anxiety, you may experience signs that are uniquely tied to therapy. Do you avoid thinking about therapy? Do you notice yourself making (inadequate) excuses about your need for more support? Is there an anxious pit in your stomach when you think about therapy? Do you find yourself searching for a therapist but not taking the step of contacting one? An incredible aspect of being human is your capacity to observe yourself; take a good look at what messages your thoughts, emotions, and behaviors are sending to yourself!

Don’t let anxiety deter you from the support you need

The average amount of time people wait to begin therapy is 11 years! That is over a decade of unnecessary struggle. Much of that wait results from problems with the mental health treatment system such as health disparities, therapist availability, and cost. However, your anxiety about therapy is one factor that remains more in your control. Whatever your anxiety level, you can still choose to begin therapy. In other words, you can decide to begin therapy WHILE feeling anxious about it rather than avoiding therapy BECAUSE you feel anxious. Don’t let distressing emotions keep you from living the choices you want!

Sleep Procrastination

Sleep Procrastination

Night can become a time when people counterintuitively resist sleep. When you are feeling stressed or anxious, your mind is on alert that ‘something is wrong.’ Without a clear plan for how to address the problem, you may find yourself “doomscrolling” on social media, dwelling on relationship missteps, or snacking. Whether you call it sleep procrastination, revenge bedtime procrastination, or something else, the end result is staying up later than you intended. Often, the next morning is filled with exhaustion, grumpiness, and regret.  

What causes sleep procrastination?

People often procrastinate with their sleep for reasons that seem to make sense in the moment. For instance, after a long day of work, sleep may feel less appealing than alternatives like watching another show on Netflix or texting with friends. It may also be challenging to sleep when someone is still ‘coming down’ physically and emotionally from intensive experiences. If you have ever tried to sleep immediately after a heated discussion, it is the same idea. Your mind and body tend to desire transition time to regulate themselves before sleep. Of course, for any person there may be a variety of other psychological, substance-related, and medical reasons why they have difficulty going to sleep.

Basic sleep and well-being tips may help with addressing the problem

One way to address sleep procrastination is to be proactive about your needs. Even if your time available is brief, prioritize your emotional needs before you go to bed. Do you need to schedule a few minutes to talk through your day with a partner? Can you carve out (and stick to!) time for a wind-down activity like showering or reading? Forcing yourself to go to bed without addressing your emotional needs can paradoxically backfire and lead to sleep procrastination.

Sleep specialists have long emphasized the importance of “sleep hygiene” for people with disorders like insomnia. Many sleep hygiene tips are useful for anyone having sleep difficulties. The more you institute a consistent sleeping routine that associates your bed with sleep, the more successful you may tend to be.

Questions to ask yourself include:

  • Is my bedroom too hot, cold, noisy, or uncomfortable?
  • Can I go to bed at a more consistent time every night?
  • Does my caffeine or alcohol use disrupt my ability to wind down and sleep?
  • During the day am I physically active and exposed to natural light?
  • Am I using my bed for purposes other than sleep and sex?

Setting up your sleep environment and routine for the purpose of sleep allows your mind to more strongly expect sleep when you are in bed. If you are having ongoing difficulties with falling asleep, you might consider only going to bed when you feel sleepy. Unable to sleep after 15 minutes? Leave your bed to engage in non-stimulating activities, then enter bed again when you feel sleepy.

Sometimes sleep procrastination is part of a more serious sleep problem

The tips above are not intended to be professional advice for someone struggling with a clinical problem. If you are distressed about your sleep or concerned that it is significantly affecting your life negatively, it may be time to consult a professional.

Types of Therapists in Ohio & Virginia

Types of Therapists in Ohio & Virginia

Choosing a therapist can be a daunting experience. You pull up Google or Psychology Today to investigate options and get lost in an alphabet soup. PhD’s, MSW’s, LISW’s, LCSW’s, PsyD’s, and more! There are also similar-sounding terms such as psychologists, psychiatrists, therapists, and counselors. Despite working in the field for nearly two decades, I still get confused at times! I’m providing today’s brief explainer to clarify some of the similarities and differences amongst providers. Please note that my explanation covers therapists in Ohio & Virginia; while many ideas hold true elsewhere, laws and regulations vary across states!

‘Talk therapy’ versus medication

A major distinction is between ‘talk therapy’ versus medication. I am a licensed clinical psychologist (PhD), and given the similarity of this title to ‘psychiatrist,’ I often get calls from people understandably confusing the two. Clinical psychologists, along with other mental health specialists, provide talk support that many people call ‘therapy’ or ‘counseling.’ In contrast, psychiatrists are medical doctors who also have specialized mental health training. While some psychiatrists may offer (usually brief) talk therapy as well, they typically focus on medications. For many problems there are effective treatments using either or both modes simultaneously (e.g., seeing a talk therapist and a psychiatrist at the same time for depression). Don’t be led astray by assumptions about talk therapy vs. medication; for instance, both directly change the brain’s functioning.

The ‘umbrella’ of therapists in Ohio & Virginia

When it comes to talk therapy, distinctions become even more confusing. It is time for us to separate out everyday language from more technical professional meanings.

Counselors vs. Therapists vs. Psychologists

In everyday language, counseling and therapy are used interchangeably to mean mental health support. In other words, there are many types of providers who fit beneath broad ‘umbrella’ terms such as counselors or therapists. I tend to use such everyday language myself – for instance, throughout this post, I’ve been using the everyday meaning of ‘therapist.’

However, in a technical sense, the terms are not the same. On average, counselors, therapists, and psychologists tend to have different educational backgrounds, regulatory requirements, and methods of approaching treatment that may impact your experience. Of course, there is great variation among each type of professional as well, so the general trends will not apply to every provider you meet.

Commonalities and differences across providers

In general, all counselors, therapists, and psychologists tend to have training in how to impact your general well-being. In providing support, all seek to be:

  • Empathetic
  • Active listeners
  • Good communicators
  • Ethical

Counselors, therapists, and psychologists also tend to overlap in their techniques and theories. No one provider type has a monopoly on mindfulness, cognitive-behavioral therapy, or other common approaches, although certain approaches seem to be more frequent among some provider types.

In addition to commonalities, providers have important differences. The largest involves the degree of training before beginning practice. Educationally, counselors usually require at least a bachelor’s degree. Therapists typically require a master’s degree after their bachelor’s, and psychologists require a doctoral degree above and beyond their master’s. While I want to emphasize the diversity of educational paths that counselors, therapists, and psychologists may travel, providers can differ by as much as 5-7 years or more in their training and supervised experiences.

Another important difference involves regulatory requirements. Most types of counselors and therapists need to obtain a license, but not all. In Ohio & Virginia, the term “psychologist” is legally protected and regulated by state boards of psychology. There is a high bar for claiming that one is a psychologist. For instance, when I became licensed in Ohio, I needed to prove not only that I had completed my (7-year-long!) Ph.D., but also that I had successfully completed a year-long internship practicing therapy, several thousand supervised clinical hours, a national psychology practice exam, and an oral exam testing knowledge of relevant Ohio legal code. To maintain my license, I complete continuing education each year and maintain my activities in line with the standards of the board. Again, most counselors and therapists have their own regulatory and continuing education requirements; just be aware that the number and rigor of requirements may differ.

A final distinction involves the methods that providers use in therapy. The story is once again one of overlap; any two psychologists may differ just as much as one provider type differs from another. That said, in general counselors tend to have training relatively more focused on practical methods and suggestions for specific issues. Therapists tend to incorporate a greater emphasis on mental diagnoses, with increased conceptualization of the underlying problems. Finally, psychologists are skilled in diagnosis, identifying the root causes of mental health disturbances, and applying research evidence to clinical work. Psychologists will bring extensive theoretical grounding to their work and are relatively more likely to work with severe mental illness.

Finding the right provider

All of these distinctions mean little if you can’t find someone to support YOUR needs. Finding therapists in Ohio & Virginia deserves its own post, but here are several important things to look for:

  • Interpersonal fit: Do you feel comfortable and supported? Will you be able to discuss difficult topics with this person?
  • Attention to science: We are fortunate to live in a time where we have ever-improving knowledge about which approaches are more likely, on average, to work for particular issues. Your therapist should not blindly apply scientific findings without individualizing your care, but ask: is your therapist in touch with evidence about what works?
  • Cultural responsiveness: You have a unique combination of values, identities, preferences, and experiences that make you “you.” A good therapist will work as a team to understand you and design an individualized treatment plan.
  • Credentialing/Experience: Regardless of the type of therapist, is there an indication that they are trustworthy and have sufficient training and competence to help you?

Hopefully after reading this explainer you feel more empowered to determine who is a good fit for you. The right provider for you may be a counselor, therapist, psychologist, psychiatrist, or someone else! Indeed, my most trusted colleagues come from a variety of mental health backgrounds. As you seek a provider, please ask them the questions that will allow you to find the person.

People do what makes sense to them

People do what makes sense to them

I can’t prove it, but I firmly believe that people usually do what makes sense to them. While that statement may sound cliché, it holds powerful meanings that can clarify who we want to be and how we get there.

How do harmful actions make sense?

An obvious objection is that people behave in all kinds of harmful, self-destructive ways. If you are like me, you can easily remember actions that were against your values or with hindsight didn’t make sense. How do such actions compute? Let me be clear that people don’t think through each action and consciously say ‘ah yes, what a great, logical action to do.” Some of our most upsetting or harmful actions occur when we feel unable to take other paths.

To understand harmful actions, let’s do a thought experiment. Envision a family member who is making an unwise decision that will hurt them and you. Now imagine that with Star Trek-like technology, I *completely* switch you into their brain and body. ‘You’ (I use that term loosely) have shed every aspect of your own person; instead, you take on the family’s member’s experiences, genetics, learning, memories, relationships, current thinking and emotions, etc – in short, every atom of the person and their experiences.

Would the modified ‘you’ would end up making the same decision as them? I hope you agree that there is a high chance. Sure, unpredictable external and internal forces might have unexpected influences; nonetheless, on average you would likely head down the same path.

What can you take from the thought experiment? Let’s dig into the implications with the next pair of topics: understanding and acceptance.

Understanding and acceptance

One lesson from the thought experiment is that your behaviors may seem foreign at times, but they aren’t arising from nowhere. The more you understand your personal context, the more you can shed light on the black box that led you to the action.

Having a greater understanding of your actions can unlock a number of paths to change: turned inwardly, understanding helps you to identify 1) problems, 2) how your desired destinations are different than the present, and 3) what internal and external factors are contributing to problems. With the knowledge of 1-3, you can better take steps toward actual change. When oriented toward others, making sense of people’s “senseless behavior” often leads to greater mental peace and improved behavior. Imagine that your best friend has been ignoring your texts. With building irritation, you finally reach them, ready to give an earful. It turns out they’ve had a work emergency! Their boss resigned, and they are shouldering the extra load. Now how do you feel toward them? How would your behavior change? Again, understanding the causes of behavior is powerful.

Importantly, understanding ≠ excusing. We all make missteps and do ‘wrong’ according to our respective moral codes. Guilt, regret, sadness, and other emotions can motivate you to seek change and repair, as long as they don’t become excessive. As a result, understanding negative emotions about your behaviors can be a useful tool for taking appropriate responsibility. Negative emotions can help us move from doing what made sense in the moment to doing something better.

Several threads I’ve mentioned are prominent in Dialectical Behavior Therapy (DBT). DBT integrates the notion of dialectics, or contradictory ideas that each seem to hold truth. One central dialectic is between acceptance and change. DBT contends that to change, you first have to accept the reality of the present and allow it to exist without seeking to resist it (i.e., radical acceptance). While radical acceptance is an ongoing process, heightening your radical acceptance can paradoxically move you toward future change. Here I can’t help but insert a similar Maya Angelou quotation: “Do the best you can until you know better. Then when you know better, do better.” Rephrased inelegantly into the current context, one might say: ‘accept that what you are doing what makes sense to you; when you learn behaviors that make more sense, do them.” I’m clearly not a poet, but the point remains: from a stance of current, active acceptance, we can free ourselves to learn, try anew, and do better.

Making sense with other perspectives

Embedded in Maya Angelou’s words is a major question: how the heck do we begin to know better? I’ve already discussed how understanding and radically accepting your behaviors can be a start. However, you have plenty of other resources at your disposal to start to know better. For some folks it is conversations with friends and family; for others it may be therapy. For still others, it may be seeking out new cultural experiences, new structured learning, trying out new behaviors directly, or all of the above. The overarching goal is to uncover perspectives that allow new behaviors to “make more sense.”

Feel like you already ‘know better’ but still are doing the same old behaviors? You aren’t alone. Still quibbling with what it means for a behavior to make sense, or to be understood? I’m in the same boat, continually. Perhaps I will tackle these topics another day – for today, I’m present in my happiness that you and I are thinking meaningfully about understanding, acceptance, and change.

The Back to School Blues

The Back to School Blues

For many people, August and September mean the beginning of the school year. Whether you or a loved one is the student, the fall can bring on the “back to school blues” as you adjust. It’s important to attend to your needs and take proactive steps to cope with school adjustments.

Life transitions tend to sap resources

Keep in mind that any major life transition frequently activates the bodily systems that underlie stress. Stress during life transitions isn’t necessarily bad; our bodily systems are amping up for a challenge appropriately! It is only when stress is chronic or results in experiences like panic attacks that it raises a red flag. Nonetheless, stress is draining. Do you end the day feeling like you’ve run a marathon? Exhaustion may be a sign that your body and mind have been on ‘high alert’ all day.

How else besides stress can the start of school trigger the “school blues?” The answer is that school can aggravate areas we already struggle with.

School transitions can trigger ‘vulnerable’ areas

Think about what the start of school often involves for students and loved ones:

  • New people (academically and socially)
  • Adjustments to existing relationships – emotional, time, and otherwise
  • New schedules
  • New sources of evaluation (e.g., exams)
  • Heightened work and planning
  • Decreased free time
  • Unpredictable disruptions (e.g., COVID)

Any element by itself could result in symptoms of depression, anxiety, or sleep disruption for some. Combined? The risks multiply. Importantly, if you possess an area of your self that is already vulnerable, transition stress within that area can leave you uncertain and doubting yourself. For instance, what if you are someone who often worries that others are judging your appearance negatively? Coming across a variety of new classmates and instructors in dazzling new outfits may present plenty of opportunities to criticize yourself. Unfortunately, stress may also drain some of the very coping resources you would typically use to combat these insecurities.

While I’ve painted a rather dire picture of risks for school blues, let’s turn to the glass half-full side.

Use your strengths to battle the school blues

First, many back to school elements don’t need to be negative. Look at the list above again, but with an eye toward reframing them. You may find that some can be viewed as novel opportunities or challenges that you enjoy seeking out.

Second, this isn’t the time to forget your tried and true self-care methods. What has worked for you in the past? The momentary newness may cause you to forget about or hesitate to use effective coping strategies.

Third, just like you may have vulnerable areas of yourself, chances are that you have relevant self-areas you perceive as strengths. Are you excellent at organizing new schedules? Do you get energized about meeting other students, or about learning a new topic? Think of these self areas as buffers you can lean upon to maintain your confidence and mood. Research suggests for people with existing vulnerabilities, developing a longer list of areas you value about yourself may be beneficial. By reflecting upon your genuine strengths and vulnerabilities, you may protect yourself from the mental downsides.

If you would like help with this reflection or have other questions about the back to school blues, please feel free contact me for a free consultation. We can discuss whether counseling would be a good fit at this time.

Little-Known Symptoms of Depression

Little-Known Symptoms of Depression

You probably have at least a vague sense of what depression is. If I forced someone in the grocery store to tell me a symptom of depression, I’m guessing they might say depression involves feeling extremely sad (after they decided against chucking a few apples at me). Prompted by the setting, *maybe* they might also say that depression symptoms can include changes in appetite. Perhaps a bagger might chime in about energy loss, and so on. Indeed, these guesses would be on target: current diagnostic criteria for depression incorporate these three as well as five other relatively well-known symptoms (lessened enjoyment, change in weight, feelings of worthlessness or guilt, lessened concentration, and suicide-related thoughts or behavior). However, our understanding of depression goes much deeper than this simple picture.

Depression looks different for each person

Certainly, many depressed people experience the most well-known symptoms mentioned above. Even so, symptoms of depression often look different from this stereotypical picture – and in fact, from many other people’s. Cutting-edge research suggests that unique combinations of symptoms may be closer to the rule than the exception.

One reason is that the diagnostic criteria don’t capture all key symptoms. For instance, one scientific paper described all the ways professionals have measured depression. The author identified 52 different symptoms that professionals have suggested might be part of depression! Part of the variation is likely due to poor measurement. However, symptoms like irritability, anger, pessimism, and crying can be parts of depression that aren’t adequately described by the standard 8-item list. Like the better-known eight symptoms, any possible symptoms of depression could always be part of another mental struggle, medical issue, or other separate cause. Thus, figuring out what symptoms are and aren’t part of your depression is an important puzzle.

A second way you may be unique concerns how troubling you find various symptoms. If you’ve ever experienced depression, you know that not all symptoms are equally bothersome. For someone who is a restaurant critic, a lack of appetite may impair their ability to work effectively. For a sales associate, their lack of concentration may be causing them to lose potential clients. In addition to experiencing the symptom itself, each person may find a symptom uniquely upsetting or impairing.

A final complexity stems from the mathematics of how symptoms combine. Even if you only use the standard eight symptoms, “depression” could still present in numerous ways. For example, current criteria suggest a person must have five out of eight symptoms for a diagnosis. It turns out there are 93 different ways a person could be experiencing ≥ five out of the eight symptoms!

Teamwork Can Figure Your Symptoms Out

Above all, the lesson to take about symptoms of depression is that each person needs to be carefully understood as an individual. The good news is that you are well-positioned to seek such an understanding and handle whatever struggles your symptoms may be causing. At Wellness Path Therapy, I consider you to be the expert on your own experiences. You are the only person who has been there minute-by-minute, experiencing what it is like to be you your entire life! By combining your expertise with professional support in understanding symptoms, you can get to the bottom of what is happening. If you are considering professional help to address your symptoms of depression, I encourage you to reach out to me or other therapists to begin your therapy journey.