The Joy of Group Therapy

Posted on September 30, 2022 by Jessica Bruno, LMFT

If we can share our story with someone who responds with empathy and understanding, shame can’t survive.

Brené Brown

I recently shared a personal experience with one of my interns about a hospital patient who once looked at me and said, “Ma’am, how could you possibly understand what I am going through?”  I was a new therapist and It was the first time the nursing staff requested I visit with a patient who had zero interest in talking to me.  To be honest though,I kind of agreed with him.  How could I understand what this man was going through?  He was an elderly black man who recently had his leg amputated due to complications with diabetes. As a young white woman without medical issues,our life experiences were very different.  I definitely didn’t know what it was like to be him and I felt like a complete failure when I walked out of his room after he asked me to leave.  

Sharing our story, especially when it’s a traumatic one, can be a difficult process, especially when it’s with a complete stranger.  When we are able to connect through with someone who shares a common narrative, something interesting happens.  I’ve seen this spark in the therapy groups I hosted at the hospital.  One patient would start sharing about the day they had their stroke, then another would explain how their stroke was very similar, and before you know it, this group of people brought together by a common diagnosis, are behaving as though they are a group of old friends, sharing the deepest details of their most difficult moments of their lives, with perfect strangers. Whether the common experience is a medical diagnosis, an addiction, a trauma, or loss, the camaraderie one receives in group therapy leads to a sense of belonging; a sense of no longer being alone in their journey.  From this place, participants can open up about their feelings, receive validation in the form of understanding, and move forward feeling supported and empowered.  

If you’ve been thinking about joining a support group, now is a great time to start.  Many support groups offer online and hybrid groups.  If you’re located in the Triad, consider attending one of the many support groups being offered at Solutions for Independence in Winston Salem beginning in October 2022.  Participants can join in person or via zoom.  For more information, call 336 701 2136 or visit www.housecallcounseling.com/groups. 

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Mental Health and Nutrition

Posted on August 29, 2022 by Leigha Myers

Our food should be our medicine, and our medicine should be our food

Hippocrates

Today, most people’s first thoughts when thinking of mental health treatment is medication. It’s completely understandable due to the way that social media portrays the regularity of taking antidepressants, antipsychotics, or even recreational drug use. So many verified “TikTok-ers” and Instagram influencers make jokes, memes, or hashtags about the medication they take that it’s been increasingly popular for the upcoming generation to be enticed to taking medication even when not needed. We’ve seen an uprising in alternative medication and specifically holistic treatment methods surging through the media in the past 10 years since social media usage has become prominent.       Practicing holistic health and integrative medicine methods are “in” and popular since new research of natural therapeutics are rising to the surface. Now, this isn’t to say that conventional healthcare or medication isn’t useful or beneficial in mood treatment and in many cases is medically necessary especially for safety concerns. The intention of this blog post is to simply spark an idea to consider a different and holistic approach to mood treatment that starts in your kitchen.  

Let’s talk about research conducted on the most prominent mood disorders- anxiety and depression. A study was conducted on the link between diet and depression treatment in 2017 to determine if there was a relationship at all. It was found that dietary choices involving healthy fats, oils, whole grains, fruits, and vegetables were statistically significant in improving BMI and mood. This provided insight for scientists to investigate the nutrients and micronutrients of the foods within the provided diet and further links between nutrients such as folate, vitamin B6, vitamin B12, vitamin D, magnesium, iron, and zinc reduced mood disruption, anxiety, and the risk of depression.

Now, let’s talk about a top 20 contestant for the most popular hashtag trending on social media right now: #guthealth. We often refer to our gut as our second brain because of the 100 million plus nerve cells that line our gastrointestinal tract. Our two brains communicate so frequently that gastroenterologists and other medical specialists often prescribe antidepressants to soothe those with gut troubles such as irritable bowel syndrome. So, what is the primary fuel source of our gut? It is simply the food that we consume.

Always prioritize your own health and safety and do not make any adjustments to your treatment without prior consultation of your medical provider. 

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The Medical Family Therapist

Posted on July 31, 2022 by Jessica Bruno, LMFT

“Apply yourself to thinking through difficulties—hard times can be softened, tight squeezes widened, and heavy loads made lighter for those who can apply the right pressure.”

Seneca
Working in a hospital offered me a unique experience as a marriage and family therapist.  My job was to help patients adjust to their “new normal” after being diagnosed with a serious illness or injury.  A new normal might be no longer going to work, being able to walk, or take care of their own personal needs.  By working alongside rehabilitation professionals like physicians, nurses, physical therapists, occupational therapists, and speech therapists, I developed a knowledge base on medical conditions, terminology, and treatments.  This allowed my patients to feel like they could talk about their experiences to someone who understood where they were coming from and what they were going through.  Their safe space was their hospital room, and our conversations about their experiences became a tool for healing.  

Medical Family Therapists like myself address the mental health of patients by first looking at the psychosocial system they are  living in.  Who they are in their family and community is key in understanding what they will need to find meaning in their recovery.  Medical Family Therapists help patients and families find acceptance of what’s happened so they can set goals for a meaningful future.

Here are a few ways a Medical Family Therapist can help:

1. Peer Support.  The most important thing for survivors of a serious illness or injury to know is that they are not alone.  Just as you would go to a specialist for treatment of a serious health condition, it’s a great idea to talk to someone who’s a specialist in coping with that health condition.  Medical Family Therapists connect patients to organizations and peer support volunteers who can take away the notion that, “No one knows how this feels”. 
 
2. Psychoeducation.  Knowledge is power, and when tackling any new diagnosis, the more we understand, the less anxiety we will experience.  Medical Family Therapists provide up to date clinical resources on diagnoses to take the mystery away from a new illness or injury.  By becoming experts in their diagnosis, patients gain confidence to better cope with it.

3. Family Therapy.  Communication connects hope with healing.  Medical Family Therapists help families talk when the words aren’t easy to find.  A serious illness never affects just one person, it affects the entire family system. Through family therapy sessions, patients can stop feeling like a burden and learn to navigate the changes in their relationships with dignity and confidence.

4. Evidence Based Interventions. Neurofeedback, EMDR, and Mindfulness Meditation are just a few interventions scientifically proven to alleviate symptoms of depression and anxiety.  A medical family therapist will identify the most useful tools and interventions based on the individual needs of the patient. 

Are you in search of a Medical Family Therapist for yourself or a loved one?  If you are located in North Carolina, visit www.housecallcounseling.com/schedule to schedule a session with Jessica Bruno, LMFT.  
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Student Interns, the Unsung Heroes of Therapy

Posted on June 29, 2022 by Jessica Bruno, LMFT

“We learn not in school, but in life”.

Seneca

Have you finally decided to start therapy, only to be told there are no therapists in your area accepting new clients?  You may want to consider meeting with an intern.  Student Therapy Interns are graduate students who have completed nearly all of the required coursework to become a licensed therapist.  Internship allows students to practice their skills in a real world setting as the final step of earning their master’s degree.  After they graduate, they can sit for their licensure exam to become provisionally licensed (or Associate level) therapists.  

Here are 5 reasons why meeting with a Student Therapy Intern may be a great option for you. 

  1. Access the most up to date clinical interventions and techniques.  Graduate students conduct a lot of research as part of their coursework- and in most circumstances, they must be crediting sources just a few years old.  This means an intern may technically have an edge on more seasoned therapists simply because of their exposure to current literature. 
  2. Expert Support in the form of Clinical Supervision.  All therapy interns must meet at least weekly with a fully licensed and experienced therapist.  Additionally, many clinical supervisors have additional education in the field of supervision to help them guide new therapists and facilitate their skill development. 
  3. Reduced Cost.  Even if you plan to use insurance, many plans have high copays or deductibles which must be met before sessions are covered.  Some policies may even deny your claim depending on the diagnosis provided by your therapist or because of the type of therapy they provide.  Therapy interns typically provide vastly reduced rates, often on a sliding scale, so no matter what your income situation is, you may still be able to see a therapist weekly. 
  4. Availability.  Since the primary goal of therapy interns is to gain experience, they may offer more flexible hours to accommodate an ideal client.  Early mornings, evenings, and weekends are all possibilities.
  5. Your Support is Appreciated.  One cannot become an expert in anything without practice.  By working with a therapy intern, you are helping them as much as they may be helping you.  Your willingness to share your story, your openness to allow your experiences to be shared in supervision, and your trust that your privacy and dignity will be protected by the high ethical standards of the counseling profession, ensure a bright future to new therapists who have dedicated their careers to helping people.  The knowledge gained by new therapists during internship will be carried throughout their entire careers, helping them assist others for many years to come. 

On behalf of my practice, House Call Counseling, I’d like to thank you for reading this article and for your consideration to work with a therapy intern.  

If you’re located in North Carolina and you are interested in working with a therapy intern, visit housecallcounseling.com/list to be placed on the Intern/Reduced Cost Wait List.

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Telehealth vs in-person therapy

Posted on May 26, 2022 by Jessica Bruno, LMFT

“Stay committed to your decisions, but stay flexible in your approach.”

Tony Robbins

On March 17, 2020, The HHS Office for Civil Rights announced that it would waive potential HIPPA penalties for good faith use of telehealth during the nationwide public health emergency due to COVID-19.  My newest client at the time had recently been discharged from a Rehabilitation Hospital and was considered medically fragile. All of my other clients were house-calls and continued with precautions like masks and social distance.  I did not feel comfortable meeting with my new client in person due to her poor health, so I offered to FaceTime her.  I’ll admit, at the time I was hesitant I’d be able to connect with her in the same way I would if we were in the same room. I knew I wouldn’t be able to view her full body language, lean in, or offer a tissue if she needed one. I expected our first session to be awkward, but I  knew it would have to be this way if I was to help her safely. 

Today, that first session feels like a lifetime ago.  I’ve learned so much since transitioning from an in-person provider to a telehealth provider. Here are some considerations if you are trying to decide between telehealth and in-person therapy.

  •  Telehealth is best for busy people. 
    • Sometimes the only break you have is a lunch break- and if it’s an hour long you can definitely squeeze in a therapy session.  I’ve met with clients in their offices, in their cars, and while they’re getting their steps in.  If you can speak privately on your phone, you can meet with a therapist. 
  • Phone only sessions are always an option.
    • I will never meet with a client via video while they are driving.  As long as they feel safe chatting while driving and they are able to utilize a hands free device, having sessions over the phone is a great option.  Phone sessions are also a good choice for people who don’t have access to high speed internet or who use a landline because of a lack of good cell reception.
  • Young children may lose interest in a telehealth session.
    • Play therapy is the best way for a therapist to connect with a young child, and this can be very difficult to do in a video session.  Consider opting for an in-person session for young kids.  
  • For family sessions- it depends. 
    • Most of my couple and family telehealth sessions involve the family sitting together in the same space, with me being on the computer or tablet in front of them.  I’ve also met with couples where one partner is away at work or on a business trip, and the other is home, but through three-way video chat, it’s like we’re practically all together.  A phone only session with more than two people, or trying to fit three people sitting together on a phone screen for video can be tricky.  My advice is to consider your needs and if in-person/in-home therapy is an option, to consider it.  

What is your favorite way to meet with your therapist?  Share your experiences or suggestions in the comments below.  

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How to Find the Perfect Therapist

Posted on April 29, 2022 by Jessica Bruno, LMFT

“How long are you going to wait before you demand the best for yourself?”

Epictetus

So you’ve been thinking about starting therapy for a long time, but you don’t know where to start.  Google, PsychologyToday.com, and your insurance company can all generate a list for you… but how do you pick? Consider these tips for finding the perfect therapist for you.  

  • Think about your goal
    • Is your goal to feel less depressed or anxious? Are you seeking resolution in a family conflict? Are you wanting to quit using drugs or alcohol? Have you survived a trauma? For as many reasons one might seek out therapy, there are therapists expertly trained in their field. Every licensed therapist completes continuing education in their specialty, and since they’re experienced in working with particular issues, they will also be able to borrow interventions used successfully with other clients to help you.
  • To use insurance or not to use insurance?
    • Many people seek out counselors who accept their insurance, but this isn’t always the best option. Your insurance company may still deny coverage if your therapist doesn’t diagnose you with an approved mental health condition. For example, I’ve had clients denied coverage for the diagnosis of adjustment-disorder because they didn’t meet the critera for a covered diagnosis like generalized-anxiety-disorder. Others may have an approved condition, but don’t want it on their permanent health record for privacy reasons. Another consideration is copay. I’ve had clients with insurance plans which still required a $50 copay for telehealth sessions. Finally, if you do want to use insurance but can’t find anyone in your network, ask your insurance company what they will reimburse for an out-of-network therapist. You may be able to see someone who doesn’t work with insurance by simply requesting a “superbill” and submitting it to your insurance company.
  • Telehealth is the New Normal
    • When I started House Call Counseling in 2018, I only offered in-home therapy. Telehealth was certainly around, but it was not typical, and most people at the time didn’t feel like it would offer the same experience as in-person therapy. Today, 100% of my current caseload is telehealth clients. Perhaps the greatest part of telehealth’s offering is the fact that you can meet with a therapist located anywhere in your state. So if you’re seeking a specialist and don’t live in the area of one, you may still have plenty of options. Some states, such as Florida, even recognize therapy licenses in other states, so research your local regulations.
  • Don’t feel bad shopping around
    • Did you have high hopes for a therapist that didn’t deliver? Or did the two of you just not vibe? If you haven’t already stopped seeing them, consider this your permission to break up. There’s nothing wrong with having a session with a few different therapists to find one you really connect with, especially if you are interested in working on issues that may require long term treatment.
  • Don’t despair if you’re struggling financially
    • If you don’t have insurance and can’t afford a therapist’s private pay rate, consider asking if they offer a sliding scale. Licensed therapists are ethically required to make a reasonable effort to provide services to those who cannot afford their full rate. These slots typically fill up quickly, so you may need to reach out to multiple therapists. Also consider meeting with a therapy intern if one is available. While interns may lack as much experience as a fully licensed therapist, they have completed nearly all of the coursework in their master’s program, and meet regularly with multiple sources of clinical support. So technically when you meet with an intern, you’re likely receiving the expertise of multiple professionals.

Have you found the perfect therapist? Share your experiences in the comments below.

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Rx Nature

Posted on March 30, 2022 by Jessica Bruno, LMFT


“And into the forest I go, to lose my mind and find my soul.”

John Muir

Last time you visited your doctor, you were most likely asked to fill out a “PHQ-9”  This is a widely used scale used by healthcare professionals to determine if you have depression and if so, how severe it is. A certain score will lead to a conversation with your doctor about treatment options, i.e., medication.  If you are one of the thousands of Americans who have already had this conversation and started a prescription, you are definitely not alone.  In the United States,use of psychotropic meds has absolutely skyrocketed in recent years, and there is no end in sight when considering the amount of stress everyone seems to be under.  But what if your doctor told you there was another way to feel better?  What if they prescribed… nature?  

Sound wild?  Not if your doctor is in Japan.  “Shinrin-Yoku” is a widely accepted practice to counteract symptoms of depression and anxiety.  Translated into “Forest Bathing”, Shinrin-Yoku utilizes all of your senses to reset your connection to the natural world around you.  For many, it’s the medicine which rids them of the everyday stress surrounding them. 

Think of Forest Bathing as another tool to add to your mindfulness toolbox.  It’s something you can practice in your own backyard as part of a morning meditation, as a way to pause a weekend bike ride, or something to practice whenever you find yourself outdoors; no forest necessary.   Whenever, wherever you practice, keep these tips in mind so you may get the most out of your Forest Bath.

  • Choose a place that is private.  You want to avoid interruptions, so choose a place that you won’t be disturbed for at least 20 minutes.
  • Get comfortable.  While sitting on the ground or on a rock sounds like the best way to feel nature, you may find the discomfort distracting.  Consider bringing along a camp chair so you can sit comfortably.
  • As you sit in your choice of spot, focus on all five of your senses, one at a time.  If you find yourself getting distracted with intrusive thoughts or feelings, bring your focus back to your breath.  Pay special attention to the way the fresh air feels as you inhale and exhale.
  • Bring yourself a treat.  A warm cup of coffee, infused water, or light snack offers the perfect chance to experience your sense of taste during your forest bath, while also keeping you comfortably hydrated. 


What is your Forest Bathing experience?  Comment below to share.

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Dogs: Better than Xanax

Posted on February 24, 2022 by Jessica Bruno, LMFT

“Dogs are better than human beings because they know but do not tell.”

Emily Dickinson

Anyone who loves their pets can describe the sixth sense animals seem to have. They know when we are feeling down, anxious, or when we’re in pain. Most pet parents will probably tell you their animals are more in tune to their emotions than people. The vast majority of American households consider their pets part of the family, so it isn’t a surprise that we have conversations with them.

Think of the last time you vented to a human friend or family member. You probably did a lot of talking, and maybe that other person didn’t even get a word in. When you look back on that encounter, do you remember feeling better when you got it all out? Chances are, the person listening didn’t fix your problem, and they probably didn’t even tell you how to fix it yourself. So what did they do? They were present. By simply offering you uninterrupted space, you were able to think about, make sense of, and process your situation on your own.

Imagine that inside your brain is a giant, tangled knot. That’s what it feels like when we’re in crisis- we don’t know where to start and the more we let ideas swirl around our head, the more tangled the knot gets. When we invite someone else into the conversation though, we are forced to find one end to start with. As we untangle the knot, our ideas take shape. A narrative appears. There is a beginning, there is a series of events, there is the acknowledgment of perspective. As we talk, we slowly pull apart the knot and straighten out the kinks. Our brain is translating all of it’s emotions into words, and all of the words into sentences, and all of the sentences into a story. When the story starts to make sense… that’s when we experience relief. This doesn’t mean it’s a happy story, or one with a clear ending. Simply having the story gives us a sense of where we are, how we feel, and what the desired outcome is. At this point we can take a step back from the story, look at it, and wonder what comes next? This feels much more organized than the tangled knot of thoughts and emotions.

Now back to your dog- does he understand all of this? Probably not. Is he going to listen anyway? Most likely. Remember- your friend the great listener didn’t help you feel better by fixing your problem; they helped you feel better by being present and listening.

You might be thinking, by this logic, I can just talk to myself! Yes- that is literally what a journal is. Talking to your dog can provide more than just a sounding board for your thoughts. His relationship to you actually contributes to a physiological process in your brain which allows you to tap into a supply of “happy hormones” (endorphins, seratonin, dopamine, etc). When you shift your focus to your dog and look at him, pat his head or scratch his ears, there is a very good chance his tail is going to start wagging. By simply noticing your dogs uplifted mood, yours will lift up too. Don’t believe me? Here’s your challenge this month: Next time you are feeling down, snuggle up with your dog (or cat, or rabbit, or goat, doesn’t matter!) and tell them all about it. Perhaps offer them a nice belly rub while you share what’s on your mind. No pet? No problem! Your local animal shelter would LOVE for you to visit and spend some time with their animals (especially the older dogs!)

Comment below to share your experiences.

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How to Get More Time and Lower Anxiety

Posted on January 19, 2022 by Jessica Bruno, LMFT

“It is not that we have a short space of time, but that we waste much of it.”

Seneca

In my therapy practice, I meet a lot of busy people. In the United States, being busy is a source of pride. Multi-tasking is not a trick to get ahead, it is a way of life. For many people, being busy is how they cope with stress. They are so consumed by their tasks, they don’t have time to worry. Distraction can be a great coping tool, but it’s only effective in the very short term. Think of your smart phone- all the apps you can open immediately for that tiny hit of dopamine. As long as you use this type of distraction with boundaries, it can be a great tool for taking your mind off of your stressor in that moment. The trouble comes when that short term distraction turns into mindlessness, our brain’s version of auto-pilot. While this process is meant to help us, it ends up zapping our time and can lead to the single most diagnosed mental health condition in the U.S: Anxiety.

Anxiety can manifest as different symptoms for everyone. How do we cope with the the intrusive thoughts, the restlessness, the fatigue, the insomnia, the panic, the insert symptom here? We turn to our trusty coping tool- fall out of the present moment, and slip back into mindlessness. The tool has now become the trigger. So how do we break the cycle of wasted time and anxiety? We take back our focus and turn it inward: Mindfulness. When we are mindful, we are focused on the present moment. Our focus is no longer on the past, or the future, or on the million what-if-scenarios bouncing around our mind. Instead, our focus shifts to what is happening right now. Mindfulness is a pause button for our brain. All those ideas are still swirling around, but our focus is no longer on them. The ultimate way to practice mindfulness is through meditation. If you’re picturing a Buddhist monk cross-legged on a mountainside, or a woman in a yoga class chanting “Aum”… you’re not wrong. But there are infinite alternatives – many of which look nothing at all like meditation.

Gardening is the perfect form of meditation for those who want to connect with nature.

For one of my clients, meditation is watching the birds on her birdfeeder every morning. For some, meditation is a prayer they say before going to bed every night. Others meditate through relaxing activities like gardening. As long as the activity involves being quiet and focused, it is meditative. Just 10 minutes a day of this practice can have profound effects on reducing anxiety. The best part? The more mindful activities you add to your day, the more time you’ll have to enjoy them. Don’t believe me? Try introducing 10 minutes of mindful activity to your day and track your experiences in a journal. Comment below to share what you think.

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