by Charles Roberts, ED.D, LPCC-S, LICDC-CS

It will be years before we fully understand how the coronavirus pandemic has changed society. But one thing that is certain: teletherapy is here to stay.

Last spring, teletherapy became a lifeline for clients during the lockdown. Almost a year later, therapists and clients are still seeing benefits to this mode of treatment. It’s convenient for clients. It has expanded access for those who have transportation barriers or who face community stigma. And most important, research is finding that symptom reduction and client satisfaction rank about the same for teletherapy as for in-person sessions.

Yet despite the widespread adoption of telehealth tools in the past year, obstacles for therapists are still prevalent. Very little formal training exists that is specific to mental health providers. Telehealth has unique policies and procedures above and beyond in-person visits. Technology issues can derail a session. And there are a host of legal risks to navigate.

Continuous improvement is at the heart of what we do. In the spirit of continually improving how we serve clients, here are three video teletherapy best practices therapists need to incorporate into their teletherapy sessions now.

Creating the right ambience is just as important on a video platform as it is for in-person sessions. Dress professionally and be on time. Remove visual clutter and physical distractions from your practice space. And don’t overlook lighting—it should be adequate without being harsh. Always position your camera so that light sources, including windows, are in front, rather than behind, you.

Pro tip: always look at your camera, not your client’s face, to show engagement. Keep in mind that positioning the camera too close to your face can make a client perceive that you are in their space. It may also cut off nonverbal cues, like hand gestures.

#2 – Know Your Technology
You may need to pull double duty as IT support, so make sure you understand how your technology works before diving in. Start by ensuring your internet connection is fast enough to support video conferencing. Test your video and audio connections before every session. And always create a back-up plan with each client during your first session. Even with preparation, technology and internet connectivity can fail without notice. You and your client should both know what to do when this occurs so that their care is not interrupted.

#3 – Protect Patient Privacy
Teletherapy presents a host of risks related to the Healthcare Insurance Portability and Accountability Act (HIPAA) standards. At the most basic level, sessions need to be conducted in spaces that are free from interruption. You will also need to ensure that your device has a lock and is not used by any members of your household.

From a technology standpoint, all text messaging, email applications and videoconferencing platforms must be HIPAA compliant.  All emails, text messages, instant messages, chat history and clinical records will need to be preserved and stored in the client’s file.

Compass Point uses HIPAA-compliant video and email platforms, and all Compass Point therapists have access to these tools.

More Best Practices for Teletherapy
Mental health providers have a challenging ethical landscape to navigate. Keeping current with new guidelines can feel overwhelming at times.

Compass Point is offering a one-day webinar called Best Practices in Private Practice (Ethics). The webinar will be available in March, May, September and November as a live webinar. It will be offered in June and August on location in Mason, Ohio.

The course will be worth three CEUs. This training will clarify Ohio Counselor, Social Worker, and Marriage and Family Therapist board and insurance company rules. We’ll also look at best practices for using teletherapy, including avoiding common legal risks. Register for the course today.

Charles Roberts, ED.D, LPCC-S, LICDC-CS

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​Interested in signing up? Please give the front office a call at 513-939-0300 to ask about the next available start date. 

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Compass Point Counseling Services, a mental health private practice, is partnering with Lee Side Wellness, a psychiatric practice, to bring comprehensive mental health and psychiatric services to a brand new location in Mason.

The new Mason location will open Monday, August 5th in a 1,600-square-foot located conveniently right off of interstate 71 at 3615 Socialville-Foster Rd, Mason, Ohio 45040.
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This partnership will allow a “one stop” comprehensive experience to our mutual clients who are looking for quality mental health care In addition to medication management as well as TMS treatment for chronic depression. Both mental health facilities are grounded in the core values that all people matter, are of sacred worth, and warrant the finest in mental health and psychiatric healthcare.

The office will open with 7 clinicians: Chrisha Anderson, Stephanie Baker, Debra Bruemmer, James Canfield, Geralyn Cleary, Mariah Goodwin and Dana Mcdonald. The new location will have 5 individual therapy rooms along with a large group therapy space.

This is for family/friends of people who have an addiction.  NOT the person with the addiction.  

Group Lead: Greg Pratt MSW,LISW-S has worked in the Mental Health Field in the Greater Cincinnati area for over eleven years.  He graduated from Thomas More College with a BA in Psychology and from the University of Kentucky with a Master’s Degree in Social Work (MSW). He has worked with individuals and families struggling with a wide range of concerns and specific needs, including individuals with both mental health and substance use struggles.

$25 per group paid upfront at our Anderson Office or Dayton office

Co-Occurring Disorders
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​A person with a co-occurring disorder has been diagnosed with a substance abuse disorder and another mental health disorder. Co-occurring disorders, sometimes called dual disorders, are best treated through integrated treatment that addresses both issues at the same time.

The brain is a complicated and delicate organ. It’s not surprising that alcohol and other drugs can cause symptoms of mental illness. The substances work by changing the way the brain operates. People who use drugs feel buzzed or high because the substances affect chemicals in the brain and the way brain cells communicate with one another.

In response to those changes, the brain adapts to the presence of alcohol and other drugs, increasing the chances that a person will develop a substance use disorder. Substance use disorders are types of mental health disorders that are more commonly called addiction.
It’s possible to have more than one mental health disorder. Substance use disorders often co-occur alongside other mental illnesses. More than half of people with substance use disorders also have a mental illness. Sometimes the mental illness comes first. In other people, substance abuse occurs first. In both situations, each disorder amplifies the symptoms of the other.
“A large number of people with substance use disorders also have some psychiatric disorders which may or may not be major,” Dr. Timothy Huckaby, medical director of Orlando Recovery Center, told DrugRehab.com. “A lot of people have underlying depression or underlying anxiety.”
Other common co-occurring disorders include personality disorders, behavior disorders and psychotic disorders. With comprehensive treatment, individuals can recover from addiction and most co-occurring mental health disorders. But failing to address co-occurring disorders during addiction treatment increases the chances of relapse.

What Are Mental Health Disorders?

The phrases “mental illness,” “mental health disorder” and “mental health issue” are often used synonymously. In its diagnostics manual, the American Psychiatric Association uses the term mental disorder to define mental illnesses, but the organization also recommends using the term mental health challenge.
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The American Psychiatric Association defines a mental disorder as: “a syndrome characterized by clinically significant disturbance in an individual’s cognition, emotion regulation or behavior that reflects a dysfunction in the psychological, biological or developmental processes underlying mental functioning.”

Some mental disorders are more common than others. Conditions such as anxiety and depressive disorders, for example, occur more frequently than schizophrenia and psychosis. Each type of mental disorder can range in severity from mild to severe.
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Developmental Disorders

Mental disorders are different from developmental disabilities. Developmental disorders, such as autism spectrum disorder and learning disabilities, impair social interaction, mobility, language and self-sufficiency.

Substance use disorders and other mental health disorders can co-occur alongside developmental disorders. But the term co-occurring disorder most commonly refers to substance use disorders and mental disorders.

Dual Diagnosis & Comorbidity

Dual diagnosis is an outdated term for co-occurring disorders. Both of these terms are sometimes confused with comorbid disorders.
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Comorbidity is a broad term used to denote the existence of multiple physical or mental diseases or disorders. Co-occurring disorders and dual diagnosis are specific to substance use disorders and other mental health conditions.
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Mental Disorders that Co-Occur with Substance Abuse

Any mental health disorder can co-occur alongside substance use disorders. The most common types of co-occurring disorders include mood, anxiety, psychotic, eating, personality and behavioral disorders. Each category includes numerous types of mental disorders that can range in severity.

Symptoms of personality disorders vary widely based on the type and severity.

Behavioral Disorders
Behavioral disorders most commonly occur in children. Many healthy people exhibit behavior problems, such as inattention, defiance and hyperactivity. However, behavioral disorders are characterized by chronic behavior problems that last at least six months.
Common behavioral disorders include:

• Attention-deficit/hyperactivity disorder
• Oppositional defiant disorder
• Conduct disorder

Symptoms of Co-Occurring Disorders
The physical and emotional symptoms of co-occurring disorders vary depending on your life circumstances, the type of substances you use and the type of mental illness you possess.

​The symptoms of mental health disorders are similar to the side effects of addiction. Thus, it can be difficult to determine whether a mental illness is caused by substance abuse or vice versa. Reputable addiction treatment centers screen patients for mental illnesses and develop plans for treating co-occurring disorders simultaneously.
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You’re here because you are curious about EMDR therapy and you want to know what it’s all about. As a therapist, I’ve learned many types of therapy that have positively changed the way I approach my practice, EMDR incorporates all that and so much more. For many years, I heard from respected clinicians about the incredible changes they have seen in their clients engaged in EMDR therapy. The therapy has gained recent momentum in the mental health world, and for good reason. EMDR is empirically validated as effective for helping people deal with trauma. It has also been shown effective with many other disruptive symptoms such as anxiety, depression, panic attacks, and addiction recovery. Think of your painful memories, thoughts, images, like a tangled ball of yarn, often complicated to talk through especially when the strings are intertwined.  EMDR therapy can help to untangle the yarn and allow you to process one string at a time, in a safe contained way. EMDR therapy can accelerate the therapeutic process by resolving painful past traumas allowing you to live more fully in the present. And who doesn’t want to live in the present?
 
Why am I telling you about EMDR?
I was trained by Dr. Stephen Dansiger, a certified EMDR therapist from the Institute of Creative Mindfulness. I experienced a life changing shift when he himself demonstrated the 8 phases of treatment on me. Keep reading and I will tell you more about these 8 phases later. During my experience I felt a relief, something years of talk therapy had not been able to process for a long time. As a clinician, I feel passionate about giving as many people the opportunity to learn about and benefit from this treatment as possible.  
 
But what is EMDR therapy?
EMDR stands for Eye Movement Desensitization and Reprocessing.  Don’t worry, it is way less complicated than it sounds. It is a non-drug, non-hypnosis, psychotherapy that combines many positive elements of numerous therapies along with left/right brain stimulation (known as bilateral stimulation), developed by Dr. Francine Shapiro in the 1980’s. EMDR therapy involves a trained therapist waving their fingers from left to right (some therapists use a light bar to achieve this part of the therapy), in a windshield wiper motion, which will trigger the brain to bring up the painful memories in an effort to process them and speed up the healing process. All of this is done in a safe environment with you and your therapist present. You are not alone in the processing of your memories. The therapist will also work to reprocess negative beliefs, images, and feelings and replace them with more positive ones. The outcome is the feeling of resolution and a more peaceful state overall. EMDR therapy has successfully treated millions of people of all ages, has gained notability with veterans of war as a primary treatment modality for Posttraumatic Stress Disorder, but also many types of other traumatic stress and negative symptoms that come along with different experiences.
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You’re probably wondering how simple “finger wipers” do all that? Interestingly enough the “finger waving” is key to the therapy. It engages something called bilateral stimulation (right to left eye movement), which repeatedly activates the opposite sides of the brain. This releases emotional experiences that are "trapped" in the nervous system. When this happens it assists the neurophysiological system, the basis of the mind-body connection, to free itself of blockages and begin to heal. In a basic sense, when a person experiences an adverse event, or trauma, the brain cannot process the event as it does normally. The brain instead takes this event and stores it, sort of like “I’ll get to this later”.  Unfortunately, the “I’ll get to this later” never quite happens and essentially these adverse feelings, memories, and thoughts become “stuck” in an isolated memory network. They can easily become re-triggered by sound, smell, feelings, and environments that were activated during the traumatic event.  EMDR therapy is able to guide the person in a safe, contained environment to “unstick” the memories, reprocess them, and replace them with more positive images. Once this happens,the person can begin to move forward with healing.
 
Who is the best candidate for EMDR?
EMDR therapy is for children, adolescents, and adults. If you or a loved one has ever experienced panic attacks, complicated grief, dissociative disorders, pain disorders, anxiety, performance anxiety, depression, addictions, phobias, sexual and/or physical abuse, body dysmorphic disorder, and personality disorders.
 
**It is important to note that a consultation with a EMDR trained therapist is the best way to determine if EMDR is right for you.
 
EMDR therapy has been designated by the American Psychiatric Association, U.S. Department of Defense, and the International Society for Traumatic Stress Studies, as a highly effective and empirically supported treatment modality for the treatment of Posttraumatic Stress Disorder (PTSD).
 
What happens in EMDR Therapy sessions?
EMDR therapy has a standardized set of protocols that a therapist will follow. There are 8 phases to the treatment, that are moved through at a varying pace depending on your readiness for the next stage. An EMDR therapist is trained to know appropriate pacing but you can determine whether to continue or stop at anytime. The therapist is there as a guide to help you get the most out of the experience, and at times may gently aide in pushing you through painful moments.  
 
Why bring up painful memories? Isn’t it best to forget them and move on?
By avoiding the painful memory you might continue to experience the lasting effects of the event, through nightmares, stress, anxiety, and panic attacks. By holding onto these memories you stop yourself from moving on. The problem with avoidance, or ignoring these memories, is that it is a temporary relief. For a brief moment it allows you to feel better and put aside the pain, but it doesn’t remove it, and worse, it allows it to keep its power over you and your joy. Often, this painful memory rears its ugly head at times when we are not prepared and leaves us crippled by its effects. EMDR therapy is not just bringing up painful memories, its moving through them in a safe, contained way. It alleviates suffering, and replaces it with positivity.
 
What happens when I’m done with all 8 phases?
After the 8 phases you will likely continue to process the material for days, weeks, or perhaps even months. You might have new insights, vivid dreams, feel angry or numb with no real answer why. This is because your are finally processing the unpleasant memories you were holding onto for so long. Your therapist will guide you through this process and advise best practices for moving forward. Some people feel a slight buzzing all over their body, similar to the feeling of when they stand up too fast. Don’t worry, this will soon fade. Your right and left hemisphere are stimulated by the finger waving motion and it is only natural that you will feel something afterwards. Often times, after a person has processed one of their target issues they will notice that some of the other target issues, are no longer are troubling them. This is because our memory networks are linked in ways we aren't consciously aware of.  Its normal to cry, feel tired, need time to be alone, or feel a little “off” because your body is starting the healing process. Allow it to heal.
 
So this all sounds like something I might want to try. What do I do now?
I would be more than happy to help you in your journey to healing! You can call our main office at 513.939.0300 and ask the office staff to schedule an appointment with Jennifer Burns for an EMDR session. I am currently taking new clients and would love to meet you.

​Where can I find more information on EMDR?
EMDR International Association
The Institute for Creative Mindfulness
U.S. Department of Veterans Affairs: National Center for PTSD