Therapy in the Time of COVID-19 and Shelter in Place: What is Teletherapy?

By Annabelle Parr

During this incredibly stressful time of COVID-19, we are having to make major life adjustments.  With the new shelter in place restrictions, you might wonder whether psychotherapy is still an option available to you. The short answer is yes!

Telehealth, also known as video conferencing or online therapy, has been available long before COVID-19, and is an important alternative to in person care.

Traditionally, therapy is done in person. However, with the emergence of new technologies, there have been an increasing number of telehealth / video conferencing options and platforms emerging and available in the mental health field over the last decade. This means that not only do we have the infrastructure available to offer confidential, HIPAA compliant virtual therapy, but also that there is already plenty of research on telehealth and its efficacy in mental health treatment.

Prior to coronavirus, teletherapy expanded access to care to individuals who were not able to get to a therapist’s office, whether that was due to scheduling difficulties or a lack of mental health care options in their community. Now, shelter in place poses a barrier to accessing in person care for all of us. Thus, telehealth via video conferencing offers convenient access to care for everyone as we are required to stay at home as much as possible.

How effective is telemental health care?

According to the Anxiety and Depression Association of America, “from a large body of research we know that telemental health leads to high patient and provider satisfaction ratings and achieves health outcomes equivalent to in-person care across all diagnostic groups” (Yellowlees, 2020). So as long as the client is willing to engage in therapy virtually and is not an extreme risk to themselves or others, research shows that telemental health is as effective as in person treatment.

How does virtual therapy work?

Typically, telehealth involves video conferencing with your therapist using a secure, HIPAA compliant platform. No extra equipment or complicated applications are required.  Clients can use their smartphones or a laptop computer with a built-in camera. Therapists are able to offer telehealth services to patients located in the state in which they are licensed. So a therapist licensed in and practicing in California is able to offer teletherapy services to patients located in the state of California. Though not all therapists were offering telehealth options prior to COVID-19, given the current situation, many have adjusted their practices to offer video counseling options to patients in need.

What should you look for in a telehealth provider?

The same things you would look for in a therapist you would see in person: you want to ensure that the therapist you choose has expertise in the areas in which you are seeking treatment for, and you want to make sure the therapist feels like a good fit for you personally. One thing we know for sure is that the quality of the therapist-client relationship is the most important factor in producing successful treatment outcomes across settings, in-person or online. This means that in order for therapy to be effective, you have to have a solid trusting rapport with your therapist. Assuming those two conditions are present, telehealth is likely to be just as effective as working with the same therapist in person.

If you find yourself struggling, feeling stuck, and/or could use some help navigating your feelings, you could benefit from Cognitive Behavioral Therapy, Acceptance and Commitment Therapy, Mindfulness, and Telemental Health Services. Dr. Shoshana Shea can help. She can be contacted at 619-269-2377.

Work-Life Balance: On Connecting with Our Values

By Annabelle Parr 

As technology has expanded in the last couple of decades, the workplace has changed significantly. With laptops and smartphones, work can follow you outside of the office and into the hours outside of 9 to 5. While the upside of this shift is that there is now more opportunity for flexibility, the downside is that it can mean pressure to work non-stop. No place is sacred when the smartphone can ping you with an email anytime, anywhere. As a result of both the increased opportunity for flexibility and the increased opportunity for being forever on the clock, work life balance is tricky. How can we create balance between work and other important areas of our lives, like family, fitness, fun, etc.?

When work life balance becomes oppressive…

Though this question is certainly valuable and worth considering, the emphasis on work life balance also has the potential to become oppressive. Are you balanced enough? Have you created the perfect balance between working and spending time with your kids and your partner? Are you doing it all with a smile?

When we fuse with this ideal of work life balance – in other words, when we hold as a literal truth that we must equally balance our time between our work lives and the other aspects of our lives – we can lose sight of the original point behind the concept. We may find ourselves feeling increasingly stretched too thin. Rather than enjoying our so-called balanced lives, we may find ourselves feeling persistently inadequate, unsatisfied, and that we are failing in some regard.

Values-based living offers an alternative approach

So what can we do instead? We can construct our own personal definition of what it means to have a fulfilling, balanced life. Acceptance and Commitment Therapy (ACT) suggests that when we connect with our own personally chosen, deeply held values (rather than values imposed upon us, designed to please culture/other people, or driven by a “should”), we construct a compass which guides our decisions. Values are not the same as goals or outcomes, but are qualities of being, toward which we can strive in each moment. When we are conscious of and connected to our values, we are equipped with a why to drive our actions. 

And once we know what matters to us, we can begin to prioritize the things that truly bring us meaning and fulfillment. We can gauge whether our lives are aligned with our values or out of sync, regardless of whether they live up to the ‘work life balance’ ideal. Then we can consider what (if anything) needs to change in order to better align with what’s really important to us. The beauty of this idea is that there is no one right way to structure our lives. To the extent that you have choices about your work and your time spent outside it, you get to decide what matters to you and what actions you can take in that direction.

How do we connect with our values?

There are a whole host of ways that we can get in touch with our values. ACT relies on experiential exercises and metaphors to teach psychological flexibility skills and to help us connect with what matters.

One exercise that can help you consider what is truly important to you is to try writing a summary of your own autobiography written twenty years from now. What’s the title? How do you hope to be described? What major accomplishments or milestones are noted? What stands out about you in your life story? 

If you’d like to try a similar exercise, imagine what you would want people to say about you in your eulogy. This exercise may sound morbid, but in connecting with the finitude of life, we can reflect on how we want to move forward with our lives and how we want to engage with the present, rather than reflecting back with regret. How do you hope you will be described by the people that matter to you most at the end of your life? How do you want to be remembered? What do you hope you will have accomplished? How do you hope to have spent your time? Who do you hope to be?

If this activity feels too morbid for you, before you decide not to complete it, be present with and honor the feelings that show up when you consider the exercise. Those feelings may have something important to say… 

Once you have done one (or both) of these activities, see what themes emerge. What matters to you? Who and how do you want to be? How do you want to spend your time? What do you want to bring to the world? You may notice some goals you have for your life, but see if you can step back from the goals and identify the qualities of being that you want to embody. These are your personal values. Now, consider how you can apply them to your life today. In what ways is your life consistent with or at odds with your eulogy or your autobiography? These are the areas in which you may want to consider making values-based changes.

IF YOU FIND YOURSELF STRUGGLING, FEELING STUCK, AND/OR COULD USE SOME HELP NAVIGATING YOUR FEELINGS, YOU COULD BENEFIT FROM COGNITIVE BEHAVIORAL THERAPY, ACCEPTANCE AND COMMITMENT THERAPY, AND MINDFULNESS. DR. SHOSHANA SHEA CAN HELP. SHE CAN BE CONTACTED AT 619-269-2377.

The Way We Use Mindfulness Matters

By Annabelle Parr

It seems like mindfulness is everywhere these days. In recent years, it has exploded on the scene as the seemingly catch-all cure for a whole host of problems, supposedly promising to address mental health concerns, decrease stress, improve performance at work, and make you a better parent. Its benefits are touted across the internet – from business sites like Forbes and Fast Company, to wellness sites like the Huffington Post, to inspirational sites like Upworthy.

It’s true that practicing mindfulness can benefit us in all sorts of ways, showing not only benefits to our mind and our mood, but to our overall physiological health as well. However, when something is subjected to as much hype as mindfulness has been, sometimes in all the air time, it can get watered down and potentially misrepresented. Depending on how we talk about mindfulness and how we choose to apply it to our struggles and our lives, mindfulness can be a huge help or it can become one more well-disguised attempt at avoiding and controlling discomfort.

So what actually is mindfulness?

Mindfulness has a long and rich history rooted in Eastern philosophy traditions, which have acknowledged its benefits for centuries. Jon Kabat-Zinn, professor of medicine at the University of Massachusetts Medical School, was a trail blazer in integrating an understanding of mindfulness into the Western conception of health. He defines mindfulness as “paying attention in a particular way: on purpose, in the present moment, and non-judgmentally.” Meditation is an example of a mindful exercise, but mindfulness can be practiced in any moment during any activity – one of the reasons it is so appealing and accessible as a means of promoting wellbeing.

Sounds ideal, right? You can practice it anytime, anywhere! The key to a stress free life is available to you in any moment! Well…not exactly.

 As Steven C. Hayes (2019) pointed out in his new book, A Liberated Mind, “it matters what mindfulness is for.” Why are we choosing to practice mindfulness? Based on any number of headlines and articles you read online, it sounds like practicing mindfulness is about getting rid of discomfort and stress. But thinking about it this way can actually make things worse! As Carl Jung noted, what we resist persists. The more we try to escape, avoid, or control our emotions, the stronger they tend to get. What’s more, when all our energy is devoted to controlling discomfort, our lives become increasingly restricted as our choices are dictated by what we are not willing to feel. When mindfulness becomes one more tool to escape or control uncomfortable experiences, it can end up fueling the same cycle that gets us caught in suffering.

So if it’s not about getting rid of stress, why should we bother being mindful?

From an Acceptance and Commitment Therapy (ACT) perspective, mindfulness helps make our lives richer and more meaningful. It does not guarantee freedom from discomfort. But it does offer us a new way to meet our pain. When we connect to the here and now rather than getting caught in regrets about the past or worries about the future, we are freed to notice what is happening in the moment and then choose to take action toward what is important to us.

The purpose is not to get rid of stress or anxiety or grief or whatever other uncomfortable feeling shows up, but rather to help facilitate awareness so that discomfort does not control our actions and define our lives. In being more present, we are free to notice not only the tough stuff like sadness or fear or frustration, but also the stuff that fills us up, like peace, joy and triumph. When we are not responsible for changing how we feel, we are freed up to change how we behave.

If you are interested in learning more about mindfulness, it can absolutely be helpful! And it can help you with things like stress and anxiety and work performance and being a more engaged parent and partner. But the reason it is helpful matters. A lot.

When you decide to show up to the moment mindfully, remind yourself that this is not a way to escape something difficult or painful. As psychiatrist and Holocaust survivor, Victor Frankl, so poignantly noted, “between stimulus and response there is a space. In that space is our power to choose our response. In our response lies our growth and freedom.” Mindfulness allows us to access that space. It allows us to hold our experience willingly and gently, allows us to notice helpful information that may be present in our experience, and allows us to make a conscious, active choice about how we want to behave. We are freed to choose to act in a way that is consistent with our values, and in so doing, we are invited to experience life as full of vitality and meaning, even when we are faced with discomfort.

IF YOU FIND YOURSELF STRUGGLING, FEELING STUCK, AND/OR COULD USE SOME HELP NAVIGATING YOUR FEELINGS, YOU COULD BENEFIT FROM COGNITIVE BEHAVIORAL THERAPY, ACCEPTANCE AND COMMITMENT THERAPY, AND MINDFULNESS. DR. SHOSHANA SHEA CAN HELP. SHE CAN BE CONTACTED AT 619-269-2377.