Category Archives: Individual Therapy

8 TIPS to Help Clients Do Homework

Posted June 6, 2018

Dr. Lane P.: Hi, I’m Dr. Lane Pederson. One of the most common questions I get from participants in my seminars is, How do I get clients to do homework? In this short video, I’m going to share with you eight tips that I find to be very effective. Continue reading

Preparing for a Provider Appointment

Posted October 23, 2017

It can be sometimes feel daunting to get all of your goals met during your provider appointment. Between your questions and goals, the treatment planning of the provider, and limited appointment length it can feel like there isn’t enough time to get everything accomplished. This can be frustrating and disheartening for individuals who experience chronic pain and medical conditions. To avoid feeling shut down during your appointments, it is important to take active steps in preparing for these meetings. This planning can help to build confidence and sense of control, in addition to working towards efficiently meeting your goals.

Prior to your appointment, take some time to plan ahead. Write down your list of questions and goals. Gather any medical history, medication lists, and any symptom tracking details you have been collecting. It can be helpful to store these details in a folder or binder. Plan out your transportation, and make sure to allow for plenty of time for unexpected traffic or road construction. Will there be parking on or off site? What is the schedule or call ahead policy for scheduling transportation? When you arrive at your appointment, ask your provider to establish the timeline, and share the tools you have gathered and your top priority goals for that meeting. Bring a notepad and pen, and make sure to write down any questions or next steps recommended by your provider. These tips can allow you to not only increase your experience of feeling heard during the appointment, but can also increase your ability to understand the treatment and to follow through effectively afterwards.

Written by:
Morgan Cusack, PsyD
Program Coordinator of Thrive for Mental Health and Chronic Pain Management at MHS

10 Days to a 10-Minute Meditation Practice

Posted March 23, 2017

Pain 1Developing a Meditation Practice Can Seem Impossible…Until You Discover How Doable It Can Be! Taken from Dr. Lane Pederson’s new second edition of The Expanded Dialectical Behavior Therapy Skills Training Manual, these free handouts explain a step-wise and doable method for bringing a brief meditation practice to your and your clients’ lives. Start today!

Click HERE to view the handouts.

Mindfulness Exercises

Posted March 16, 2017

DBT Manual 2Mindfulness is one of the pillars of DBT and has become increasingly important across contemporary therapies. Yet many therapists are at a loss for examples to suggest and use with their clients. Taken from Dr. Lane Pederson’s new second edition of The Expanded Dialectical Behavior Therapy Skills Training Manual, enjoy this free handout you can use with any client looking for mindfulness exercises…and remember, mindfulness is not what you’re doing, but how you are attending to what you’re doing!

VIEW HANDOUT HERE

5 Tips for Completing Paperwork on Time

Posted January 30, 2017

Consult 1Paper cuts are becoming outdated with new mandates for electronic medical record keeping, but that does not mean all our paperwork woes have vanished. As a professional, there is no avoiding paperwork because of it being so important, but it can also be the first thing to slide when things get hectic. Here are some tips to help you get your paperwork done more efficiently.

1. Routine
Work to develop a routine and stick to it! Completing your notes in session or making sure your notes are complete by the end of each day is ideal. Figuring out what works for you and establishing a routine takes energy on the front-end, but will likely pay off.

2. Consistency
Once you have developed your routine, make sure that you stay consistent. Scheduling time for paperwork on your calendar is a great way to do this if you can stick to it!

3. Backup Plan
We work in a field where things can be unpredictable and throw off our game plan. Make sure to have a backup plan when these things happen. Sometimes we need to be flexible to meet the needs of our clients!

4. Support
If you are struggling to get paperwork done on time and have tried implementing these strategies reach out for support. Sometimes we need some support, problem-solving advice, or even accountability to help manage our workload.

5. Reward
We all know about reward and reinforcement, right? As professionals, we can use this on ourselves as well. When you complete your paperwork, find a way to reward yourself. Go for a walk, have a cup of tea, or chat with a co-worker.

We do very important work, but no one can see that if we do not get our paperwork done in a timely and complete fashion.

Myths About Mindfulness

Posted May 5, 2016

By: Dr. Lane Pederson

Many people, therapists included, have misconceptions about what mindfulness is and what it is not. Sometimes these misconceptions get in the way of engaging in mindfulness practice. Below are some of the most common myths about mindfulness.

• Mindfulness is Buddhist (or some other philosophy or religion)
While a large variety of philosophies and religions promote mindfulness practices, mindfulness is best thought of as a human activity that is owned by no group or person. Mindfulness belongs to us all, and furthermore, mindfulness and its benefits are supported by robust research that clearly shows its psychological, emotional, physical, and performance-based benefits.

• Mindfulness is all new-age-y, wavy-gravy or (insert your judgment here)
For some reason, mindfulness seems to conjure images of people in flowing robes, sitting in serene settings, existing in some unreal world disconnected from your or my reality (admittedly, many photos showing people practicing mindfulness promote those stereotypes). The facts are that mindfulness is for everyone, and that people across all races, ethnicities, cultures, religions, occupations, and socio-economic statuses practice mindfulness.

• Mindfulness is a fad or trend
Mindfulness has been around since the dawn of consciousness, making the Beatles or Rolling Stones look like fads by comparison. Not much stands that test of time. When the end of the world comes, only cockroaches and Keith Richards, practicing mindfulness, will remain. Enough said.

• Mindfulness takes a lot of time
While some advocates of mindfulness stress 45 minutes (or more) of meditation or other mindfulness practice daily, the fact is that you can achieve benefits from taking just a few minutes (or even moments in some cases) to re-center yourself mindfully in the moment. When you consider how much time we all spend distracted by problems, taking a few minutes to breathe or otherwise practice mindfulness is a great tradeoff.

• People who practice mindfulness are always mindful (and effective)
A mindfulness student once saw his teacher eating while watching TV. Angry at the apparent hypocrisy of doing more than one thing at a time, the student challenged his teacher. “You always teach one-mindfulness, lecturing ’when you walk, walk, when you pray, pray, and when you eat, eat,’ and now I see you both eating and watching TV!” The teacher calmly replied, “When you eat and watch TV, eat and watch TV!” Mindfulness does not create perfection, and practitioners will likely experience the benefits but will certainly not always be in the moment. Further, seeking to be ever-mindful means you are clinging to a goal and as such not in the moment.

• Mindfulness is done only during meditation or other mindfulness practice
This myth is one of the biggest, and it is analogous to saying people only move their bodies when they exercise. Think of meditation and other mindfulness practice as exercise for the brain, building the skills needed to collect and focus your attention and then guide your behavior. Just as physical fitness is about developing a healthy body, meditation and other mindfulness practices are about building healthy mental processes so you can be mindful in the moments of everyday life.

• Mindfulness is only about pleasure, peace, and relaxation
While mindfulness can be pleasurable and promote peace and relaxation, mindfulness is also about relating to experiences that can be aversive, uncomfortable, and even painful. Think about how often we try to escape these types of experiences only to make them worse! Perhaps paradoxically, using mindfulness to accept and relate to what is painful can transform it; mindfulness is fundamentally acceptance-based and non-judgmental, which releases the helping of suffering we often dump on pain.

• Mindfulness can turn off problems, or otherwise make them go away
Mindfulness is not about turning anything on or off. Rather, it is about deciding what to focus on and when. What mindfulness can do is offer a way to focus away from your problems when you choose, getting a break, and to focus on your problems when you choose with a different approach that might transform your relationship to them, as mentioned above.

• People with attention-deficit, racing thoughts, intrusive thinking, or other problems cannot practice mindfulness
Even though mindfulness does not turn off or make problems go away, it is a set of skills you can practice to eventually minimize the impacts of these problems on your life. For example, if your problem was racing thoughts, you would simply notice when they distract you (gently and non-judgmentally), and then turn your mind to the chosen focus of your attention. If your problem is attention deficits, then practicing the skill of (re)focusing your attention (i.e., mindfulness) is perfect for you!

• Children, people with cognitive disabilities, or (insert another category of people) cannot do mindfulness
Watch young children eat, play with their toys, and explore. They are engrossed, and there. This is mindfulness. People of most developmental and cognitive levels have the ability to focus their attention and connect to the present moment, and can have that ability fostered. To this end, having a parent, friend, or loved one practice mindful engagement with them will gently pull along their mindfulness skills, even if they cannot explain mindfulness conceptually. For those without abstract thought, we simply make explanations of mindfulness more concrete. Smell the flowers, and blow out the candles.

• You are unable to do mindfulness
See above, and also remember that you already practice mindfulness sometimes, with some things, in some places. Where and with doing what do you find yourself totally connected and inhabiting the moment? Maybe it is when you play an instrument or sport, or when you are doing a hobby, or into the flow of your work. Maybe it’s when you are in your garden, cooking, or connecting spiritually. Use existing times of mindfulness to branch out and develop your skills, remembering that mindfulness is like any other skill-set: You get out of it what you put into it. Practice your practice, and the rewards will come with time.

Practical Advice for Stuck Clients

Posted November 30, 2015

So many of us consult on the intervention level when a client is not making significant progress.  We offer therapists advice like, “try a cognitive reframe,” or “be mindful of the behavioral contingencies,” or offer some other “ingredient” from our preferred therapies that we think will be the catalyst for change.  And why not?  We need interventions to do therapy, and our treatment manuals are basically recipe books full of ingredients that promise results for our clients.  In fact, most seminars rally around a particular treatment manual, and some even go so far to say they have the 5 (or 10) best strategies to help even your most stuck client!

Therapy manuals and their ingredients are important, and we should learn to do our therapies well, but research shows that the interventions we use in therapy actually account for a small amount of the variance in change.

So what influences outcomes more than interventions? 

Unsurprisingly, the therapy alliance is of vital importance.  However, you may be  surprised to learn that the therapy alliance accounts for 5 to 7 times more of the variance in change than treatment manuals and techniques!

Thus, while intervention-based consultation will always have its place (again, we need interventions to do therapy), it may be more wise to consult on the how the quality of the alliance is affecting the outcome.  To this end, consider these three factors related to alliance, ALL of which research shows need to be present for a positive outcome:

1) Relationship: This is the third of alliance most obvious to therapists.  Relationship is definitely about rapport and the therapist-driven variables of authenticity, empathy, and respect.  While providing these qualities along with a nonjudgmental stance seem like common sense, it can nonetheless be difficult at times when working with a stuck client.

2) Agreement on a Goal: Having a common goal for the therapy defines the work and speaks to the active part of alliance.  Often when therapy is not working it is because there is not a shared goal to bind the alliance and create active roles in the therapy.  Ask yourself: “What does the client want?”  Without a shared goal, there is no therapy!

3) Agreement on the Therapy and its Methods as being Legitimate to Reach the Goal/Solve the Problem: This third part of alliance speaks to how successful outcomes result from an interactive connection between therapist, client, and therapy/interventions in the pursuit of the identified goal.  To be effective, agreement on the therapy and methods needs to be based in genuine belief and expectancy on the part of the client and allegiance on the part of the therapist.

Without therapy alliance, virtually no intervention will carry much success. Therefore, whenever you have a stuck client, start with making sure all three parts of the alliance are present and in play!

5 DBT Skills to Enjoy the Holidays

Posted November 18, 2015

Finding yourself or your clients stressed out and dreading the holidays? While many struggle through the holidays, that doesn’t mean we are powerless to use our skills. Building on our 5 skills to survive the holidays blog, we offer 5 more skills to actually enjoy the season. Here they are:

1. Build Positive Experience (BPE):
BPE starts with being mindful of positive events that are happening all around us. Often we miss opportunities for fun or connection because we are lost in our problems and worries. Time to awaken and take advantage of positives that are possible now. Listen to favorite holiday music, watch time-honored movies, and commit yourself to investing in the season. Make sure to schedule times to get out and about to get-togethers, community functions, services, and other events that pop up during the season. BPE takes investment, planning, follow-through, and sometimes a dose of opposite-to-emotion too!

2. Attend to Relationships (A2R):
A2R is a specialized type of BPE. Relationships are like plants in that they need to be watered or they wither. The holidays are the perfect time to send cards, pictures, or to write a meaningful note or letter. Connect by phone, Skype, or in person if possible. Take extra time to let others know that they matter to you.

3. Contributing:
Surprise a friend, loved one, or co-workers with cookies or another treat. Participate in parties and events in whatever way you can…even your presence is contributing. If you are able, consider volunteering your time with any organization that helps those less fortunate, or take time to set aside and donate items you no longer need. Support an organization like Toys for Tots or volunteer to be a Salvation Army bell ringer. Whenever you can, think about how you can give, which is a true meaning of the season.

4. Self-Soothe:
Get into your senses. The holidays are filled with sights, sounds, smells, and tastes that are pleasing to our senses. Connect mindfully to these moments, and allow yourself to relax into what the holidays have to offer.

5. Participate:
Participate is a core mindfulness skill, and it means fully immersing yourself in what you are doing in the moment. Truly inhabit each experience with your full self, gently letting go of distractions to get back to being with what you are doing and who you are with during this season. Remember that we can participate in stress and misery, or in the many opportunities for joy that the season can offer us.

5 DBT Skills for Surviving the Holidays

Posted November 10, 2015

Holidays can be a time of joy or misery. While we cannot control the world around us, or make reality unfold according to our preferences, we can practice our skills to navigate challenges and focus on what is most important to us…thereby influencing our mood for the better. Create a more stress free holiday season for yourself and others with the following skills. And stay tuned for the next email on 5 skills to not just survive, but to enjoy the holidays!

1. MINDFULNESS
Mindfulness is about paying attention to the present moment, on purpose, with an open heart and nonjudgmental stance. It is about directing what we want to focus on and when based on our wisdom and what will work. During the holidays our minds get hijacked by worries about families, get-togethers, gifts, and balancing the competing pressures of the season. The remedy is to slow down and focus on this moment, taking one thing at a time, and doing exactly what is needed (which might be just being present and not doing a thing!). We can only influence the future through this moment, so live it as effectively as you can. Also remember to take time to practice breathing, imagery, or to simply contemplate the true meaning(s) of the season.

2. OPPOSITE TO EMOTION (O2E)
The holiday season might mean that you have a lot to do. When pressure builds, procrastination and avoidance can grow. Avoidance behaviors get reinforced by what we call negative reinforcement…there is temporary relief that comes with avoiding any activity that causes stress. Step out of this trap by acting opposite to procrastination and avoidance behaviors by doing tasks and activities that need attention…take the first step and throw yourself into it. Also, don’t be afraid to balance this strategy by simplifying and letting go of task and activities that are truly non-essential.

3. PLEASED
The PLEASED skills are all about self-care. Halloween candy is still around, and more holiday goodies are on the way. Unfortunately, many of us cope with stress by indulging in the excesses of the season. It feels good in the moment, but probably works against our larger goals. This is the time to be more mindful of eating healthy, balanced food, getting more movement in our day, and improving the amount and quality of our sleep. We like to think that self-care can wait until January 1, but really the time for it is today. An increase in these skills will help make the holidays more joyful with less stress. We all do better when we feel better!

4. RADICAL ACCEPTANCE
This skill means letting go of fighting reality. When you accept and give up the fight, then you free up your mental and emotional resources to be as effective as you can. Almost by definition, needing to use acceptance means that the situation you are choosing to accept is not your preference and you do not like it. For a greater good you might need to see your in-laws (or your own family), or go to that holiday or office get-together, or make some kind of compromise. Practicing an attitude of acceptance with life’s difficulties is a nice alternative to fighting every battle and making yourself suffer over what is. That is not to say give up and give in. Sometimes we do need to set boundaries or solve a problem…but if you need to do that, you will still be more effective if you start with acceptance.

5. WILLINGNESS
This skill is the opposite of trying to control everything or take a my way or the highway approach to others and life. Being willful limits our options and forces everyone into corners. Maybe it does not have to be your way! When appropriate, learn to let go and go with the flow. Be willing to do whatever is necessary to accomplish a goal or to contribute to a get-together or another person. Let go of your preconceived notions of how you think a situation should be and practice flexibility. Holidays can make us feel out of control, which we sometimes react to by trying to control everything. People who practice willingness learn to bend so they don’t break!

MHS wishes you, your friends and family, and your clients a joyful holiday season!