We wanted to inform you of a counseling scam that is going around the internet. In a nutshell, a potential client contacts you asking to pre-pay for counseling. He is out of the country, or somewhere distant and intends on using the sessions when he returns. He then sends you a check for too much money. The check is an overpayment. He contacts you and requests you send him a refund for the overpayment. He needs the money ASAP. So you send him money. The problem is, the check then bounces, and you are out money. Please be very careful of scams, never ever send someone money unless you are certain that it is the right thing to do. If someone “overpays” you, make sure the money is cleared before ever sending money back.

If you get a suspicious email, its probably best not even to reply.

Give an Hour is a nonpolitical organization whose current project focuses on the mental health needs of military personnel and their families. We are offering a range of mental health services in order to address a variety of needs for the individuals seeking services. Our definition of “family” is quite broad and includes but is not limited to the following: spouses, children, parents, siblings, extended family members, and unmarried partners. We are offering our services to anyone who is or has been affected directly or indirectly (through a relationship with someone in the military) by the current conflicts in Iraq and Afghanistan.

The individuals who seek services from Give an Hour may benefit from different types of support or treatment. We believe that most of those affected by these conflicts would not need mental health services if not for the unusual and extreme circumstances within which they find themselves. Furthermore, many of those seeking services may not be familiar with counseling or psychotherapy. Therefore, you will see terms such as “services” instead of “therapy” to reflect this philosophy.  We believe that being sensitive to the specific circumstances that bring these individuals to our organization is critical for success.

While the standard within the mental health community is to meet with the client in the practitioner’s office, we recognize that this may not be feasible for some individuals seeking services from Give an Hour (called “visitors” on our Web site). We encourage the use of telephone support in those situations where the individual is unable to meet in person with the provider. We understand that  providers will need to rely on their professional judgment to determine when such contact may be insufficient to meet the individual’s mental health needs.

We will provide a variety of materials on our Web site to help clinicians familiarize themselves with the military culture and experience. We will also have links to a variety of military Web sites and Web sites sponsored by military support organizations such as the National Military Family Association. We plan to partner with the Veterans Administration and other military service providers to establish specific procedures for critical situations such as the hospitalization of active duty personnel and decisions regarding a soldier’s fitness to serve. In addition, we will have information available on our Web site regarding the assessment of post-traumatic stress disorder. Only mental health professionals who have training and experience with the treatment of PTSD should list themselves as available to provide this service. Clinicians not trained in the treatment of trauma will find guidelines to assist them in locating an appropriate provider.

Sign up here!

Want to jump start your online private practice by using a great domain name? I am selling www.onlineprivatepractice.com.  I secured it some time ago but my career path has moved in other directions.

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Just go to http://www.networksolutions.com enter the domain name in the search box, click “search,” then on the results page, click on “make a certified offer.”

BONUS: You get 5 months free before you need to renew!

The conversation between Dr. Frances Sommer Anderson and Bronwyn Thompson continues (renamed, per Dr. Anderson’s request, TMS and RCTs).  For the first part of the dialogue, go here.

From Dr. Anderson:

Bronwyn,

First, I want to clarify: I have the keenest respect for RCTs. I was trained as a rigorous experimental psychologist before I switched to clinical psychology and psychoanalysis. I advocate research on the clinical reports made by medical, mental health, allied health care professional professionals, and people who have found relief from “TMS” pain. That research has already begun, in a study of fibromyalgia using RCTs (Howard Schubiner, personal communication February 2010) submitted for publication in a peer-reviewed medical journal. An application for research support from NIH has been submitted to expand this research.

I hope that the current and succeeding generations of pain professionals and concerned lay people will promote RCTs to evaluate the methods we have found to be effective, case by case, in our clinical practices for 40 years. We all recognize that in order for TMS to be included in the DSM, there will need to be substantive documentation that it is a “syndrome.” Pushing toward that goal, along with the aim of educating the public about TMS, the TMS EDUCATIONAL WORKING GROUP, a non-profit corporation, has just been formed by a coalition of people who have been successfully treated for TMS and health care professionals experienced in treating TMS, many of whom will be contributing to LA Mindbody Conference in March 27-28, 2010.

I would now like to invite you, Bronwyn, to comment on a section of my original response to your response: I recommend reading about the theoretical and empirical foundation for my treatment technique in my chapter in Relational Perspectives on the Body (www.francessommeranderson.com). I provide a detailed case presentation of my treatment of a patient with TMS pain, illustrating how overwhelming emotions were related to her long history of back pain and how she was relieved of this pain as she worked with disavowed affects. I ground my “technique” in the publications of psychoanalyst researchers such as Henry Krystal (Michigan State University), his son John Krystal (Yale University), and Graeme Taylor (University of Toronto) and his colleagues in Canada. These clinician-researchers have focused on the role of emotions/affects in health and illness. In particular, their findings document the value of recognizing what we’re feeling, and developing the capacity to tolerate and regulate both positive and negative emotions.

Feelings/emotions/affects become problematic when we need to avoid experiencing them because they may be overwhelming. Intolerance and avoidance of emotions can be associated with physical as well as psychological illness, as documented by these and other researchers. Researchers are increasingly focusing on the significant role of emotions, e.g., in the neurobiology of fear (Joseph LeDoux) and the neurobiology of trauma, e.g., Bessel van der Kolk and his colleagues. How these dysregulated emotions are related to health and illness should concern all practitioners.

My treatment approach is also influenced by the field of contemporary neuroscience, which the author values as a model in explaining chronic pain syndromes. I want to emphasize that I am not at odds with the identification of a neurobiological substrate for pain and other disorders. I am in favor, however, of an integrative approach rather than one that values biology or psychology over the other: Unfortunately, valuing neurobiology over psychology is once again a manifestation of the dichotomous mind vs. body philosophy that still informs much of Western medicine. My point is made most convincingly by a number of current clinicians and researchers. Allan Schore’s (http://www.allanschore.com/) integration of data from the psychoanalytic theory of development, neurobiology of attachment, and the neuroscience of emotional regulation demonstrates the value of an integrative synthesis of knowledge from the domains of psychoanalysis, psychology, and neurobiology. Daniel J. Siegel (http://drdansiegel.com), a psychiatrist who has studied mindfulness meditation and neuroscience, uses the term “interpersonal neurobiology” to capture the complexity of the interpenetration of the psychological and the neurobiological realms of theorizing (The Mindful Brain). A psychologist, Wilma Bucci (http://www.referentialprocess.org/), is a cognitive science researcher (Chapter in Bodies in Treatment, FSA Editor; www.referentialprocess.org) who has developed a “multiple code theory,” arguing for a “congruence” between psychological and neurobiological models of emotional and cognitive processing. Candace Pert’s substantive research (http://www.candacepert.com/), offered for a general audience in Molecules of Emotion, demonstrates how “emotions” are stored in every area of the body, including in the molecules.

The Where the Client Is interview with Dr. Anderson that got things rolling:

As a psychologist, I am not qualified to make a medical diagnosis, even a psychosomatic diagnosis such as TMS. A physician distinguishes the TMS pain through an interview and examination initially, thereby linking mind and body with a diagnosis of TMS. Teamwork with that physician is a requisite. Let me elaborate by illustrating why the teamwork is necessary. When I’m treating a patient who has been given a TMS pain diagnosis by a physician, I obtain written consent to collaborate with the physician, explaining the “rehabilitation team” approach, learned at Rusk Institute, which I have used effectively with Dr. John E. Sarno for more than 30 years…[continued]

Thompson’s response to the interview is here.

[U]nfortunately there is not a lot of good evidence for Dr Sarno’s hypothesis, particularly the second part (that people need to ‘heal’ their repressed emotions).  Having said that, some of the mindfulness and acceptance material I’ve been reading suggests that, instead of repressing, controlling or focusing on negative emotions, we may find it more helpful and less distressing to experience these ‘lightly’ or nonjudgementally, and in doing so, release ourselves from their influence and choose to act according to our values…[continued]

Dr. Anderson’s response to Thompson (here in full; posted as a Word document on HealthSkills):

Thank you for your careful reading of my interview and for posting your commentary.  I respond in the spirit of dialogue that opens up the very important topic of integrating domains of knowledge about mental, emotional, and neurobiological processing.

First, I want to clarify that Dr. Sarno and the clinicans who work with him do not do “chronic pain management.” We aim for pain relief in treating a mindbody pain condition that Dr. Sarno has delineated in his peer-reviewed publications and in his books directed at a broader audience.  Dr. Sarno initiated his treatment approach 40 years ago, when he was trying to treat people for whom ALL approaches to pain relief and management had failed, e.g., surgery, hypnosis, CBT.  I was fortunate to join his pain service 30 years ago, while it was still in the pioneering phase.  Dr. Sarno discovered, in collaboration with the psychotherapists who were on his rehabilitation team, that his patients had difficulty acknowledging their emotions, or affects–I will use this term interchangeably with emotions going forward.  It was common that these people could not feel positive or negative emotions.

While Dr. Sarno did not collect data via randomized clinical trials to document that his approach to pain relief works, his clinical success can be indirectly assessed by noting the volume of sales of his books and the vast number of testimonials on the internet attesting to complete recovery from pain, such as http://www.tmswiki.wetpaint.com. In addition, physicians from around the country, indeed from around the world, have been inspired by Sarno’s theory and treatment approach and have begun offering their own elaborations of it, e.g, David D. Clarke (www.stressillness.com), David Schechter  (www.schechtermd.com), and Howard Schubiner (www.unlearnyourpain.com).  The impetus for the upcoming Los Angeles Mindbody Conference on stress-related pain (www.lamindbodyconference.org) has come from patients who have been successfully treated by this approach, as well as from physicians and mental health clinicians who have worked with Sarno.  My colleague, Eric Sherman, PsyD, and I have been inspired to publish a book of cases studies in 2010, Pathways to Pain Relief (www.pathwaystopainrelief.com), to illustrate how we treat people who have been diagnosed by Dr. Sarno with Tension Myoneural Syndrome (TMS).

Like the author of this post, all of us who have been influenced by Dr. Sarno’s theory and treatment have an interest in “emotional regulation and self regulatory systems,” although we may be using different terminology.  I recommend reading about the theoretical and empirical foundation for my treatment technique in my chapter in Relational Perspectives on the Body (www.francessommeranderson.com).  I provide a detailed case presentation of my treatment of a patient with TMS pain, illustrating how overwhelming emotions were related to her long history of back pain and how she was relieved of this pain as she worked with disavowed affects.  I ground my “technique” in the publications of psychoanalyst researchers such as Henry Krystal (Michigan State University), his son John Krystal (Yale University), and Graeme Taylor (University of Toronto) and his colleagues in Canada.  These clinician-researchers have focused on the role of emotions/affects in health and illness.  In particular, their findings document the value of recognizing what we’re feeling, and developing the capacity to tolerate and regulate both positive and negative emotions.  Feelings/emotions/affects become problematic when we need to avoid experiencing them because they may be overwhelming.  Intolerance and avoidance of emotions can be associated with physical as well as psychological illness, as documented by these and other researchers.  Researchers are increasingly focusing on the significant role of emotions, e.g., in the neurobiology of fear (Joseph LeDoux) and the neurobiology of trauma, e.g., Bessel van der Kolk and his colleagues.  How these dysregulated emotions are related to health and illness should concern all practitioners.

My treatment approach is also influenced by the field of contemporary neuroscience, which the author values as a model in explaining chronic pain syndromes.  I want to emphasize that I am not at odds with the identification of a neurobiological substrate for pain and other disorders. I am in favor, however, of an integrative approach rather than one that values biology or psychology over the other:  Unfortunately, valuing neurobiology over psychology is once again a manifestation of the dichotomous mind vs. body philosophy that still informs much of Western medicine.  My point is made most convincingly by a number of current clinicians and researchers.  Allan Schore’s (http://www.allanschore.com/) integration of data from the psychoanalytic theory of development, neurobiology of attachment, and the neuroscience of emotional regulation demonstrates the value of an integrative synthesis of knowledge from the domains of psychoanalysis, psychology, and neurobiology.  Daniel J. Siegel (http://drdansiegel.com), a psychiatrist who has studied mindfulness meditation and neuroscience, uses the term “interpersonal neurobiology” to capture the complexity of the interpenetration of the psychological and the neurobiological realms of theorizing (The Mindful Brain).  A psychologist, Wilma Bucci (http://www.referentialprocess.org/), is a cognitive science researcher (Chapter in Bodies in Treatment, FSA Editor; www.referentialprocess.org) who has developed a “multiple code theory,” arguing for a “congruence” between psychological and neurobiological models of emotional and cognitive processing.  Candace Pert’s substantive research (http://www.candacepert.com/), offered for a general audience in Molecules of Emotion, demonstrates how “emotions” are stored in every area of the body, including in the molecules.

Thompson responds with How to Judge a Treatment:

Pain, like many other conditions, is complicated by the fact that it’s invisible – we don’t have any objective measures of pain itself, and we have to rely on behaviours (including verbal self report and movements) to determine whether treatment has done any good.  Behaviours are strongly influenced by external factors such as other people’s responses, along with internal factors such as beliefs and expectations…[continued]

Thompson’s response to this post:

Thanks for posting this discussion in full. I’d like to just correct a couple of points – ‘tension myoneural syndrome’ is not a term used commonly in New Zealand (and it also doesn’t appear in the International Association for the Study of Pain Taxonomy and Classification of Chronic Pain). I also note that it’s not a term used in DSM iv, nor indeed in any of the formal classification systems used in health care.
Now I’m not saying having pain that is associated with increased anxiety/stress or low mood (or even ‘trauma’ associated with a diagnosis of something like PTSD) do not exist. That’s silly because they do. What is arguable is their aetiology, and their ongoing management.

The terms more commonly used to describe widespread body pain (or regional pains) is central sensitisation conditions, and can include such things as fibromyalgia and regional pain syndromes. These are recognised as influencing the sensitivity of the nervous system and increase the sympathetic nervous system responses to change.

I did laugh a bit at the suggestion that what I’m saying returns to the great ‘mind and body’ divide – because that’s usually what I’m accusing the medical professionals I sometimes work with of doing! In fact it’s very clear that the whole experience of having pain is a psychological one with underlying neurobiological systems underpinning it.

I don’t see this as mutually exclusive, simply that we have much to learn about the ways the psychological and social processes work. It certainly doesn’t take away from the influence of attitudes, beliefs, biases and learning – but it does mean that we may not be in the best place to describe how they influence us. I’m really excited about neurobiological processes, because they do start to give us some idea of how our fabulous brains (and nervous systems) go about influencing things that have until now been a mystery.

I am personally not comfortable with using approaches that need special assumptions, and that can’t be tested. That’s why my response was around the need to use an evidence base in the peer reviewed literature. And I can’t find outcome studies of Dr Sarno’s approach – which is, in the end, the best way to determine what works and what doesn’t, irrespective of the mechanisms involved.

regards
Bronnie

The conversation continues here.

What do you think?

HAPPY NEW YEAR from Where the Client Is!

Thanks for stopping by, participating, contributing, and otherwise making the site possible.  Special thanks to all commenters, interviewees, and book excerpt-providers. I learned a lot; hope you did too.

For 2010, planning a widening focus, from practice launching, marketing, and promoting to practice doing.  That means more from clinicians–interviews, articles, etc.–about how they actually go about working with clients.  Theories and interventions tried, embraced, and dropped…trainings attended, warned-against, and recommended…the world of therapy from ACT to Z .  And, of course, continuing tips about the practical stuff–growing your practice, staying in business.  What works, what doesn’t.

Join in the conversation!  If you’ve got something to contribute, jump in. Here’s one way to start: send in a list of your 5 essential therapy reads. What wisdom do you think back to as you’re doing your clinical work? What books do you suggest to therapist friends?  What do you love about them? Write it down, send it!

Best of luck with all you do in 2010. Here’s to a great year.

Thanks Again,

Will

Where the Client Is

So you’ve got your private practice going.  Now what?

The interviews and book excerpts from marketing types will continue–of course.  Added to the mix will be conversations with clinicians about how they actually work.  What’s helping, what isn’t. Theories, interventions, practice tips.  Not only how to get clients, but how to keep them, and, once they stay, how to ensure they’re getting the help they need and expect.

So stay tuned; keep coming back.  And, if you want to be interviewed about what you do, or otherwise contribute, don’t hesitate to write.

Happy New Year!

Before he was deployed to Iraq, Scott Shore refused to take aspirin for headaches.

Six years later, suffering from post-traumatic stress disorder, he takes six medications daily for ailments ranging from depression to insomnia.

“Just to leave my house and take my kids to the park is a struggle,” said the 34-year-old Mission Viejo resident, who also receives counseling from the Department of Veterans Affairs.

But another part of Shore’s therapy began in January with the Soldiers Project. The Los Angeles-based nonprofit includes a network of mental health professionals who provide free, unlimited, confidential counseling to service members returning from Iraq and Afghanistan and their families.

“It’s helped me open up a little bit more,” Shore said.

Judith Broder, a psychiatrist and founder of the Soldiers Project, said the idea came to her after she saw a Hollywood play featuring monologues of soldiers’ lives overseas. She was so shaken by their experiences that she awoke the next morning with the idea for the project.

The network, founded in 2005, has expanded from Los Angeles across Southern California and to Sacramento, Seattle, Chicago, New York and Boston. The licensed mental health professionals practice from their private offices, eliminating the long lines and crowds of people often seen at the VA.

The nonprofit can be reached at (877) 576-5343 or at www.thesoldiersproject.org.

5 Secrets to Finding All the Clients You’ll Ever Need, by C.J. Hayden

7 Steps for Attracting an Endless Stream of Referrals, by Juliet Austin

10 Ways to Market Your Private Practice Today, by Susan Giurleo

12 Months to Your Ideal Private Practice, by Lynn Grodzki

67 Surefire Ways to Attract Clients, by Juliet Austin