Teletherapy

Teletherapy

By: Sharon Burris-Brown, LICSW, NBC-HWC

Teletherapy

Recently, President Trump has expanded Telehealth coverage for Medicare recipients during the COVID-19 crisis.  More and more therapists are either choosing to do teletherapy or are being mandated by their clinics to go online during this time.

Telehealth and teletherapy has picked up steam and many insurance companies are covering it.

Advantages

Teletherapy offers greater access to the most ill individuals who have the most difficulty in getting to a clinic.

Telehealth and teletherapy is a boon for those who live in rural areas where doctors and therapists are scarce. In 2015, a study published in the American Journal of Preventive Medicine found that Psychiatrists, psychologists and psychiatric nurse practitioners are unequally distributed throughout the country.  65% of rural areas lacked a psychiatrist. And almost half of rural areas lacked a psychologist.

And in many areas, the technology is good enough to get a clear audio and visual connection.  Therapists use HIPAA compliant platforms to ensure confidentiality and secure connection.

Teletherapy affords the flexibility that in person sessions do not.

Increased stress and isolation for many of us right now is a huge factor.  Maintaining momentum with therapy can be an integral part of one’s self-care plan.

People who are wary of starting therapy may find teletherapy a safer alternative.  Once having had a positive experience with teletherapy, they may be more likely to switch to in-person sessions.

Disadvantages

Individuals may feel much more comfortable seeing their therapists face-to-face.  And this is a very personal decision.  Often, clients do not have a private, separate space away from their family members to feel comfortable participating in teletherapy.

With more people at home, more are online at the same time, internet issues may be more prevalent.

Therapists are working with more limited information, because they can’t see the client’s body posture and movements.

Therapists are often not allowed to work across state boundaries unless they are licensed in the state that the client either resides or even if the client is in that state temporarily.

Types of Teletherapy

Video and audio conferencing can almost feel like you are in the room with your therapist.  But a fast-growing type of e-therapy is “asynchronous” or via chat.  Asynchronous e-therapy occurs often via secure text and e-mail where client and therapist will connect at different times.  Chat is connecting through text only in real time.

When Teletherapy May Not Be Appropriate

Teletherapy has been shown to work about as well as in-person therapy sessions for certain clients.  However, those clients who need a higher level of care—who struggle with addictions or complex trauma, for example, may not do as well with teletherapy.

Certain therapy modalities are not effective or as effective when doing teletherapy such as some trauma therapies.

Asynchronous and text-based e-therapy should not be used for suicidal clients.  Visual cues to determine deteriorating mental health are extremely important to assess these individuals.

Set Yourself Up for Teletherapy

Discuss the challenges and benefits of going to teletherapy with your therapist if you have any questions or concerns.  Your provider will let you know whether some of the therapy modalities he/she has been using with you can or would not translate to teletherapy.

Check your insurance to determine if it is covered.  Most are covering telehealth and teletherapy but some are not or may have restrictions.

Check to make sure you have a speedy connection and a private and quiet place for your teletherapy sessions.

Rest assured that your therapist has a structure and technology to maintain your confidentiality and privacy.

Articles  

1. https://www.usnews.com/news/health-news/articles/2020-03-17/to-keep-seniors-safe-at-home-medicare-expands-telemedicine
2. https://www.ajpmonline.org/article/S0749-3797(18)30005-9/fulltext
3. https://www.apa.org/monitor/2017/02/online-therapy

Childhood Trauma Part 2 – The Wisdom of SMART

Childhood Trauma Part 2 – The Wisdom of SMART

By: Sharon Burris-Brown, LICSW, NBC-HWC

Childhood Trauma Part 2-The Wisdom of SMART

SMART ROOMS

At the Union Plaza location of Lyn-Lake Psychotherapy, young kids and teens will soon be able to jump into crash pillows, crawl through fabric tunnels, do summersaults on mats, wrap themselves in weighted blankets, bounce on a trampoline or an exercise ball. You might think there is a playground inside this building. However, these play tools will all be part of Lyn-Lake Psychotherapy’s SMART room.

SMART stands for Sensory Motor Arousal Regulation Therapy. SMART is a body-oriented therapy modality for kids and teens who have experienced complex, developmental trauma.

Already sold on the power of the body’s role in healing trauma through her work as a trauma-informed yoga teacher, Mariah Rooney, LICSW, RYT naturally gravitated to body-oriented therapy processes to help kids and families who have experienced great adversities.

The 101 on Sensory Motor Arousal Regulation Therapy

SMART ties together the work of Occupational Therapists (1) that help kids who struggle with processing sensory information and trauma theory and research. O.T.s guide kids to create an optimal sensory experience for themselves through deep pressure, rhythmic movement and resistance allowing them to integrate sensory experiences they may have been deprived of, thus rewiring the brain to heal these deficits.

Children who go through repeated trauma especially from those people who are supposed to love and care for them, are particularly impaired. That part of the brain that deals with dangerous situations becomes over reactive and their “ability to process, integrate and categorize what is happening: at the core of traumatic stress” (2) breaks down.

SMART specializes with helping kids who have symptoms from complex trauma integrate trauma and sensory issues to heal both their bodies–enabling them to better regulate their emotions, their sense of self and to repair their ability to attach to a trusted caregiver.

“SMART is a highly adaptable treatment”, says Rooney. “It is both child-led and clinician guided”. The therapist will mirror what the child is doing as well as gently lead the child through movement and touch that will ultimately help that child get to an optimal sensory experience. This allows the child to meet his own sensory needs and to neurologically integrate the sensory experience.

Results

SMART reflects the research on trauma that shows trauma (3) is often re-experienced through the body and through sensory channels. SMART improves regulation of the body and the emotions through engaging the child in “embodied play” (3)—basically using the whole body in full sensory experience.

“Trauma is an inherent disruption in rhythm”, says Rooney. Rhythmicity shows up in the dance of action and response between infant and caregiver. It shows up in the sensory experiences of being held and rocked. “We get out of sync with ourselves and with others. SMART helps restore rhythmicity in relationships and connections to ourselves”, Rooney goes onto explain.

And in fact, early research has shown that SMART improves anxiety and depression (4) in traumatized kids and teens. Rooney has seen positive results in both the ability for these kids to manage their emotions: such as a decrease in problem behaviors like tantrums and defiance and a strengthening of the attachment bond with their trusted caregivers. In addition, many of these kids do better at school.

As a SMART-trained therapist, Rooney first mirrors and guides the child to go through the embodied play experience to its completion modeling to the child’s parent how to do this at home. “It is a great tool to build attachment”, she states. “A lot of caregivers have their own trauma and so there could be restoration and healing for them as well”.

SMART was one of the somatic or body-oriented therapies that was developed when research on how trauma affects the brain and the body explained why talk therapy had not helped these kids. “In fact, traditional talk therapy can be dysregulating”, Rooney states. Many of these kids have experienced trauma before they could speak. Therefore, trying to get at trauma through words does not work. “In addition, when an individual re-experiences trauma, the speech center part of the brain goes off line”, adds Rooney.

“One of the things that is amazing about SMART is it makes therapy much more accessible, because it can be fun for kids to move their bodies”, says Rooney. “SMART rooms offer space for exploration and the use of different things that interact with different sensory experiences. Our bodies have incredible wisdom for knowing what is needed to heal”

If you feel like you need the support of a mental health professional, remember that you’re not alone! If you have any questions, please contact us, we’re here to help!

Resources

1. Mariah Rooney-mariah@therapy-mn.com
2. The Minnesota Trauma Project- www.mntraumaproject.org
3. The Trauma Center at JRI-www.traumacenter.org
4. SMARTMoves-smartmovespartners.com
5. The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. Van der Kolk, Bessel MD. Penguin Books, 2014.

Articles

1. https://childmind.org/article/treating-sensory-processing-issues/
2. http://www.traumacenter.org/products/pdf_files/preprint_dev_trauma_disorder.pdf
3.https://www.researchgate.net/profile/Maggi_Price/publication/319319850_The_Boy_Who_Was_Hit_in_the_Face_Somatic_Regulation_and_Processing_of_Preverbal_Complex_Trauma/links/59cae2610f7e9bbfdc36b684/The-Boy-Who-Was-Hit-in-the-Face-Somatic-Regulation-and-Processing-of-Preverbal-Complex-Trauma.pdf
4. https://rampages.us/otebp/wp-content/uploads/sites/29816/2018/07/CAP-somatic-support-for-trauma-adolexcents.pdf

Childhood Trauma Part 1 – 101 on Trauma

Childhood Trauma Part 1 – 101 on Trauma

How people respond to traumatic events in their lives depends on numerous factors, one of them being the age at which they experience a traumatic event. In very young children, trauma can have a significant impact on their development across all areas of their lives. Some of the ways in which trauma might disrupt a child’s life include (but are not limited to) developmental delays, sensory integration issues, dysregulated behavior and emotions, and difficulty creating meaningful relationships with others. 

But let’s dig a little deeper into how trauma affects children, as well as the treatment options that are available to help minimize trauma’s impact on children. 

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What is trauma? 

Trauma is a term that has been thrown around a great deal on social media lately. Simply put, trauma can be the result of an incident that threatens the safety of an individual. Sometimes traumatic symptoms can occur from a single incident, but many individuals seeking therapy have experienced multiple incidents or long-term trauma, also referred to as complex trauma.

ACES (Adverse Childhood Experiences) are potentially traumatic situations that have occurred in childhood, such as: abuse of all kinds, violence in the home, witnessing violence in one’s community, having a parent(s) who is mentally ill and/or addicted to substances, growing up in poverty, parental abandonment and having a parent who was incarcerated. 

Community discrimination and generational trauma, as well as bullying, separation from a primary caregiver and medical trauma were left out of the original list of ACES but can also have profound effects on a child’s wellbeing.

Preverbal trauma occurs before the child is old enough to speak or speak fluently (~ages 0-3), which is also before a child is able to create coherent, long-term memories of events. Oftentimes, people struggle to recall many details of traumatic events they experienced during their pre-verbal years. They may even have no memory of it whatsoever. Nonetheless, children and adults can still suffer negative effects of trauma that occurred during their preverbal years. 

PTSD-Post Traumatic Stress Disorder is a mental health condition consisting of a constellation of symptoms that occur in some people who have experienced traumatic incidents.  Not everyone who has experienced traumatic incidents develops PTSD. Moreover, some people who do not develop PTSD following trauma may instead develop other mental health conditions such as anxiety, depression, disordered eating, and substance use disorders.  

A Very Short Primer on Attachment

Damage to the relationship between the child and their primary caregiver can also occur in response to trauma. Conversely, damage to the child-caregiver relationship can be traumatic. Secure attachment between child and primary caregiver allows a child to feel safe.  Secure attachment forms when a child’s basic needs are met, such as food and shelter, touch, and sensitive emotional interactions from an in-tune primary caregiver that allow the child to feel valued, loved, and safe.

In early childhood, children need a trusted caregiver to help them regulate their emotions.  Consider when a baby cries and is picked up and held, for example.  The child learns that their emotional needs will be met and, in turn, is more likely to grow up trusting that others will be able and willing to meet their social and emotional needs as well.

When the attachment is not secure, dysregulation of emotions may occur—explosive episodes such as mentioned above are an example of what can happen when a child is dysregulated. And the child is much more at risk for mental health issues and substance use problems, and may be unable to nurture healthy relationships.

Sensory Challenges 

Deprivation, neglect, and complex trauma in very young children impact brain development directly, and can make it difficult for them to either filter out or accurately recognize sensory input. Holding, rocking, talking, cooing to infants all plays a huge part in developing the part of the brain that integrates sensory experience.

Imagine children with brain deficits for filtering out sensory stimuli being placed in regular classrooms filled with 28 other kids.  Noise, lights, activity can cause intense anxiety and they will be prone to lashing out or may curl up in the corner of the room with their hands over their ears.

Those kids who lash out or cringe in the corner may be performing sensory avoiding behaviors.

And, those children who perform sensory seeking behaviors often appear hyperactive.  They may be the kids who can’t keep their hands to themselves, who are always fidgeting or talking or flinging pencils.  They are seeking sensory stimulation.

“Deep touch, the rhythm of rocking, all play a part in developing the proprioceptive and vestibular systems”, Rooney explains.  The vestibular system is the part of the brain that affects balance and understanding where one’s body is in relationship to others and in space.  A child with those deficits may seem unusually clumsy—perhaps often bumping up against other kids or banging into things.  Damage to the proprioceptive system can cause delays in gross and fine motor skills.

Executive Function

Executive Functioning is an umbrella term that includes a set of tasks that comes from the prefrontal cortex or the rational, command, decision making part of one’s brain.  These skills include time management, prioritizing, organizing, delaying gratification, decision making, remembering to do and complete tasks.  Complex trauma can also interrupt the development of the pre-frontal cortex.

It is perfectly normal for kids to forget to do homework or to turn it in late (or not at all) from time to time, or to forget their gloves at school.  However, frequent forgetfulness and disorganization may be due to a developmental issue that goes beyond what is considered “normal” for that child’s age and stage of development.  A middle school kid may struggle to remember when to do homework assignments and this is normal.  A 17 year old teen who has a pattern of forgetting homework, losing items, forgets to brush his teeth or to take showers is likely suffering from executive functioning deficits.

School Difficulties and Cognitive Delays

Traumatized kids are often not set up to learn.  There are too many barriers that get in the way for traumatized brains to take in new information, to store and organize new material.  Trauma can create an imbalance of the parasympathetic nervous system – the part of the brain that helps people calm down after a frightening incident.

Traumatized children live mostly in survival mode where many situations they encounter can potentially continue to re-traumatize them. When the trauma is re-experienced, the brain’s speech and rational decision-making centers can go offline, making it impossible for the child to calm themselves down enough to make good decisions. 

For kids and families who have experienced adversities, healing needs to begin by connecting to their bodies’ inherent wisdom which helps them connect to and regulate their emotions.  It is key to repair the ability to securely attach to a trusted caregiver as well.  Bruce Perry, a psychiatrist who specializes in child-hood trauma and who wrote the powerful book, “The Boy Who Was Raised as a Dog” about his experiences working with traumatized kids, puts it thusly: “regulate, then relate, then reason”.

If you feel like you need the support of a mental health professional, remember that you’re not alone! If you have any questions, please contact us, we’re here to help!

By Sharon Burris-Brown, LICSW, NBC-HWC

Resources

1. https://www.mntraumaproject.org
2. The Boy Who Was Raised as a Dog. Perry, Bruce, Szalavitz, Maia. Basic Books.  (2017).
3. The Trauma Center at JFI. www.traumacenter.org 

Articles

1. https://www.cdc.gov/violenceprevention/childabuseandneglect/acestudy/about.html
2. https://www.researchgate.net/publication/327784916_Parent-Child_Attachment_and_Children’s_Experience_and_Regulation_of_Emotion_A_Meta-Analytic_Review
3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5859128/