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    • Recovering from a Traumatic Birth

      Dealing with the Trauma of Giving Birth  For many new mothers, giving birth is one of the most exciting times in life. After all, you’re bringing a new tiny human into the world — one that you love more than pretty much everyone else. You can’t wait to meet the little guy or gal.  In the ideal world, giving birth would be a seamless, painless, uplifting experience. Everything would go according to your birth plan, and you’d meet your bundle of joy quickly, without any hiccups along the way.  Unfortunately, that doesn’t always happen — quite the contrary. According to a recent study, as many as 45 percent of new mothers experience birth trauma.   What Is a Traumatic Birth Experience?  A traumatic birth experience occurs when a new mother experiences discomfort or distress during the process of giving birth. Since every woman is unique, each new mother may experience trauma differently.  Contrary to what the term might suggest, a traumatic birth experience doesn’t necessarily stem from a physical birthing complication (e.g., a uterine inversion or an emergency C-section).   In many cases, the trauma can be psychological (e.g., stressing out over giving birth in a hospital during COVID-19). After all, the birthing experience can be incredibly stressful and physically exhausting — even when everything goes to plan.   The Physical and Emotional Effects of a Traumatic Birth  After a traumatic birth, new mothers have to deal with physical and psychological pain.  Physical trauma  All new mothers are physically exhausted after giving birth. Since most muscles strain during contractions, it’s perfectly normal to be sore throughout the body after giving birth. Of course, there’s also vaginal bleeding and vaginal soreness to deal with. On top of this, hormones fluctuate considerably, making new mothers perhaps more emotional than normal.   While every new mother is different, it generally takes between six and eight weeks for the body to recover after giving birth.  Psychological trauma  In addition to the physical trauma that new mothers have to deal with, many women also experience psychological issues after giving birth.  Postpartum depression  As many as one in seven new mothers develop postpartum depression after giving birth. When this happens, women can feel hopeless, sad, and isolated. These feelings often translate into a decreased appetite, loss of sex drive, and lack of appetite, among other negative outcomes. On top of this, women dealing with postpartum depression may also struggle to bond with their newborns.  While exceedingly rare, some new mothers develop a condition called postpartum psychosis, which can lead to dangerous thoughts and behaviors. If you or someone you know who’s recently given birth is dealing with hallucinations, paranoia, or delusions, seek medical help immediately.  Post-traumatic stress disorder (PTSD)  Depending on how bad the birthing experience is, some mothers can develop PTSD. One study found that mothers who were less educated, had less prenatal healthcare, and gave birth prematurely were most likely to be diagnosed with PTSD. Additionally, research also suggests that new mothers who’ve suffered from depression and those who were victims of childhood sexual abuse and domestic violence are also more likely to develop PTSD.  In addition to affecting a new mother’s well-being, PTSD can also damage romantic relationships. Women who’ve had a traumatic birth report a lack of sex and arguments with their significant other over the birth itself, among other things.  Now that you have a better idea of what a traumatic birth is and what a new mother might experience in the aftermath of one, let’s turn our attention to the most important piece of the puzzle: what women can do to overcome these feelings and live their best lives.  Postpartum Healing: How to Overcome a Traumatic Birth Experience  From the outset, a traumatic birth experience can seem downright devastating. But there are some things you can do to overcome the trauma.   It may take time, to be sure. But as long as you’re dedicated to improving your headspace and becoming the mom you’ve always been destined to be, you will get through this challenge before you know it. Here are some ways to make that happen. 1. Think about your experience While you might be tempted to block your trauma out of your mind, that pain will always exist below the surface unless you confront it head-on. And that starts with being upfront with yourself. Spend time thinking about what you’ve been through and try to understand exactly why you feel the way you do. Whenever you get a moment, you might want to try journaling to really clear your mind.  Once you’ve processed your thoughts, it’s time to share them with those closest to you — your partner, your family, and your friends. Don’t share anything more than you’re comfortable with. But the sooner you can connect with someone else about what you’re going through, the faster the weight will be off your shoulders. 2. Spend time with your new child It’s not at all uncommon for new mothers to feel disconnected from their babies after a traumatic birth. While you might not be able to prevent those feelings from happening, you can proactively try to address the issue by making a point to spend more time with your newborn. Easing into skin-to-skin contact and breastfeeding when you’re comfortable can help you get through this difficult time.  3. Talk with a professional about your traumatic birth At the end of the day, you need to know that you don’t have to deal with this entire situation on your own. While talking with your friends, family, and partner about your emotions and what’s going through your mind can be helpful, you may be best off speaking to a neutral third party when the going gets really tough after giving birth.  After all, emotional healing when you have a tiny new human in your life can be hard — even if you aren’t experiencing postpartum depression. Speaking with a professional therapist who specializes in treating new mothers can make all the difference in the world.  If you’re struggling after a traumatic birth experience, reach out to a therapist today to get the help you need to adjust to this huge life change.  ... Read More

    • Dr. Aaron T. Beck: The Father of Cognitive Behavioral Therapy

      Dr. Aaron T. Beck: The Father of Cognitive Behavioral Therapy  On Monday, Nov. 1, the world lost an incredible psychiatrist when Dr. Aaron T. Beck, the aptly named “father of cognitive behavioral therapy” who pioneered the field and taught at the University of Pennsylvania and other colleges, died peacefully in his sleep at the impressive age of 100.   Throughout his storied career, Dr. Beck earned many awards, including the prestigious Gustave O. Lienhard Award from the Institute of Medicine. He also co-authored 25 books and upwards of 600 articles over the years and, in 2017, was named the fourth most influential physician over the last century.  In 1994, Dr. Beck, along with his daughter Dr. Judith Beck, co-founded the Beck Institute, a nonprofit organization committed to helping people around the world live more fulfilling lives through the promise of cognitive behavioral therapy, also known as CBT.  What Is Cognitive Behavioral Therapy?  At a very basic level, CBT is a talking therapy that’s all about helping people solve their problems by understanding how the way they think about the situation at hand influences how they respond to it.  For example, if a small business owner who runs a tight ship gets a letter from the IRS and immediately starts thinking about the worst-case scenario, chances are they will be stressed out and respond irrationally to the circumstances — much to the chagrin of those in their lives.   By learning that the way they mentally interpret an event influences how they’ll physically respond to it, the small business owner might use CBT to retrain how they react to letters from the IRS and remind themselves to take a deep breath the next time one invariably ends up in their mailbox.  According to Dr. Beck, the way we think about issues can be established in childhood. And if we think about issues the wrong way, these cognitive errors could lead to problems down the road.   By enrolling in CBT sessions, Dr. Beck believed people could unlearn these unproductive ways of thinking while developing healthier responses to unwelcomed situations. Rather than stumbling into a tricky situation and feeling overwhelmed, people can learn to break down big problems into smaller manageable parts, making it that much easier to respond to them in a calm, cool, and collected manner.  Why Is Cognitive Therapy Important?  There’s not much any of us can completely control in this world. That said, we do have control over how we think about the world and our experience in it. This is why CBT can be particularly helpful — and why Dr. Beck’s daughter, Dr. Judith Beck, is continuing her father’s work at the Beck Institute.  With that in mind, let’s take a look at some of the main reasons therapists and their clients find CBT to be particularly attractive.  It’s generally risk-free  While clients might deal with uncomfortable emotions and sentiments during CBT sessions, this is more or less par for the course when it comes to any form of therapy. Aside from crying, getting upset, and otherwise feeling awkward, there’s very little risk when patients decide to use CBT to confront the problems they’re facing.  That said, it’s important to remember that CBT is not a quick fix for behavioral and mental health issues. While it can be particularly helpful for many patients, it’s not the right treatment for everyone, e.g., those with complex mental health needs.  It can help people overcome serious trauma  Ultimately, the whole point of therapy is to help people become the best versions of themselves possible — and this is an area where CBT shines. By helping clients reframe how they think about issues, it’s possible to help them overcome all sorts of issues, including stress, anxiety, depression, and even more serious traumas, like sexual abuse and physical abuse.  It produces quick results  Whereas some approaches to therapy might take patients months or even years to overcome the issues they’re facing, CBT can deliver results quickly — in as fast as five sessions. This is attractive to both clients who want to solve their problems as quickly as they can and therapists who want nothing more than to improve their patients’ lives; the sooner that happens, the better.  How CBT Changed the World  At the end of the day, all of us see the world through a distorted lens, at least every now and again. Thanks to Dr. Beck’s innovative work in the realm of CBT, the stigma around mental health has perhaps faded at least a bit, as it made therapy more approachable to pretty much everyone.  While the world is no doubt a little less bright due to Dr. Beck’s passing, we can take comfort in the fact that his work will live on through the Beck Institute — and that CBT will continue to evolve to provide more help to even more people who need it.  To continue your learning, read more about the development of psychotherapy and our understanding of mental health here. Interested in CBT for yourself? Search for therapists near you and filter your results by Type of Therapy > Cognitive Behavioral Therapy (CBT).  ... Read More

    • 5 Tips for Helping a Client When You’re Both Stuck

      by Megan Paterson, Licensed Marriage and Family Therapist in Roseville, California 5 Tips for Helping a Client When You’re Both Stuck Ever had a client who keeps booking appointments and coming in faithfully, but you can’t figure out why? You know, the type of client that makes you wonder, “What are we even doing here?” All of your suggestions, re-directs, and reframes just seem to float in the room and out the window to Neverland. This client seems to be in the exact same stuck place week after week. If you find this frustrating, you’re not alone. As a clinical supervisor, I often hear about how therapists feel “stuck;” as a therapist myself, I have been here as well. What do you do in this situation? 1. Go Back: What Do They Want? Go back to the basics! What is the presenting problem? What brought this client into therapy in the first place? Every client who seeks therapy makes that initial call to you for a reason, seeking a change. Keep this reason in mind and bring it up in session. This sounds basic, but it’s so helpful to return to in treatment because it is how we measure progress. Ask questions to remind the client, why did he/she/they seek services in the first place? What is the change they are looking to experience? 2. Double-Check: Is the Diagnosis Right? After re-visiting the “presenting problem,” you should double-check the diagnosis. Ask your client what symptoms they are experiencing, giving particular attention to what might validate or undermine your current diagnosis. Reconsider what treatment goals and methods you can develop and implement based on the diagnosis. I have always found going back to “presenting problem” and “diagnosis” to be useful when I notice that “stuck in session” mode reoccurring. It helps me focus, and it allows clients to participate in their own wellness plan. It holds clients accountable for their work with you; you are not his/her/their “friend” and this is good boundary to always re-visit without having to straight out say it. 3. Consider: Mull Over These Questions Once you’ve clarified the presenting problem and the diagnosis based on the client’s symptoms, here are few questions to ask yourself to help resolve this “stuckness” for both your client and yourself: What conflicts could arise for this client when change occurs? Maybe the fear of “change” keeps this client stuck. What does this client gain from being “stuck?” Maybe it’s attention or predictability. How has this client experienced trust in their life? Explore “trust experiences” with your client. Trust is built in droplets, and if your client has a history of betrayal or lack of trust in relationships, this may be a reason for feeling “stuck.”  Address “trust” as a goal and use your relationship of building rapport and trust as an intervention and see if the feeling of “stuckness” reduces. Am I providing containment for this client to feel heard? And maybe that in itself, right now, is working towards the goal? Am I as the therapist talking too much in session? What would it change if I remained quiet a bit longer? 4. Ask: Is the Client Ready to “Graduate?” Remember, if the client is not meeting a diagnosis, then they do not meet “medical necessity” for therapy. This is a good thing to communicate to your client. They might not need therapy! Termination is a good thing; celebrate this phase of therapy! If they aren’t ready to finish their therapeutic work, but you come to realize that you can no longer help them, you have other options that further their interest! Don’t be afraid to refer out or provide “natural supports” options. Help them connect with friends, family, and community supports. 5. Stay Curious: Reconsider the Value You Bring If your client pays you and books another session, something is probably working even when you mentally label a session as “stuck.” Therefore, pay attention what keeps this person coming back. You are offering a service, meeting a need for this client, maybe even when you feel like you don’t. Creating space, modeling containment, hearing clients  — these are powerful services. The energy in a session can change, especially when it is clear to the client that they are heard and they are safe. Provide safety, build trust, say less, and you will see change in your “stuck” sessions and in your work with your clients. Let go of judgment, get curious about this “stuck” feeling in session, ask questions about “stuckness” — and see what unfolds. Sometimes, when you call the elephant out in the room, it gives you something to talk about. Did you know GoodTherapy reserves publishing opportunities for members? If you have wisdom to share with the public or other therapists, check out the “Submit an Article” section of your Member’s Area to get the scoop. Not a member yet? Explore GoodTherapy membership opportunities. ... Read More

    • Business Formation for Therapy Practices

      by Connor D. Jackson, JD Connor D. Jackson is a healthcare attorney based in Chicago who serves independent practices in several states. Visit his firm’s website here. Business Formation for Therapy Practices One of the first questions many prospective independent practice owners ask is, “Do I need to establish an LLC or a PLLC before I open?” They also want to know, “Is this something I can do myself? Should I have my trusty accountant set it up for me?”  For a psychotherapist — or any licensed healthcare provider — professional regulations bring even more considerations and constraints. Let’s discuss those considerations and constraints and talk about how to move forward with a new practice. Corporate Entities The first concept to understand is that of a business “entity.”  It’s possible to open a business that is, legally speaking, indistinguishable from you, the owner.  Any expenses or revenues flow to or from you. The business’s debts become your debts. Someone could sue you for the actions you carry out for your practice, such as entering into a contract or taking out a loan. Such a lawsuit would put your personal assets at risk. Legally, this form is called a sole proprietorship. It’s the default structure for any business that doesn’t establish a corporate entity with the state.  But what if you want to limit your personal liability for the actions or debts of the practice? In this case, creating a corporate entity allows you to separate yourself from the practice and become a “member” or “shareholder.”  Corporate entities give members and shareholders limited liability, which protects personal assets from legal claims against the business in many situations. When creating a corporate entity, you have the option of two primary structures: a limited liability company (LLC) or a corporation. Corporations are incorporated, and limited liability companies are organized. Licensed healthcare providers need to be aware of two subtypes of these structures: professional limited liability companies (PLLCs) and professional corporations (PCs). Some states, such as Wisconsin, call professional corporations service corporations (SCs). These companies are organized or incorporated, respectively, to deliver professional services. However, the definition of professional services varies by state. Whether a state mandates that a therapy practice create a PLLC instead of an LLC or a professional corporation instead of a corporation requires a careful reading of that state’s laws and regulations. Fees and Formalities For many practice owners, finding the proper structure requires balancing the end goal (liability protections) and the costs in money and effort. The monetary fees, for example, differ for the entity types. But individual states’ fee schedules vary widely, too! An established California LLC, for instance, will pay an annual tax of $800. In contrast, an Illinois LLC will pay an annual report fee of only $75. Forming a corporate entity also requires creating corporate governance documents, which are legal documents that determine how your entity functions. For example, an LLC should have an operating agreement and a corporation should have bylaws. These documents discuss liability, payment of profits to members or shareholders, and many other factors that have legal consequences and impact your legal rights and obligations.  Further, to claim the protection of limited liability, you need to maintain corporate formalities. Corporate formalities might include issuing stock  filing annual reporting to the state  segmenting funds of the entity from your personal funds consistently entering into agreements in the name of the entity (not your personal capacity) recording all the entity’s activity in signed resolutions.  Typically, small or solo psychotherapy practices find professional limited liability companies more appropriate than corporations because they require fewer corporate formalities. Additionally, the filing fees can be lower than those of corporations.  An attorney can help you work through the options and understand the best structure for you. You might also launch a practice as a sole proprietorship (sacrificing the liability protections of a corporate entity) and create your entity later, once your practice grows. Just keep in mind that any contracts you enter into as a sole proprietor will not automatically transfer to your corporate entity down the line. Corporate Entities and Multi-State Practice When considering the proper corporate structure for a practice, It’s important to remember the rationale for having corporate structures at all. First, the practice owner seeks to separate their personhood from their work. Also, they notify consumers of the entity with which they are doing business or seeking healthcare services. These reasons illustrate how your profession intertwines with your corporate structure. To operate in multiple states — in person or virtually — you need licenses issued by the appropriate state agencies before you can treat clients in those states. When it comes to telehealth, the client’s location is typically where the care takes place. For example, say that you’re based in Texas and have a Texas license. However, you work with clients who live in Michigan. Thus, you ought to have a Michigan license as well. Failing to do so could invite professional disciplinary action in Michigan as well as Texas. Such activity could also invite claims of misrepresentation or even fraud (depending on your intent). States aim to protect consumers from harmful acts. They do so, in part, by requiring professionals to put consumers on notice of their professional status in its applicable corporate structure.   Requirements Vary Widely By State From an organization or incorporation standpoint, requirements for delivering services across state lines vary by state. So if you’re operating a multi-state practice, you need to understand the laws in each state in which you deliver care.  For instance, in Michigan, a clinical social worker may choose either an LLC or PLLC structure. Meanwhile, Illinois requires licensed clinical social workers to deliver services through PLLCs. Thus, a dual-licensed provider in these states who wanted to enjoy limited liability protection might need two entities to render care in both locales. States may also have specific waivers for delivering care across state lines (e.g., PSYPACT for practicing psychologists). However, these exceptions are few, in our experience.  Some states, such as New York, require proof of your licensure from the State Department of Education before they will accept your professional entity. In other states, an assertion of the professional purpose of the company suffices. (But if you were to practice a profession outside your scope, this would remain grounds for discipline.) State laws also vary on which professions can co-operate a single professional entity. For example, what if a licensed clinical social worker wanted to organize a multi-member LLC in New York with a licensed professional counselor?  They would need to research whether the state allows that co-ownership. And when researching the requirements, keep in mind that each state may not have identical licensure. For example, Texas likely defines a “licensed mental health counselor” differently from New York or California. Corporate Entity vs. Tax Designation Many new business owners conflate corporate entity types — the business formation — and tax designations.  You may have heard your accountant discuss the benefits of a particular tax structure, such as an S-corporation or a C-corporation. The tax structure determines how a corporate entity will be taxed.  Corporate entities are assigned a predetermined taxation method. For instance, a single-member LLC is automatically taxed as a sole proprietorship. As a result, the profits and losses of the LLC are taxed the same way as personal income and losses. However, corporate entities can elect to be taxed in a way that is different from the default taxation method. For example, an LLC that meets specific requirements can elect taxation as an S-Corporation. Accountants are experts at finding beneficial tax strategies. Meanwhile, attorneys focus on forming corporate entities that meet the rigorous requirements of the state. Healthcare’s strict regulatory environment magnifies the complexity of creating those corporate entities. Thus, a good accountant is a treasure and should serve as a key member of your team of professional advisors. However, accountants seldom have the background and experience to establish a proper healthcare business formation with robust corporate governance documents. How to Get Started A healthcare attorney can provide the best guidance on these matters and prepare your business formation with all necessary supporting documents. But perhaps you’re not ready to hire a lawyer or don’t yet have the resources. In this case, contacting the state agency responsible for business entities is a good start. They can direct you to information and answer your basic questions to help you get moving. This article is made for educational purposes and is not intended to be specific legal advice to any particular person. It does not create an attorney-client relationship between Jackson LLP Healthcare Attorneys and the reader. It should not be used as a substitute for competent legal advice from a licensed attorney in your jurisdiction. ... Read More

    • Putting Kids First: Choosing Marital Partnerships and Co-Parenting over Divorce

      Putting Kids First: Choosing Martial Partnerships and Co-Parenting over Divorce As many couples find out the hard way, the spark that led to them falling in love and getting married doesn’t always last forever.  Should you find yourself in such a scenario, you typically have three options:   Work on repairing the relationship.  File for divorce.  Give a marital partnership or co-parenting a try.  While splitting up is difficult for any couple, it’s much harder when kids are in the picture because of the way they might respond to the situation. It’s not uncommon, for example, for some children to think that they themselves are the reason their parents are getting divorced.  To be sure, divorce is definitely warranted in some cases — particularly if you’re keen on dissolving legal bonds with your spouse. If you simply can’t get along with your partner any longer, you may be better off divorcing so that you don’t expose your kids to chronic conflict, which can have disastrous effects on their development.   That said, a clear-cut divorce isn’t always the best option. To give their children the love and support they need to grow up to be healthy, contributing members of society, more and more couples are embracing alternative approaches to parenthood.  Should We Stay Together? Lifestyle Alternatives to Divorce  According to the New York Times, divorce rates have been on a downward trend of late. On one hand, this is due to the uncertainty of the pandemic, as couples decide to weather the storm together. On the other, it’s because more and more parents are pursuing more modern types of relationships, including marital partnerships and co-parenting agreements.   Marital partnerships  Also known as a parenting marriage, a marital partnership is a non-romantic marriage where the parents stay together and live as a family for the sake of their children. Also known as a parenting marriage (a concept developed by Susan Pease Gadoua, LCSW), a marital partnership is a non-romantic marriage where the parents stay together and live as a family for the sake of their children. From the outside, a parenting marriage looks exactly the same as a traditional marriage. When you’re in a parenting marriage, you still go out to dinner and the movies together as a family, for example.  Though they are difficult for both spouses, marital partnerships deliver a number of benefits to children. Not only do they ensure kids have a consistent, stable upbringing, but they also ensure that both parents are present during important activities and events.  Co-parenting  Of course, living with someone you’re no longer in love with doesn’t necessarily appeal to everyone. Depending on the circumstances leading to the split, it might not even be worth it to even try.   In these circumstances, it’s still possible to maintain a healthy, civil relationship with your spouse after a divorce by embracing a concept called co-parenting, which is also known as platonic parenting.  Like the name suggests, platonic parenting is the process of two parents coming together amicably to raise their kids together. While parents might get legally divorced and live in different places, they both raise their kids together, seeing each other often in both public and private settings. This provides the stability and continuity kids need to lead healthy lives.  Co-parenting is not without its challenges. Chief among them is the fact that co-parents need to be respectful to each other at all times and never disparage their ex in front of their kids. But with the right approach to co-parenting, you can teach your kids great lessons about constructive problem-solving and how to communicate effectively while also reducing the stress and anxiety that would result from a more significant split.  What Do Kids Really Need from Their Parents?  At the end of the day, whether you decide to work on your marriage, try a parenting marriage, or become co-parents ultimately is not all that important. What matters most is that you are able to give your kids the childhood they deserve.  Whatever approach you take, it’s important to keep your kids safe, listen to them and spend time with them, and provide affection, order, and consistency. You also need to set and enforce limits, understand how your children spend their free time, and stay on top of any medical and mental health concerns.  If you’re in a hard place in your relationship and don’t know what to do, all hope isn’t lost. Talking to a therapist can help you figure out the best path forward. The right therapist will be able to help you determine what you want, what aligns with your values, and how to make it happen in a healthy way that doesn’t hurt your children.  Ready to give therapy a try? Search for a qualifed therapist in your community today.  ... Read More

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