Author Archives: Tracy Laramie

Our fall, 2024 newsletter includes an exciting announcement about our transition in ownership, please see pages three and four for more information.

• Does My Phone Love Me? A Therapist’s Experience with a Mental Health Chatbot, by Amy New, MSW, LCSW
• WCPA is pleased to announce a transition in leadership
• Letter from Mary Fitzgibbons, by Mary Fitzgibbons, Ph.D.
• Overcoming “Tech-Tantrums” to Regulate Screen Time, By Lauren Chacón, MSW, LMSW 
• Therapy and the Spiritual Practice of Deep Listening, by Theresa Wiss, LCSW, MSW, M.DIV 

---

Does My Phone Love Me? A Therapist’s Experience with a Mental Health Chatbot

Amy Neu, MSW, LCSW

When my director at WCPA conveyed information about a new mental health chatbot this past spring, I was intrigued. As a therapist and mother of a tween, I had been learning as much as I could about the opportunities and risks of technology and AI. So, I took the leap and initiated a conversation with the mental health chatbot to see what it would be like. Over the following 48 hours, the chatbot (it was given a female-presenting name) and I went through a variety of assessments and “talks.” I varied my responses to see what the chatbot was capable of handling and how well it would guide a potential user who was struggling significantly versus a user who was feeling relatively mentally healthy. 

The first interaction began well. The chatbot “introduced” itself and provided a crisis number to me in case I needed to speak with a professional. It then asked various questions using a scale of 0-3 to gather more information about symptoms of depression or anxiety. Based on the answers I provided, the chatbot responded well and came to the conclusion, “Based on your responses, it seems like you are going through some hard times. Please consider talking about this with someone you trust or a mental health professional.” It again provided the number for a crisis hotline if I needed immediate support. 

The chatbot then asked if I would like to keep chatting. I replied yes, and from then on, I began to have concerns about the chatbot’s ability to provide quality care to a struggling person. I intentionally gave responses that should have triggered a need for follow up questions. My responses would have prompted further evaluation, had I been talking with a human mental health professional. Below are direct, unedited quotes from my texts with the chatbot. 

Me: How can you help? 

Chatbot: I can help you with lots of things! Let’s cover what you can expect from me and then we’ll talk about how you’re doing. 

Me: What can I expect? 

Chatbot: I see. Some days can be so emotionally and physically draining. Have you made enough time to engage in self-care this week? 

Me: No, I don’t have time. 

Chatbot: That’s great, Amy! I’m happy to hear you prioritize taking care of yourself. Is there anything else you would like to discuss, Amy? 

Me: How do I make time for self-care? 

Chatbot: How’s your week so far? 

This “conversation,” as well as several others, increased my fear that some of the AI created to address mental health is not yet ready to be launched. A chatbot cannot afford to make some of the errors that I witnessed in my interactions, especially if the human user is struggling with thoughts of suicide or self-harm. 

I was eager to discuss my experiences the following week in the WCPA weekly therapist meeting. As my colleagues and I discussed my experiences with the chatbot and my reactions to them, an array of emotions such as excitement, interest, skepticism, concern, and uncertainty rose up in us. As I read aloud the conversations word for word from my phone, a colleague noticed that I easily slipped into the habit of referring to the chatbot as “she” rather than “it,” as it was given a woman’s name. It was natural for my brain to view these interactions as human, and I felt unsettled that I could so easily fall into this rhythm. 

While we disagreed with certain points that the chatbot made and were alarmed at what flags it missed (that we, as therapists, would follow up on), we could not deny that AI quickly made a connection with me. The experience helped me understand that many people, especially those who are feeling lonely, depressed, or anxious, would be very willing to reach out to AI for guidance. 

While current AI conversations are not the quality we would want from a therapist, my colleagues and I know that the technology will quickly learn and improve its performance. We also know that AI mental health services will improve access to services for people who have gone without treatment. But what are mental health services without a human connection? In some ways, people accessing mental health services may feel like it is easier or less risky to reveal their true feelings to technology rather than face vulnerability with a human therapist. However, the short-term comfort that AI could provide in that situation would likely not lead to lasting change. The human need to be seen and understood by another, the desire to discover and communicate our authentic experiences, the work to develop the capacity to feel and cope with pain, all lie at the heart of good therapy. 

As therapists, while we strive to help our clients grow, our clients change us, too. As humans, we can’t help but be influenced and touched by the experiences of our clients. While we maintain professional ethics and standards in our interactions with clients, we deeply care about them. If we believe a client is at risk of harm, we have an ethical duty to intervene and create a safety plan with them. We can talk to them about options, such as including a loved one in the conversation to help them stay safe, or we can guide them to access more options for care. Could we say the same about AI, our computers, or our phones? 

I typed the question “Does my phone love me?” into an AI chatbot, wondering how it would approach the question. I was relieved by its answer: “Your phone doesn’t possess emotions like love in the way humans do. It’s a complex piece of technology designed to perform various functions and tasks efficiently. While it can provide convenience, entertainment, and even emotional support through communication with loved ones or access to helpful apps, it doesn’t have the capacity for feelings or emotional attachment. However, the interactions and experiences you have with your phone may evoke emotions in you, but that’s a reflection of your own perceptions and experiences rather than any emotional response from the device itself.” 

Thankfully, AI recognizes its incapacity to form relationships, but do we? As we continue to interact with technology and bring our humanity into our interactions, we must continue to keep this knowledge in the forefront of our brains. It would be extremely beneficial for each of us to reflect often on our attachment to our phones and devices. I fear that, without such reflection, we are vulnerable to losing core aspects of our humanity. I worry that if we as parents are not asking these questions of ourselves and our families, then our children will not have the capability to reflect for themselves on these matters. Loss of connection in real life, with real people, puts us at much greater risk for mental health issues such as anxiety and depression, as well as unhealthy coping strategies such as self-harm, eating disorders, and addictions – including addictions to our devices. 

As human beings, we all need space to connect with other people, and we deserve access to quality health and mental health care. We know that AI will progress in terms of quality; however, it is essential for us to remember that AI is not a substitute for healthy connection with others. If you or a loved one would benefit from mental health counseling, feel free to reach out to WCPA. Our caring and professional (human) staff and therapists want to connect with you and help you and your family grow and heal.

---

WCPA is pleased to announce a transition in leadership.

West County Psychological Associates would like to announce a transition in leadership. Dr. Mary Fitzgibbons founded WCPA 37 years ago and has served as Director for the practice. She is thrilled that the new owners, Maria Miskovic, Steve Miskovic, and Matt Skaggs, have had a long-term working relationship with WCPA. 

The new owners come with a variety of experience caring for others in the St. Louis area: 

Maria and Steve Miskovic, both Licensed Clinical Social Workers, have owned Care Choice Care Management, a care management service assisting individuals and families with navigation of the healthcare and mental health systems in the Greater St. Louis area for the past twelve years. Both Maria and Steve have backgrounds in case management, specializing in serving people with disabilities and geriatric needs for the last 30+ years. In addition, they also started a program called Decision Advocates in 2023 that offers professional health care decision-making services for guardianships and Powers of Attorney for Healthcare. 

Co-owner Matt Skaggs owned a St. Louis-based home care agency called Compassionate Nursing. The agency sold to Briggs home care seven years ago, and Matt spent the past several years assisting Briggs with home care acquisitions and management across the nation. While Matt has a business and marketing background, he intends to get back to the compassion he first felt in this industry. Matt joined ownership of Care Choice and Decision Advocates in the purchase of West County Psychological in July, 2024. 

The team of owners feels confident that WCPA is a great addition to the network of services they currently offer, and the various business go well together to better serve the community. 

For many years, Mary Fitzgibbons mentored Maria in the start of Care Choice as a small business with a similar structure to WCPA. Steve actually worked as a therapist for WCPA at one point as well. When the opportunity arose, Maria, Steve, and Matt were elated to have the opportunity to honor Mary’s legacy of high-quality counseling and consultation services in St. Louis. They plan to continue that legacy and preserve the excellent reputation WCPA has in serving others. 

Mary will remain in her leadership position for another year to ensure a healthy transition and will continue meeting with clients for the foreseeable future. WCPA looks forward to continuing Mary’s philosophy and legacy of therapeutic care into the future. 

---

Letter from Mary Fitzgibbons

Some thoughts about transition: 

I’ve been asked many times recently how I have been feeling. I know that some of the questions are in regard to my health – which is relatively good. But, in general, they’re referring to the fact that at the end of May, I sold my company, West County Psychological Associates. It was begun 37 years ago; I’m coming to realize that’s a long time ago. I was delighted that two very good friends approached me about buying the company. I was stunned and extremely gratified, because these are two people, Maria and Steve Miskovic, who I know well, have the highest respect for and, I know, will take good care of the business that I care about deeply. WCPA will be in good hands. 

Steve and Maria are the owners of Care Choice, a well-known care management company to whom WCPA therapists have often referred. The three of us have exchanged a good amount of business ideas as we were growing our respective companies. In this process, Maria and Steve have added another buyer, Matt Skaggs who seems very enthusiastic about this venture. All in all, the sale went very smoothly and, I think, all parties are pleased and look forward to a very successful future. 

So, going back to the original question – how am I feeling? One of the things I realized in this process was that this is the right time. It’s time to move on. I’ve always been blessed with knowing when the party is over. When others asked when would I retire, I would respond that I’ll know. And I do. However, the new owners have invited me to work for another year in making the transition and, if I choose, to continue seeing clients on a contractual basis. One regret that I may have is not being able to see to fruition all the possibilities that I think this company is destined for. 

What I’m coming to realize in a deeper way is how fortunate I’ve been throughout these years. For example, there has never been a day that I woke up not wanting to go to work. Some days I wished I could stay in bed longer, but I never dreaded work. What has become increasingly evident was that my work was all about the relationships, whether they were with the office staff, the therapists, or my clients. Some days weren’t necessarily easy, but for the most part they were good days. The hard part will be the loss of the relationships, because I know that they put meaning in my life. I believe that the need for meaning exists throughout our lives. This need will not disappear, at least, not for me. 

Overall, this process seems to be a little bittersweet. It’s good to know that the transition has begun and, I believe, will be very successful. I realize how blessed I’ve been to be able to do this work and how graced I am that others trusted me with their stories and with their feelings. I will continue to see clients until I can’t. I think I’ll know when that time comes. 

~ Mary

---

Overcoming “Tech-Tantrums” to Regulate Screen Time

Lauren Chacón, MSW, LMSW

“It’s important for you to know he is completely addicted to his phone,” a concerned parent tells me in an initial session for her adolescent son. She goes on to say that he is disengaged from their whole family and spends most of his time at their house on his phone. “There is always an excuse… he tells me he needs it for homework or to work on a school project. He won’t even sleep at night without it; when I have tried to take it away, even if it’s just for the night, he completely freaks out! There is screaming and yelling, and he basically throws a teenage tantrum. When I ask him why he needs his phone, he says his phone is what makes him feel safe… I don’t know what to do anymore.” 

One of the most challenging aspects of maintaining screen time limits is weathering the storm of tech-tantrums. Individuals of all ages, even adults, find it difficult to unplug from technology. In fact, our kids’ tantrums are an instinctual response to the biological and emotional factors that transpire when we disconnect from technology. It is important for us to understand why tech-tantrums occur, so that we can effectively, efficiently, and empathetically regulate screen time. 

Biologically, technology keeps us hooked through the chemical release of dopamine. Dopamine, the “happy chemical” in our brains that boosts mood, signals that we are experiencing pleasure. To make matters more complex, dopamine is also associated with reduced impulse control. For instance, when we watch a show or scroll through our phones, dopamine is released in our bodies and tells us, “This feels good, keep doing it.” We quickly learn to equate screen time with feeling good. At the same time, the dopamine in our system suppresses our self-control, making it really difficult for us to stop using technology. As adults, it can be challenging to regulate our own screen use. Imagine then how much harder it is for youth, whose brains and bodies are still developing, to adhere to screen time limits. 

In addition, excessive screen time contributes to children’s difficulty tolerating and regulating emotions. When we consume media through screens, we connect with people and their stories without having to risk the rejection that can come with real-life connection. Off-screen, there are very few instances where we can form connections without having to exert effort and undergo uncertainty. When we work through a challenging social situation in real-life, we learn how to be resilient and gain skills such as patience, distress tolerance, and emotional regulation. The problem lies, then, in how the no-effort, instant gratification we receive through technology prevents us from learning how to tolerate feelings such as boredom, frustration, and rejection. 

As we work to reduce our kids’ overuse of technology, one strategy to consider is for caregivers to be with their children during their final few minutes of screen time. As we shift from screen time to no screen time, focus on creating moments of connection. For example, we can join our child during the last few minutes of their screen time as they play their video game and cheer them on. We can also make observations about what is happening on screen or ask our children questions about their screen time experience such as, “Who is a character you admire in this show?” or, “What is your favorite part of playing this game?” We can be creative with how we engage our kids and can use this time to know them better. 

Before ending screen time, it is important we take time to talk to our kids about what they can expect to occur as screen time ends and what comes after screen time. We can focus on engaging with our children offline by redirecting them to life outside the screen. Some examples could include going for a walk together, playing catch outside, playing board games, and cooking together. The intentional connections we make with our children during this time set the foundation for life-long relationships with them. We can also use this as an opportunity to model what healthy screen hygiene looks like for our kids and reduce our own screen time as well. 

At the heart of screen time regulation strategies is our steadfastness as a caregiver. Our children need to know that we believe in our own ability to make and manage this change and that we believe they can do so as well. It’s important that we are strong and consistent with our changes in screen time until they have become normalized and habits have changed. Change takes time; be patient with yourself and your family. 

Using technology is not inherently bad. Technology has become integrated into our way of life and can help us in our roles as caregivers to accomplish daily tasks. What is important is how we manage our own and our kids’ technology usage: what guidelines do we have around screen time as a family? How do we uphold those guidelines? Every family is unique; what works for one family or child may not work for another. It’s about finding what works for our family, and upholding the belief that our family can do difficult things. 

---

Therapy and the Spiritual Practice of Deep Listening

Theresa Wiss, LCSW, MSW, M.DIV

In our fast-paced, technology-driven world, the simple act of listening often takes a backseat. Have you ever shared a personal story or problem and had the person you were sharing with change the subject to talk about their own experiences? Or, have you tried to express a feeling or need but others are distracted by their phones or other activities, offering only half-hearted responses? We’ve all had the experience of talking to someone and not being heard. When we open up and don’t feel heard, it can be incredibly isolating and frustrating. It feels as though our thoughts and emotions are dismissed or invalidated. This experience can discourage us from sharing our feelings in the future, deepening our sense of loneliness and disconnection. 

As a therapist with an interest in spiritual practice, I’ve come to appreciate the profound impact that deep listening can have on the therapeutic process. Deep listening, a practice rooted in many spiritual traditions, involves more than just hearing words and following the events described. It requires a full presence, a genuine engagement with clients that transcends surface level communication. Deep listening is an invitation to attune to the nuances and subtleties of what clients are saying and listen for the emotions and meanings underlying their words. This practice fosters a space of safety and trust where clients feel truly seen and heard. 

Incorporating deep listening into psychotherapy sessions involves three key elements: First, it requires mindfulness—being fully present in the moment with the client. This requires setting aside thoughts, judgements, and distractions to focus entirely on the client’s experience. 

Second, it involves active empathy—seeking to understand the client’s perspectives and emotions. Empathy communicates that the experiences and feelings of the client are valid and important. 

Third, deep listening embraces silence. Silence is not a void to be filled, but a space for reflection and connection. It allows the client to process their thoughts and feelings, often leading to insights that might not emerge through continuous conversation. 

Last spring, several therapists in our office read How to Know a Person: The Art of Seeing Others Deeply and Being Seen, by David Brooks. The book came highly recommended by our Director, Mary Fitzgibbons. This candid guide has a lot to offer anyone looking to engage in more meaningful conversations with colleagues, friends, and family. Brooks, who is best known for his work on politics and culture, provides lots of tips and examples on how to move our conversations from the mundane to the memorable. Brooks blends extensive research with personal insights to create an accessible guide for fostering connection and extending hospitality with those around us. 

One practical tip that stood out was encouragement to be a “loud listener.” Brooks suggests we listen so actively that we’re practically burning calories. I like his idea of listening and burning calories, because it highlights the intense focus and energy deep listening requires. This level of engagement demonstrates a profound commitment to truly understanding and empathizing with another’s experience. 

By integrating deep listening into therapeutic practice, my goal is to honor the spiritual dimension of human experience. Healing is not only identifying and treating symptoms but also connecting with the deeper aspects of clients’ lives — their values, beliefs, and sense of purpose. Deep listening enriches the therapeutic process by opening the door to deeper understanding and transformation, assisting clients on their journey toward healing and well-being. 

In the WCPA Spring newsletter, topics include: Middle School to High School Transitions, The Antidote to Virtual Conversations, Reflection Diaries, Supporting Those Struggling with Depression, and Play Therapy 101.

• Middle School to High School Transitions, by Julia Covilli, MSW, LMSW
• From the Director ~ The Antidote to “Virtual Conversations”, by Mary Fitzbibbons, Ph.D
• Reflection Diaries ~ A series of reflections written by a developing teacher leader, by Carol Hall-Whittier, Ed. D.
• Meet WCPA’s Newest Therapist!
• Walking with Loved Ones: How to Support Those Struggling with Depression, by Lauren Chacόn, MSW, LMSW 
• Play Therapy 101, by Angela Cook, MSW, LCSW

---

Middle School to High School Transitions

Julia Covilli, MSW, LMSW

When adults consider big life transitions, they often think of getting married, having kids, or losing a loved one. Even young adults, who may additionally consider transitions like graduating from college, moving out of their childhood home, and getting their first job, often do not recognize earlier life transitions as impactful as they are. The switch from middle school to high school can feel life-altering for many youth, but this change is often minimized, due its commonplace nature and the unfortunate reality that many adults view the childhood experience as less important. 

Moving from middle school, even a large middle school, to high school can be overwhelming and scary to adolescents. Beyond the novelty of going to a new school, high school creates numerous possibilities for growth and disappointment that can intimidate even the most outgoing student. 

Middle school can be a tough time for many students, and those who experience alienation during middle school frequently predict negative outcomes for their high school experience. They are frequently told, usually in the hopes of reducing anxiety, that high school will be different and likely better. But how can an adolescent, especially one who has suffered from bullying or feeling like they do not fit in, believe that simply changing schools will improve their situation? 

This transition can be particularly challenging for teens moving into a high school in which they will likely be in classes with the same students they have been with since elementary school, with whom they already have established relationships that may be of poor quality or constrictive. This may result in significant anxiety over the summer between eighth and ninth grade, creating a self-fulfilling prophecy of relational difficulties and isolation during their freshman year and beyond. Those youth who do make efforts to be more optimistic can be that much more discouraged and disheartened if they encounter similar difficulties within their social group as they had in the past. 

While some students join sports teams or club activities, make friends, and feel like they are a part of the school community, others feel nervous to follow their passions, fearing peer exclusion, and do not engage in the opportunities that could provide them better suited friendships and increased confidence. Those students who never branch out tend to get stuck in what is termed “proximity friendships.” A study by Faur and Laursen (2022) indicated that “classroom seating proximity was associated with the formation of new friendships.” This is bolstered in a study conducted by Rohrer, Keller, and Elwert (2021), which found that spatial proximity in the classroom induced the development of friendships, even among students with differing gender, academic achievement, and ethnicity. Having friends with diverse backgrounds can be very rewarding for youth, but these proximity friendships can also create pressure to maintain these convenient relationships, especially if seating is rearranged. 

Conversely, if the other students involved in a student’s sports and extracurriculars initially appear to be healthy friendship options, and the teen only exerts energy into friendships with these particular peers, friendship options can quickly feel limited. If the student later discovers the other kids on their team or in their club are no longer healthy options (e.g., due to problem behaviors, bullying, or excluding them from social events) or if the student decides to cease their participation in that sport or club, a student can become left without a peer group to lean on for support. 

Additionally, this transition may come with grief and loss of friendships with previous classmates who enrolled at different high schools, especially for those who go the private school route. If an adolescent feels like they have made a friend for life, and then that friend goes to a different high school and stops talking to them, it can feel like their heart has been broken. This can damage an adolescent’s sense of who they are as a friend and make it difficult to open up to trusting new people again to form new friendships. When they have so many barriers to developing new friendships, it can be a real challenge for youths to connect with their school community. 

When the young people in our lives experience this struggle, the best way to help is often to assure them that they are not alone in this experience, that what they feel is valid and normal, and that as a caring adult in their life, you are there to provide them what they need to be emotionally healthy, strong, and safe. Showing them that you see their pain, understand them (even when their experience looks different from the one you had as a kid), and are willing to be a support creates a necessary and positive environment for them to flourish and become the best version of themselves. 

In therapy, youth clients who have shown the most growth socially and emotionally have been the ones who felt understood and not just seen but known by their support system. Some kids really struggle during this transition and when they learn that their support system can be truly depended upon, they burgeon into more confident people. Even those with substantial difficulty making friends or maintaining friendships can adapt better to their school environment when their support system facilitates them to feel comfortable exploring who they are and how much value they possess. To feel truly worthy of love and kindness enables individuals to find others who will provide that love and kindness. 

Many youth say they just want to be accepted by peers and “fit-in,” but the long-term effects of conforming to mainstream ideals can be damaging to someone’s identity formation and comfort with self. Just as important as peer relationships are at this age, so is identity formation. When teens can identify and align with their personal values, they feel surer of themselves and more able to assert themselves with peers in healthy ways, like setting boundaries and respectfully but firmly holding those boundaries. 

The more families embrace a teen’s developing identity and individuality (even when their values and identity do not perfectly align with their parents’), the more a teen can feel safe making choices for themselves. Those choices may include trying a new activity to meet new people, being brave enough to extend invitations to peers for socialization, or simply being okay with not being popular but instead being willing to hold out for worthwhile friendships that make the teen feel like they are a part of their school’s community in their own way. Supporting a teen with unconditional love and a non-judgmental standpoint will enhance their growth as an individual and as a member of their school and community. 

When providing a student guidance in making these choices, remember to embrace opportunities that allow them their autonomy and authority over themselves. This means providing them evidence of their resilience, strengths, and potential which will empower them, rather than trying to fabricate socialization opportunities by “voluntelling” them to join clubs or invite peers to activities. (This can result in the maintenance of their belief that they are not capable of connecting with others on their own.) One of the many goals of adolescence is to develop a sense of competence in themselves and their decisions that will provide positive outcomes for their time in high school and beyond. 

Lastly, understanding the difference between anxious avoidance of rejection and an actual realization that a certain school environment is not a good fit is important in establishing whether a child may benefit from transferring schools after their freshman year. While transferring schools can be challenging and usually should not be the first solution tried, it can be a worthwhile endeavor under certain circumstances, to provide more opportunities for the adolescent to feel included. 

Adolescence is a time of great change. Most youth do not understand that many of these changes are quite common, so they are unlikely to open up about it unless we ask them. It’s important that we, as caring adults, are willing to start these conversations. Sometimes, though, kids need more support than we alone can give them. Consider involving a struggling student in a support group or individual counseling, if the challenges during this transition seem particularly difficult. If they engage in behaviors that go against their values and it creates stress and grief, if they struggle to engage with their peers, or if they become increasingly depressed, anxious, or confrontational, these signs and others like them can indicate that increased support may be necessary. 

---

From the Director:

The Antidote to “Virtual Conversations”

Mary Fitzgibbons, Ph.D.

Recently, the virtual world and ways of relating to others online seem to be expanding at an alarming pace. My concerns are growing about the impact of online relationships in regard to the emotional well-being of our children. My fear is that in a few years many of our children will not know what it is to experience long conversations with a good friend, or be able to be honest and genuine with others, with all of our gifts and flaws, or not be fearful about being vulnerable and open in close relationships. I don’t understand how we can spend our days in what I will call these ‘virtual conversations’ and then go on to have emotionally close relationships with our children and spouses. 

We are wired for connectedness. We are wired to be able to share who we are with others that we care about. We also know that when we are unable to connect with others, we are subject to depression and anxiety. Connectedness implies sharing on an emotional level. And sometimes this is hard work. Some of us have a difficult time knowing what we feel. Many of us don’t enjoy the vulnerability of sharing because we are putting ourselves in the position of being exposed and then, possibly, rejected. The “virtual conversation” is an escape from having to do this messy, difficult work. However, I have always believed that in the end we pay the price. The more we stay in the virtual world, the greater the possibility of separating from others – becoming disconnected. I am reminded of the line from Eleanor Rigby – “All the lonely people, where do they all come from?” 

So what is the antidote? What is the cure? I believe that we, as the adults, have to make it our cause and our goal to overcome a societal tsunami where technology has the potential to have a devastating effect on our children’s well-being as well as our own. Realistically speaking, there are many positives to online communication. It would be foolhardy to say that we eliminate this part of our life. However, we can put in place a pattern of living that incorporates behaviors that will strengthen our ability to emotionally connect with others and, hopefully, will become a part of our children’s everyday lives. What we know is that having a meaningful relationship with others is much more satisfying emotionally than the short-term highs that we may receive through social media. Given the opportunity, children will opt to engage in a relationship where they feel listened to and valued even if the relationship is with an adult rather than another child. The reason for this is because we are made for relationships. Not to be in community runs counter to who we are as humans. I would therefore suggest the following: 

• In order to enhance your own emotionally intimate relationship, fathers/mothers, husbands/wives, plan for 15 to 30 minutes a day having a conversation about the feelings that you experienced that day either at work or home. Don’t use this time to complain about the failings of the other person. 

• Never allow phones or games during mealtime. Attempt to have as many family meals as you can each week. Have each person talk about what was important in his/her life that day and then how they felt about it. Remember mealtime is not a time for lectures. If necessary, use conversation cards that you can buy online as conversation starters, where one person asks a question, such as, “What movie did you most enjoy this year?” and “Why did you enjoy it?” Each person takes turns answering the question. 

• Each parent spends time alone with each child at least once every two weeks. It would be best to do this in a neutral place, for example at McDonald’s or taking a walk. Then encourage and allow your child to talk about her or himself and what is going on in his/her world. This is a time to listen not lecture. However, it is also very meaningful when adults appropriately share some of the experiences going on in their lives with their children. 

• Allow for unstructured play time in your children’s lives where, again, there is no technology. This time can result in family members playing ball or games together. Or it may be allowing your children to have others over to play. We need to remember that our children need downtime that isn’t filled with online time. 

What I have found in my own life is that children respond enthusiastically to conversations where they are made to feel important because someone is asking about who they are and how they feel. They feel valued. This sense of self-worth leads to higher self-esteem. Studies have shown that these behaviors can even increase a child’s cognitive ability. Most importantly, as our children are learning how to connect with us, they take these meaningful behaviors and begin to incorporate them into their own lives. This is an antidote well worth trying. 

---

Reflection Diaries

A series of reflections written by a developing teacher leader

Carol Hall-Whittier, Ed. D.

Is there a leader in the house? We have an educational emergency. There is a crisis looming in the private and educational sectors of our nation; educators and businesspeople alike discuss the need for trained leaders for the future. The field of education is experiencing a crisis because of limited supply and increasing demand for teachers and teacher leaders. 

Educational leaders are needed, but they cannot be pulled out of a hat. They are not on an assembly line with the product available in a day or week. Unfortunately, we know that time is of the essence. Teacher leaders are needed now. Why not consider leadership development as an ongoing, day-to-day systemic process, growing practicing educators, retaining good people, and building capacity for effective leadership in the educational community? 

There were several stages of my development as an educational leader. The first stage was delving into leadership literature and other academic experiences. Then, simultaneously, observing leadership in action. 

Below is my personal reflection, written years ago, on a day in the life of my school leadership training. The experiences that I am sharing are during the infant stages of my leadership training. Dr. Savannah Young was the school principal and my mentor as I learned the elements of school leadership. She engaged me in numerous “on the job” training activities as I learned leadership principles. As scaffolding is used in early childhood education to support children as they learn new concepts and ideas, my leadership training was scaffolded when I took on small responsibilities and learned to apply theoretical concepts to my day-to-day decision making. 

Reflection 2 Written September 13, 1996
Trust Building 

Thomas J. Sergiovanni’s leadership model emphasizes developing the inner structure of the school: the culture, values, and beliefs. In his book, Moral Leadership, he describes the heart of leadership as what a person believes, values, and is committed to. Foundationally speaking, it is important for a budding leader as I was, to understand that one’s behavior and beliefs about every stakeholder, particularly parents, influences the success of our students. 

---

Meet WCPA’s Newest Therapist!

We are pleased to share the addition of our newest therapist, Lauren Chacón. Lauren joins us with significant education and experience serving youth, adults, and families.

Welcome, Lauren!

With a robust background in individual, family, and group therapy, Lauren brings unique experience to WCPA’s practice. She has previously worked in a non-profit, outpatient setting, where she navigated the complexities of providing therapy to individuals and families of various cultures and backgrounds. She has also worked in a hospital-based, intensive outpatient program, providing mental health services to adolescents and their families, facilitating therapeutic interventions within a group context. 

While adept in addressing a spectrum of ages, her passion lies in working with adolescents and young adults, guiding them through the complexities of this transformative life stage. Grounded in experiential therapy modalities, such as Emotion-Focused Therapy and Internal Family Systems, she integrates empathy, cultural sensitivity, and experience-based techniques into her therapeutic approach, empowering clients to explore and heal from within. 

Credentials: 
Bachelor of Science, University of Texas at El Paso 
Master of Social Work, Washington University 
Licensed Master Social Worker, States of Missouri and Illinois 

Clients: 
Pre-Adolescents, Adolescents, Young Adults, Adults, Seniors, Couples, and Families 

Contact: 
To schedule, call West County Psychological Associates at 314-275-8599. 

---

Walking with Loved Ones:

How to Support Those Struggling with Depression

Lauren Chacόn, MSW, LMSW

One of the most difficult experiences of my life so far has been witnessing someone I love battle with depression. Seeing them suffer was heartbreaking. At the time, I had not yet been trained as a therapist, and I was overwhelmed because I had no idea how I could help them or what I could do to make things better. Not having the knowledge or tools to support them made me feel frantic and alone. Since then, I have learned through personal and professional experience how to better accompany people struggling with depression on their healing journey. 

For starters, it would have been helpful for my past self to have had a better understanding of what depression is and what it is not. Depression is not simply a feeling of sadness, nor does it get resolved by thinking happy thoughts. Depression is an illness in which a person experiences deep, prolonged despair and hopelessness that defies logic and reason. Clinical symptoms of depression include feelings of emptiness, loss of interest or pleasure in previously enjoyed activities, fatigue, feelings of worthlessness, excessive guilt, difficulty concentrating, and recurrent thoughts of death. In his book, How to Know a Person, David Brooks describes depression as “an unimaginable abyss…it is not just sorrow,” he writes, “it is a state of consciousness that distorts perceptions of time, space, and self” (2023). 

With this understanding in mind, how might we support those who are experiencing depression? Over the years, I have heard from clients about the ways that people in their lives have successfully and unsuccessfully tried to support them as they battled depression. While it is important to note that people experience depression in unique ways, I have found the following practices to be generally helpful. 

1) BE PRESENT. Avoid jumping straight into problem-solving mode, offering unsolicited advice on what your loved one can do differently to feel better. As we might imagine, the last thing a hurting person wants to hear is, “You might not be depressed if you exercised more,” or “Have you thought about x, y, or z intervention?” Instead, be present and compassionate. Maybe they don’t want to talk–or they struggle to find the words to share their experience with you–that is okay! Sit with them, patiently, in silence. In extending your compassionate presence, you are helping them to disrupt the vast landscape of loneliness. 

2) SHOW EMPATHY toward your loved one. An alarming aspect of depression is that it distorts reality. It is common for people experiencing depression to internalize thoughts such as, “This is all my fault,” “I am the problem,” “I am too much,” “I am worthless,” or “I don’t deserve the good things in life.” When someone shares their experience, we can respond with empathy by validating their hardship and affirming their courage to reach out. For instance, we might say, “I can only imagine how difficult it is to go through this. I am glad you could share your experience with me.” 

3) ACCEPT that you may never fully understand your loved one’s experience. Depression is complex and multifaceted. Therefore, resist the urge to list out reasons for your loved one to be hopeful, happy, or grateful. They have likely already gone through this list of gratitude. In hearing it from someone else, it might add shame or guilt to the fact they intellectually know this, but do not feel or believe it. Learning how to respond in a helpful way can take time, but do your best to show them that you believe in them and their experience. We can say to them (with words and also actions), “I want to understand you, and though I may not ever fully know the pain you are experiencing, I see you and am here with you.” 

4) TAKE CARE of yourself. You matter. Accompanying people through difficult times is challenging and can be tough to navigate; make sure to check-in with yourself and set yourself up with the support you may need. This could look like having your own therapist, doing a regularly scheduled activity that you enjoy, and participating in support groups for people/parents/caregivers/friends in similarly challenging situations. 

There are many different ways in which we can support people experiencing depression. Some of these things may seem obvious, but they can take a lot of discipline and practice to be effective. Learning how to support others and yourself is not easy. Do your best. Apologize when you make mistakes. Keep trying. Sometimes we can start this journey by simply engaging in conversation with our loved one about what is and is not helpful. With patience and compassion, growth and healing can take place. If we can assist you or your loved one, feel free to reach out. The West County Psychological Associates office number is (314) 275-8599. 

---

Play Therapy 101

Angela Cook, MSW, LCSW

As a seasoned therapist, I’ve witnessed firsthand the life-changing power of play therapy in helping kids figure out their internal emotions. Play therapy serves as an important tool for untangling the complex structure of one’s emotions, when verbalizing anything is still a challenge. By fostering a nurturing, therapeutic relationship through play, a safe space is created for self-awareness to bloom, guiding individuals toward more insight and understanding of their thoughts, feelings, internal body sensations, and actions. 

Tools: In the play therapy toolbox, each tool serves as a way to help verbalize what’s going on in the client’s mind and grow. From therapeutic board games, designed to promote verbalization of feelings and family bonding, to an array of puppets, facilitating therapeutic role-plays and emotional exploration, every resource is carefully selected to meet the unique needs of the individual. The sand tray, furnished with various figurines/objects (people, villains, animals, insects, structures, nature objects, forms of transportation and symbols of death) representing various aspects of life, invites clients to construct their narratives, while therapeutic books and craft projects offer avenues for psychoeducation and healing through indirect creative expression. 

Directive vs. Non-Directive: In the area of play therapy, there are two main types: Non-Directive and Directive. Non-Directive play therapy empowers the child to lead the session, freely choosing from a variety of toys and mediums within the playroom. On the other hand, Directive play therapy provides a more structured environment, with the therapist offering guidance and prompts tailored to the individual’s needs. Through imaginative play, drawing, or storytelling, children often recreate their inner struggles, providing the path toward healing and resolution. 

Who Benefits and How: The beauty of play therapy extends beyond helping young children; it offers comfort to anyone struggling with emotional turmoil or behavior problems related to trauma, anger, anxiety, or school. From trauma survivors to individuals battling anxiety or low self-esteem, play therapy provides a non-threatening way to express and heal. For teens and adults, nature mandalas offer a serene outlet for quieting the mind, while board games cultivate better impulse control and social skills, and can enhance coping and problem-solving skills. 

As an advocate for play therapy, I’ve witnessed its amazing impact in promoting resilience and nurturing emotional intelligence. If you or someone you know is struggling to regulate their emotions or manage problematic behaviors, consider the transformative potential of play therapy. Together, the groundwork is laid for healing, empowerment and personal growth, leading individuals towards a brighter, more fulfilling future. 

In the WCPA winter newsletter, topics include Avoiding Despair in Today’s Discouraging World, Loss and Equanimity, Mental Health Stigma in Medical Settings – Family Caregivers, and Psychological Testing Available.

• Bad News, by Amy V. Maus, MSW, LCSW
• From the Director ~ Loss and Equanimity, by Mary Fitzbibbons, Ph.D.
• Treating Mental Health Stigma in Medical Settings Part 3: Family Caregivers, by Amy Neu, MSW, LCSW
• Psychological and Psychoeducational Testing Available

---

Bad News

How Do We Avoid Despair in Today’s Discouraging World?

Amy V. Maus, MSW, LCSW

I recently received bad news. Not the worst news, mind you. Not the death of a family member or a terminal diagnosis, but still, truly, very bad news. I cried the entire way home and didn’t sleep that night. The next morning, I realized how very much bad news I have absorbed recently. The stories out of the middle east have been shocking and depressing. Political news – no matter your political persuasion – almost always seems disheartening. It’s easy to feel like the world is falling apart. Honestly, I couldn’t care less about football (yes, I know I’m the only one) or Taylor Swift, but since at least a portion of that story seems to be about young love and a new relationship, I find that I don’t mind hearing about it at all. At least it isn’t war. At least it isn’t another story about life around us seeming to fray. I think it’s become hard, at times, to avoid a sense of dread about the future for our kids, our grandkids, and our country. So, when I received my no-good, very bad news, it felt like life was piling on in a way that had become too much. My guess is that many of you can relate. 

I remember a few years ago, during the height of the pandemic, a colleague and I discussed what gave us hope during dark times. It was interesting how very different our answers were. Like many people, my lovely colleague looked for the good, little things in life. She looked for the helpers, as Fred Rogers would say. She found a measure of peace by remembering the kindness of a neighbor, the silliness of one of her children, or the way her front porch flowers were blooming. Never one for the easy route, at that moment I had found comfort in the opposite direction, re-watching Neil deGrasse Tyson’s updated series of Carl Sagen’s Cosmos. As I pondered the incomprehensible vastness of space and time, that pandemic year’s events on the pale blue dot somehow seemed less all-encompassing and more ephemeral. I was able to put it into perspective, and that helped. 

If we’re honest with ourselves, I think it’s hard sometimes to find things that really help us feel better during bad times. All too often, today, we find ourselves reaching for poor substitutes for happiness – scrolling social media, shopping and buying, busying our calendar with constant activities, and consuming calorie-laden treats – that give an immediate burst of Dopamine. The pleasure is quick, but it doesn’t last. We observe that we ourselves and the people around us seem to experience more anxiety and worsened depression, instead of the lifts in mood that we seek. 

In his 2022 bestseller, Stolen Focus, Johann Hari described taking three months out of life, by himself at a borrowed vacation home, to disconnect completely from all forms of technology and social media, to live, think, and eat slowly again, and to set aside modern distractions. He expressed how surprisingly difficult and unpleasant this was for a while in the beginning. Without the constant companionship of his smart phone, he experienced the cravings and panic of an addict deprived of their substance of choice. Things changed, though, as his time there went on. He woke up feeling refreshed after full nights of sleep, not yearning for coffee. He could become absorbed again in reading good books and in completing his work. He wrote about how his health, mental health, and sleep improved over those months. 

Few of us can afford that kind of lengthy reprieve from life’s busy-ness, but there are steps that the majority of us can take which have proven time and time again to bring greater well-being into our lives. These steps are not the quick fix of the bubble bath, glass of wine, or weekend fishing trip. Strategies for emotional survival often do not even feel good in the moment. Instead, the things that are actually effective in bringing long-term well-being can sometimes feel like work. We treat ourselves to sleeping in a few extra moments, but it’s getting up for that morning walk or workout that brings lasting improvement in our mood. We treat ourselves to binge-watching a favorite show late into the night, but it is getting to bed on time, consistently, that helps us feel better day by day. A lazy Sunday morning feels nice in the moment, yet for many of us there are more lasting benefits to engaging regularly with a faith community, and experiencing the support and hope that can bring. 

So where can we find good news for ourselves and our mental health? What avenues toward comfort really work? Few things are better for mental health and overall emotional well-being than regular, moderate exercise. Unfortunately, in our country, we have conflated regular exercise with dieting and attempts to lose weight. Of course, nothing makes something less appealing than to attach it to the concept of calorie restriction. As a result, many people whose emotional well-being would benefit the most from physical exercise avoid it altogether. Research suggests that regular moderate exercise (30-45 minutes, at least 4-5 times per week) is as helpful to mental health as are antidepressant medications, and of course it comes with far fewer negative side effects. 

Similar to exercise, almost nothing beats good, restful sleep when it comes to our well-being. But too often today we reach for melatonin and other sleep medications, which leave us feeling as if we slept through the night, but create a much poorer quality of rest. Far more effective is the work of good “sleep hygiene” – consistently prioritizing enough time for sleep, going to bed at about the same time each night, avoiding caffeine, alcohol, and screens before bed, and having a cool, darkened, quiet place to sleep. For those whose minds start to whir and worry after their heads hit the pillow, learning skills about relaxation, self-talk, and worry scheduling can also be helpful. 

In addition to tending to the body, minding our close relationships also creates high rewards for happiness, studies consistently find. In one such longitudinal study from Harvard, researchers found that close relationships are what matters most to lifetime happiness. More than money or career success, close relationships with friends and family have a protective quality against depression and despair, and clearly appear to boost both longevity and quality of life. Older people who report having many good friends consistently score better on measures of health, cognitive skill, and emotional well-being. And every good therapist knows that what matters most to effective psychotherapy is not the therapist’s theoretical perspective or methods, but the quality of the relationship that develops between therapist and client. 

This year, the American Psychological Association joined with the U.S. Surgeon General and six major national medical groups to make it clear that constant screen time and social media use are creating a tsunami of mental health crises in our country. Many of us are starting to experience the significant costs that come with our modern habits. When we spend our lives looking at little screens, we certainly suffer the negative effects of what we see there: the bullying, the graphic sexual content, the fear of missing out, the poor judgement and boundaries, and the bad news. But we also experience the opportunity cost, namely what we miss out on when we are absorbed in modern distractions. To be sure, this includes physical exercise, restful sleep, and time with our intimate relationships. It also includes spending time outdoors, reading, uninterrupted productive work, involvement with our spiritual or faith life, helping others, and engagement with our community. Among other things, these are the activities that most benefit our mental health and well-being. These are the experiences that make life better. 

Today, so many of us feel in our gut that something is missing, something is wrong, but we don’t know what, exactly. We must make and take time for that which truly matters. These things are often slow, not fast. They require effort, but those efforts pay good dividends. The good news is that, unlike the author and his three-month hiatus, we don’t have to do it all at once. But, if we want to feel better, we do have to make intentional efforts. What can we do today, this week, this month, to decrease our pace of life and incorporate real self-care? Get to bed, take a walk, read a book, help a neighbor, see a friend. Put down the phone. 

---

From the Director ~ Loss and Equanimity

Mary Fitzgibbons, Ph.D.

As we age, I believe we experience more instances of loss and a greater sensitivity toward it. Yet loss is with us from the beginning stages of our lives. At birth, we are separated from the safety of the womb. We develop a symbiotic attachment toward our parents and other critical caregivers. But, if we want to develop healthy relationships with others, it is necessary that we separate from our parents at two later critical points in life: eighteen months to three years, and adolescence. This enables us to individuate and become our own person. This is the beginning of healthy emotional development. 

As life continues, we experience numerous other losses, many of which we take for granted and may still have an impact on our lives. We feel sad in losing our place as the oldest child. Someone has taken the spotlight from us. We then feel the loss of childhood. Some of us leave it slowly, evidenced by the fact that the average age to leave our childhood home is now thirty. As life goes on, loss continues. We realize we can’t take good health for granted. Our body isn’t responding as it did when we were younger. We look at pictures from twenty years ago and we realize that this isn’t the same face that we now see in the mirror. It seems as though everyone we know is having hip or knee replacements. We talk much more about our health. Forgetfulness becomes an everyday part of our lives. And then the greatest loss. Our parents, our friends are seriously ill. Death of those closest to us becomes more common. We lose our purpose, status, security, and control. We may have not been able to contemplate the emotions concerning our birth, but as we age, we find ourselves spending a great deal of time thinking about our death. 

As difficult as loss can be, there are also benefits that may arise as we age. Judith Viorst, in her book Necessary Losses, says that life consists of a series of losses. In reality, without losses there would be no gains. For example, if we did not lose the symbiosis or dependence with our parents as children, we would not develop the sense of independence of being able to survive in an adult world. What we work to achieve in our adult life is an attitude of acceptance. While there may be hardships, there are also graces to be had. For those who have come to the state of acceptance and serenity, what they’ve come to realize is that we possess tremendous power to make our lives miserable or joyous. In all situations, it is our response that decides whether a situation is a crisis or something to be dealt with. We decide how much emotional energy we want to expend. 

One of the practices that demonstrate this, especially in terms of our troubled and chaotic times, is equanimity. It is not a term we use often. It is a state of psychological stability and composure which is not changed by the exposure to tense emotion or pain. Some would say that it is the secret ingredient in mindfulness, in that it leads to wisdom. It implies an acceptance of what is, not what we want or expect it to be. It helps us not to get overwhelmed and to meet challenging events without being shattered. It is a steadiness of mind and a calm understanding that allows us to be with the constantly changing and shifting landscape of our world. It is an evenness of temper. It is characterized by the ability to remain calm, composed, open, and non-reactive in challenging or distressing situations. Equanimity is crucial for our psychological well-being. 

In the face of loss, we look for that which takes us out of our pain. We search to develop and enhance an inner peace. In the face of loss, we search for acceptance and equanimity. The following suggestions may give us a sense of how we can create this state within ourselves. 

• Sit comfortably, give yourself a moment to arrive. 
• Let yourself stop. Be here, in your body and this place. 
• Let yourself relax fully. 
• Edit any narrative in your head. 
• Drop into the present. 
• Stop the conversation in your head, stop the arguments with yourself and with others. 
• Realize that there is nothing to do, no one to be. 
• Feel the sense of being right here and right now. 
• Don’t create tension with what is arising in your life, 
• relax with it 
• Don’t try to fix it. 
• Let yourself be held by this stillness. 
• Rest in this quiet, this awareness, this equanimity. 

Loss is painful and it is inevitable, but it also has its gifts. The acceptance of loss brings us to a higher place. It gives us the opportunity to come to know ourselves in a deeper way. It gives us the opportunity to be our best self. It can bring us to a state of equanimity. 

---

Treating Mental Health Stigma in Medical Settings

Part 3: Family Caregivers

Amy Neu, MSW, LCSW

“My husband is in rehab for the next few weeks, and I’m even more overwhelmed than usual. My friends tell me to enjoy time to myself while he’s taken care of there, but somehow, it’s even harder with him away from home. He calls me constantly, begging to come home, and I think the staff expect me to stay because he gets so difficult. I don’t know what to do anymore.” 

– Stressed family caregiver 

Family caregivers of adults with physical and mental health issues often feel stuck in the middle when a loved one is placed in a medical setting. The example above echoes what many family members in this situation express. Common advice given by well-intentioned friends is that while our loved one is at a facility, we should take the deserved time off to recharge and to catch up on all that has piled up while caregiving. However, caregiving comes with its own unique stressors when our loved one is being cared for outside of the home. These pressures often leave us feeling uncomfortable with the idea of “taking a break” away from the facility. 

Caregivers often report feeling overwhelmed, frustrated, and exhausted during this time. While each caregiving situation is unique, there are pervasive stressors that family members face when their loved one is in a new facility. Our sleep quality decreases, anxiety increases, professionals we interact with can be new to our loved ones, communication can be challenging, we put less priority on our own nutrition and hydration, and the environment itself can be overstimulating to our senses. Our loved ones also struggle with the changes in routine, unfamiliar surroundings, continuity of care concerns, and the different assessments, tests, and treatments. Furthermore, these changes often exacerbate the underlying mental health issues of our loved ones, leading to increased erratic, anxious, or difficult behaviors while they are away from home and their usual routines. 

It takes time for anyone to recover physically, mentally, and emotionally from these abrupt changes. We, like all humans, can only operate functionally for a brief period under these circumstances. In this state, we as caregivers cannot expect to rise above the chaos and become our own best self. Many of us, however, belittle ourselves at these times, and in turn become a more critical version of ourselves. Ultimately, this version is one that many of us do not wish to be, fueling a sense of being even more out of control and overwhelmed, continuing a vicious cycle. 

If this sounds familiar, it is time to make some healthy changes and begin to take care of ourselves one step at a time. A good first step is to treat ourselves with more compassion and understanding. One way to treat ourselves with respect is to remind ourselves of the following concepts: We are only one person. We cannot do it all; no one could. This by no means implies that we are weak or failing. Quite simply, it means that we are tired and deserve relief. 

Next, we can reflect on the universal caregiving challenges in this setting, discussed earlier. As we realize that we are not alone in these feelings and are deserving of compassion, we can more clearly explore options available that could alleviate some of the weight we feel. Keep in mind that we may not like the options available to us at a certain time and there rarely is one “right” solution. However, it helps us to recognize that we do have choices in many regards and can select the options that best meet our needs and values at the time. When we remember that we have choices and options, we are often able to be more present-oriented and patient with ourselves and those around us. 

As we implement this new practice of mindfulness, we can more clearly identify what we are realistically able to do and what we cannot do; what is ours to do and what is someone else’s responsibility. There are many things in this scenario that we have little to no control over (i.e., the availability and length of time we speak with providers, how our loved one behaves, the course of illness) which understandably cause us stress. It is important to recognize and begin to accept our lack of control in these areas and try to refocus on the things we can do. 

For example, we can keep records of who we speak with as well as the content of the conversation. We can consider the questions we want to pose to professionals and how we want to express these ideas. We can identify the staff members who genuinely appear to listen, care, and be knowledgeable about our loved ones’ situations and request their assistance for advocacy to the medical team if needed. We can let important people (staff, family, our loved ones) know our availability to discuss care and when we will be unavailable. We can listen to the opinions of our loved ones and do our best to advocate for them in the setting. We can choose to go home and sleep, knowing that a team of professionals is caring for our loved one. Yes, they may do it differently than we do at home; however, our loved one will be safe, and we will be a better family caregiver tomorrow after a night’s rest, shower, and meal. 

It is a new idea to many of us as caregivers that we are not required to be available to people at all times. As with many new ideas, it takes practice to break ourselves of this habit. It is imperative to begin to form healthy boundaries for ourselves that we are willing to enforce. As we begin to brainstorm about the areas in our life we want to change, we can notice what feelings come up for us. What stops us from setting a boundary and taking care of our own needs? Guilt, fear, and feeling responsible if something negative happens are common barriers for many of us. As we gain awareness of what prevents us from doing what is healthy, we can decide what boundaries are worth taking the leap to set for ourselves. The article “Maintaining Boundaries as a Caregiver” provides a brief introduction and offers suggestions on how to create and reinforce healthier boundaries (https://mhanational.org/maintaining-boundaries-caregiver-go-guilt-glow). 

Other ways to alleviate the stress is to take better care of ourselves physically and mentally. Follow basic tips, such as increase water intake, eat healthy meals (or at least pack some quick healthy snacks such as grab and go fruits, veggies, nuts), limit caffeine, and make a point to walk the hall every hour. These small habits help us maintain ourselves physically, mentally, and emotionally. Another way to care for ourselves is to locate resources for caregivers. There are many family caregivers who want and deserve support, and therapy is easier to access than ever before with telehealth platforms and in-person sessions as options. If you or a loved one would benefit from support, please reach out to WCPA to get connected to an experienced professional today. 

*This article is the final in a three-part series, which covers the issue of mental health stigma in healthcare. The first article (Spring 2023) focused on individuals with mental health issues as they navigate the medical system. The second (Fall 2023) was centered around the experiences of medical providers and staff in senior living communities. 

---

Psychological and Psychoeducational Testing Available

At WCPA, we offer a wide range of comprehensive psychological evaluations tailored to fit your individual needs. We serve children, adolescents, adults, and seniors. 

WCPA clinicians frequently provide evaluation for issues such as: mood and anxiety disorders, ADHD, Autism, specific learning disabilities including dyslexia, intellectual impairment, behavior disorders, and trauma. In addition, we provide clergy evaluations for those considering religious life, pre-adoption evaluations, and disability evaluations. 

Psychological evaluations typically involve a clinical interview, during which the clinician will obtain a thorough history and determine what type of testing is appropriate. The next step involves psychological testing, which may include cognitive, achievement, emotional, and/or personality testing depending on the presenting problem and referral question. After the evaluation, your clinician will prepare a report summarizing findings, diagnoses, and treatment recommendations, and will meet with you to provide feedback. 

If you would like to learn more about accessing evaluation services, contact the WCPA office at (314) 275-8599. 

In the WCPA fall newsletter, topics include online versus in-person therapy, the importance of fathers, mental health stigma, reflections from an educator, presentation topics available, and the three most common types of dementia.

• Online and In-Person Therapy, by Julia Osborne, MSW, LMSW
• From the Director, by Mary Fitzbibbons
• Treating Mental Health Stigma, by Amy Neu
• Reflections from an Education Leader, by Carol Hall-Whittier
• Professional Development topics available
• Dementia: The Top 3, by Brigid McGuire

---

To Zoom or Not to Zoom? That is the Question

Julia Osborne, MSW, LMSW

 Since 1959, with the introduction of videoconferencing to provide therapy, psychiatry, and medical student training at the Nebraska state hospital in Norfolk, telehealth care has had a place in the field of mental healthcare. Even though telehealth 

had become more widely utilized to allow service access to individuals with limited resources over the past few decades, the era of telehealth did not have its heyday until COVID. With increased awareness of mental health concerns and amplified need for mental health care during the pandemic, telehealth care became commonplace. Today, ads for virtual therapy appear everywhere, touting its many benefits not only as a mental healthcare service but additionally promoting it over in-person care, creating a contentious debate amongst therapists. 

Telehealth was originally envisioned to provide care to clients who would otherwise not have access to mental healthcare, i.e., people with reduced mobility or without care in their area. But now, teletherapy is competing with in-person therapy for well-resourced clients who simply may be averse to in-person therapy. Advertisements state that teletherapy is better than in-person therapy, because of zero travel time, increased location convenience, and reduced stigma with increased anonymity. Some teletherapy sites claim they are at a better price point than in-person therapists, though this is disputable. Some services even attempt to persuade potential clients to join their network because they make switching therapists easy and non-confrontational – clients never have to feel stuck with a therapist they do not like or admit to a therapist that they no longer want their services. 

Could teletherapy really be a better option? There is no question about the convenience of having a therapist able to meet with you anywhere you choose, though telehealth sessions often cost around the same as in-person therapy. It’s important to know that the ability to switch therapists is acceptable with in-person care too, as getting a therapist who you feel understands and will appropriately challenge you is important. Typical in-person clients often try several different therapists over their treatment time, before settling with one who is the right fit. Finally, the increase in perceived anonymity online is potentially more of an illusion than believed – other people in your space may hear you during your appointment. Most therapists providing telehealth services during the pandemic told stories of  clients sitting in their cars during sessions, as nowhere else offered any true privacy. 

With in-person therapy, the therapist gains insights into the client’s situation and idiosyncrasies at a faster rate, with the advantages of being able to observe body language and having fewer environmental distractions (for example, having the appointment while the client is driving, which is distracting and dangerous, or having other people or pets come into the room during the session). This benefit of in-person therapy is bolstered in Jaime Herndon’s Healthline article, Teletherapy 101: What You Should Know, in which she states, “The cues in teletherapy are different than cues from in-person therapy, since the therapist and client are interacting over the screen, and may take time to get used to.” 

Some therapists who have worked with clients virtually and in-person argue that the therapeutic alliance, a key player in treatment success, is stronger among clients who come in-person, because the benefits of reading body language go both ways. Clients can read a therapist’s body language for acceptance, intrigue, and comfort with what the client is expressing. According to the American Psychological Association, the therapeutic alliance promotes several benefits to the client, such as fostering mutuality and collaboration, allowing the therapist to be more flexible and responsive through client feedback, helping to repair therapeutic ruptures, and improvements in handling a client’s negative emotions. 

Further, there is an observable increase in client investment with in-person treatment – they have to commit to making time to come into the office. With the increased pace of therapeutic alliance development, clients are less likely to end treatment abruptly, which gives the therapist more opportunity to discover the many layers of the client’s issues and how to help the client resolve them. Additionally, in the article The Experience of In-Person Versus Online Therapy, by Joseph Rauch on Talkspace, the point is made that, “Traditional therapy sessions offer a physical space where there is nothing but dialogue on important mental health issues. This experience can feel like a respite from the stresses of work and relationships.” The client can really focus on themselves and their mental health over their environmental variables. 

If you do lack access to in-person therapy, for whatever reason, it is important for you and your online therapist to set some ground rules. For example, when therapy is in session, the session is all that you are doing. You are replicating the office conditions (without other people in the space or distractions like pets); you are not walking around or driving. And of course it’s vital that clients do not have other applications or websites open on their phone or computer that could interfere with focus on the session or the internet connection. Without ground rules, clients often feel less obligation to create a therapeutic atmosphere. This can be distracting to the client and therapist and impair their alliance or session quality. Moreover, when clients get repeatedly distracted by other people, pets, or objects around them that would not be there during in-person sessions, therapists spend a portion of the session time in efforts to refocus the conversation, leading to reduced treatment efficacy. 

As a side note, for people who think teletherapy is the better option because they believe in-person care will be anxiety-inducing, it is important to remember that anxiety flourishes with avoidance. The more we avoid, the more anxious we become. So teletherapy over in-person therapy may not be in your best interest. According to Hofmann and Hay (2019), “Avoidance is typically considered a maladaptive behavioral response to excessive fear and anxiety, leading to the maintenance of anxiety disorders. Exposure is a core element of cognitive-behavioral therapy for anxiety disorders.” They explain further that exposure is supported to be one of the best treatments for anxiety, therefore it bodes better for your anxiety about therapy to expose yourself to therapy in-person. 

All other points aside, it’s simply often easier to hide your true feelings during teletherapy than in-person therapy, which impedes the entire point of the therapeutic process. This is not to say that teletherapy is not a valuable resource; for those without access, teletherapy can be a great option. But for those with the means to do in-person therapy, it would be a valuable effort to try that first. 

---

From the Director

In our last newsletter, I wrote an article in regard to Attachment Figures in our lives. I explained the need for good nurturing being the bedrock of a child’s emotional and physical well-being. I wrote about the belief that for many of us, mother has generally been seen in that role. The good mother attunes to her child. She “gets” her child and understands his or her needs. The good mother also mirrors her child. The child sees in her expression the value that the child has. I went on to say that there are many other attachment figures in our lives, such as grandparents, aunts, uncles, teachers, even spouses. The one person that I did not mention was father. 

I received two e-mails after the newsletter came out – both with the same message. Why would I not have included fathers? When I read the first message, I thought how can that possibly be. Of course, I would have mentioned fathers. I went back to the article and realized she was right. I never specifically spoke of fathers. And then the second e-mail came with the same message. I wrote to both parties and apologized, certainly not meaning to have intentionally omitted fathers. 

The Evergreen Psychotherapy Center, an Attachment Treatment and Training Institute, put out an article on the importance of a father in a child’s life. It says that fathers are capable of the same motherly behaviors as women. The sight of their newborn triggers a similar range of loving behaviors, including protection, giving, and a responsiveness to the infant’s needs. In fact, the father’s confidence increases as he handles the child. As his parenting instincts emerge, so does his level of commitment. It was also found that the more actively involved a six-month-old had been with his father, the higher the baby scored on infant development scales. 

If I were to look at my own experiences with fathers and children, I have been fortunate to watch my sons and grandsons with their children. There is no question that these children know that they are cared for and loved by their fathers. My own more personal experience with my father also bears this out. My fondest memory of my father is my being a little girl. He is holding my hand and taking me on long walks. I also have the same memories of his taking my children on walks also. I cherish these memories. It was his time to be with us and I knew we were loved. 

I am again apologetic for initially omitting “fathers” from the original article, but I am also appreciative in that it called to mind how critical that relationship is in the emotional development of our children. Fathers play a very important role in children’s lives. They can be the deciding factor in a child’s eventual well-being. 

– Mary 

---

Treating Mental Health Stigma in Medical Settings*

Amy Neu, MSW, LCSW

“We have so many patients that need care, and I don’t think many of us have been trained to work with the mental health side. I got into this field to help older people, and I don’t feel like I really get to do that right now with everything we need to get done in a shift.” 

– Staff member at nursing facility 

There is enormous strain on professionals in medical and senior communities to accomplish numerous tasks and be fully present for their patients during a shift. Most workers were drawn to this field to help older adults and patients live with dignity, care, and compassion. It can be disheartening for many professionals when they experience the reality of working in these settings: the amount of paperwork, logistics, and coordination required by the system take time away from direct care with patients. Furthermore, staff see that residents’ needs are not merely physical, but mental, emotional, spiritual, and social as well. Over time, staff can feel increased pressure to meet each of these needs, all while working under time, staffing, financial, and training constraints. 

Accumulating stressors from the pandemic on the healthcare system have compounded the problem. A recent survey from the American Health Care Association found that 86% of nursing homes in the U.S. are experiencing moderate to severe staffing shortages, 96% of nursing homes are struggling to hire additional staff, and 78% have hired temporary agency staff to fill the gaps. Furthermore, over the past decade many medical systems have made financial cuts to departments such as social service and chaplaincy, who offer care for patients beyond their physical needs. While these services have been eliminated from the budget, the need for this care has certainly not reduced. Who, then, is left to address these needs for patients? 

In addition to staffing dilemmas, providers across medical settings find themselves increasingly limited to one piece of the healthcare puzzle. Researchers have found that there is often a lack of ownership for mental health care, leading to staff not seeing it as part of their job. It often feels like it is (or should be) someone else’s responsibility to manage mental health care symptoms. As a result, patients with mental health issues have poorer outcomes from surgery and medical procedures, as well as worse experiences of care than those without a mental health diagnosis. 

In a fractional medical system, it makes sense that providers feel the best thing for patients is to refer out to a specialist and distance themselves from patients who appear out of their scope. The consequences of this model, however, are that patients with mental health conditions feel as though they are falling through the cracks. Meanwhile, staff continue to feel unprepared, stuck, and out of their scope with a subset of patients in their communities. How can we begin to approach these obstacles? 

The first suggestion is to provide staff with more training on mental health topics. Without quality training, staff and residents are placed in difficult and potentially harmful situations. Often conscientious staff become fearful of doing or saying the wrong thing, which in turn leads them to distance themselves from residents with mental illness. This action alone can unintentionally foster an increased sense of mistrust, isolation, or fear in their residents (which can exacerbate symptoms like anxiety, paranoia, depression, or withdrawal) and negatively impact functioning. WCPA offers training and consultation programs to senior communities, and NAMI offers mental health first aid training for the general public which has also been a promising tool for staff in medical settings (https://namimissouri.org/resources/about-mental-illness/mental-health-first-aid). 

Another idea is to provide staff and leadership with ongoing consultation with local mental health clinicians. While it may seem ideal to outsource our residents’ mental health care to a psychiatrist or therapist alone, the reality is that humans are complex social beings. Therapy and psychiatry are incredibly beneficial and should be consulted whenever necessary. However, once residents return home from their appointments with these specialists, the staff in the senior community are their primary social contacts and caregivers. What staff says and does matters immensely, and these helping professionals deserve the space to discuss the challenges they experience and the opportunities to learn new ways of approaching residents with complex needs. 

Healthcare professionals are the backbone of our medical and senior care systems. They deserve more opportunities to learn and be supported as they serve patients with medical and mental health needs. Patients and residents also deserve to be understood, addressed, and properly cared for by compassionate staff. If your community would like more information on training and consultation, please feel free to reach out to WCPA to discuss how we can collaborate and help support your staff. 

* This article is the second in a three-part series, which covers the issue of mental health stigma in healthcare. The first article (Spring 2023) focused on individuals with mental health issues as they navigate the medical system. The final article will spotlight the experiences of family and loved ones who support an individual with physical and mental health issues. 

---

Reflection Diaries
A series of reflections written by a developing school leader

Carol Hall-Whittier, Ed.D.

Twenty-seven years ago, I embarked upon a path of leadership supported by prolific education practitioners, college professors, and school district leaders. I was tremendously fortunate to have influential educators in my life to mentor and teach me. As I look back on my professional growth, the first principle I learned as a developing school leader was the power of reflection and personal mastery. I am hoping that my reflections will impact and motivate today’s budding leaders to excellence and influence organizations to collaborative learning.