Journey

This article originally appeared in Macaroni Kid on July 1, 2021, by Lindsay McKeen, LCSW, CCS, Outpatient Therapy Supervisor, Health Affiliates Maine. 

Question: My husband and I divorced last year and while initially our daughter (11) was adjusting well to the big change in her life, she seems to be struggling more and more. We want to find a counselor for her to talk with. I’m wondering if you can suggest what types of questions are good ones to ask when trying to find the right counselor? My ex and I want to be sure it’s a good fit. Thank you so much.

Answer: It can be difficult to take that first step in getting yourself or a loved one into counseling, and even more so when you are navigating a new family dynamic and trying to find that support for your child. It is important that you and your ex-husband are on the same page here. In sharing this awareness of her needs and interest in finding a counselor that is a good fit for her, you are off to a good start.

Before looking at what to ask of the counselor, it is important to be sure the right questions have been asked within the family. While your child may not be hands-on in the search for a counselor, it will end up being her service and provider and so including her voice early on may help enhance her connection and engagement. What is her understanding of counseling? Is she agreeable to seeing a counselor? Are there any questions she would like answered before seeing the counselor? Does she have any questions for you? While parents are the decision makers, children value being heard and having a sense of control where appropriate. Giving her this voice before starting the counseling relationship can set a good tone for creating a trusting environment where she feels she can be open about the struggles she has been having.

Then, when it comes time to ask questions of the potential counselor, it may also be helpful to ensure you and your ex-husband have similar definitions of what a “good fit” would look like. You may have already had this dialogue, or you might try answering the questions below with one another to see if your definitions align. Many counselors also have online profiles and viewing these together could be another way to get a sense for what you both are looking for in a counselor for your daughter. Here are some topics and questions to consider when looking for a counselor:

Experience: While it is possible for counselors to work with people of all ages, many counselors find their niche in working with certain client populations. This niche may be developed around age group, diagnoses or presenting concerns, and/or specialized treatment approaches. Asking about the counselor’s experience may help you feel more comfortable with their ability to support your daughter with her needs.

  • Does the counselor have experience working with children or your child’s particular age group?
  • Does the counselor have experience working with families, especially those navigating divorce?
  • What is the counselor’s therapeutic modality or approach to working with children?

If you have spiritual beliefs or other cultural considerations you would like considered by the counselor:

  • What is the counselor’s understanding of that belief/culture?
  • How does the counselor manage differences in beliefs/culture and/or how does the counselor understand the ways in which the belief/culture may impact a child’s mental health care?

Potential Scenarios: In learning about the counselor’s experience and approach in therapy, you may get a sense for how the clinician will interact with the child and family, or you may want to ask more questions to get a better understanding. You might try thinking ahead to potential scenarios that might arise using the questions below:

  • How will the counselor navigate confidentiality and privacy for the child in relation to parental involvement?
  • How will the counselor handle concerns that they themselves or the parent(s) have identified?
  • How does the counselor foresee handling differences in opinion that may arise between parent(s), child, and/or counselor?

Logistics: Though the counselor’s experience and approach are likely most influential in selecting the right provider, the logistics are important too. Having discussions about the logistics upfront can help clarify expectations of both parties and minimize disruptions to the counseling relationship once it has begun.

  • Does the counselor provide in-person or telehealth-based services?
  • Does the counselor have the availability to offer a standing appointment? Or is their scheduling flexible/varying depending on the week?
  • Does the counselor have any policies in place around attendance or payment?

  • What are the counselor’s practices for communicating information to parents?
  • Are there expectations for parental involvement?
  • What is the best way to communicate with the counselor?


Though this article presents many questions and considerations for finding the right counselor, know that this is not all-inclusive. Having conversations with your ex-husband and child may expand or narrow this list to what feels most relevant to her needs. Most important in this process is open communication, with one another and the counselor, keeping in mind that the common goal is to support your child, and that the search can continue if you find yourselves feeling like the counselor is not a good fit.

 

Lindsey McKeen, LCSW, CCS is a clinical social worker and Outpatient Therapy Supervisor at Health Affiliates Maine.

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Mental health can and should be a daily practice, taken into consideration more often than “when something is wrong” or when going through a particularly difficult time. Taking care of your mental health is a preventative form of care and by incorporating daily rituals and practices into your life, you can give your mental health the attention it deserves.

Here are nine things you can do to take care of yourself so you can take care of others:

Take a mental health day. You know yourself best. If you feel that you need a break, take one. If you don’t have vacation or paid time off, consider taking mini breaks throughout the day to renew your energy and spirit. It’s okay to slow down and not feel rushed to cross everything off the to-do list at once.

Switch up your evening routine. Try winding down in a different way than you typically do if you’re feeling particularly stressed or “off.” Think about what relaxes you and adopt that into your routine: reading a book, taking a long bath, chatting with a friend.

Adopt a vacation mentality. Put your phone setting on do not disturb between 9pm-7am. Go swimming instead of sweating at the gym. Walk in the park with a friend during lunch. Ignore emails after you’ve clocked out for the day/week. Whatever you do on vacation that feels relaxing and rejuvenating, try bringing some of that into your daily life.

Meditate for five minutes every day. Perhaps you’ve heard this advice before, but the science doesn’t lie! Meditation eases stress and anxiety, calms your nervous system, helps with memory and so much more. There’s no need to put pressure on yourself to gain some important insight or enlightenment. Sit quietly, focused on your breathing with no judgment of the thoughts in your head. With regular practice, you’ll begin to feel the benefits.

Be mindful of what you eat and drink. It’s a common coping mechanism to comfort our emotions with food, drink or other substances. We all have different nutritional and lifestyle choices, but we suggest being extra mindful when experiencing stress, anxiety or depression as sugar, junk foods and alcohol will make you feel worse (even if you feel better temporarily).

Consider reaching out for professional help. There is no barometer, specific feeling or event that warrants a person to “need” or want professional counseling. We all have varying life circumstances and coping strategies. If you feel like you “shouldn’t be this upset” or that “others have it worse” we suggest allowing yourself permission to seek help. We all deserve it.

Prioritize rest. Our culture values the “hustle” and though hustle has it’s time and place, we also need rest. You know your body and mind best—if you need a morning off work, take it. If you need a long weekend alone, take it. If you need to sleep in just a little bit longer, sleep in! The to-do list is not going anywhere and you’ll need your physical and emotional health in top shape to do your best.

Write down as many inspiring messages as you can. They can be lyrics, affirmations, reminders to move your body, drink water, have gratitude—any message that uplifts you. Keep them close by, such as in a desk drawer, a large jar or your phone’s notebook app. If you need a pick-me-up, reach for one. Alternatively, download an app that sends positive affirmations to your phone daily. It’s proven that we bring to life the thoughts that we tell ourselves (even unconsciously), so let yourself think positive thoughts!

When we feel that we are in control of our thoughts, feelings and emotions we’re bound to continue the work that allows us to feel that way. However, if you think you may need professional help, reach out. Everyone needs help at some point in life. It takes courage and strength to recognize when help is needed and seek it out.

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If you are asking this question, you are probably not alone. In fact, 18 million Americans struggle with misusing alcohol or with the symptoms of Alcohol Use Disorders (AUD). If you feel as though your relationship with alcohol is a problem or could become a problem, it is important to know that you are not alone. There are resources that can provide help and guide you through a recovery journey. Arming yourself with information is a good first step.

What is Alcohol Use Disorder (alcohol addiction)?

There are hereditary and environmental factors to addiction, but many times the cause is not known. The following are some of the symptoms that characterize AUD.

The individual:

  • drinks more or longer than they initially intended to
  • has tried to moderate or stop drinking in the past, but has been unable to
  • spends a lot of time drinking or recovering from the effects of drinking
  • experiences cravings, or strong desires to drink
  • drinks even though it interferes with home, family, work, or school responsibilities
  • drinks even though it causes trouble in their personal life
  • gives up activities or obligations that were once important, in order to drink
  • gets into situations while drinking that may be risky or cause harm
  • continues to drink even if it causes depression, anxiety, or other health problems
  • has to drink more to produce the desired effects
  • has withdrawal symptoms when not drinking

NOTE: According to the DSM-5 Diagnostic and Statistical Manual for Mental Disorders, showing two-three of these symptoms in the last year may indicate a mild alcohol use disorder, while showing four-five symptoms indicates a moderate AUD. Displaying six or more symptoms signifies a severe alcohol use disorder.

Who is at risk for alcohol use disorders?

Drinking alcohol in moderation can be okay for some people. This means that while they may feel the effects of alcohol consumption, they do not feel compelled to keep drinking. Moderate drinking is classified as no more than one or two drinks per day for men and women.

Using alcohol when bored, stressed, lonely, depressed, or if there is a genetic predisposition to addiction (family members with AUD), can lead to further serious problems. If you or someone you care about is drinking to get through the day, it may be time to reach out for help.

How does alcohol affect physical health?

Like any substance consumed in excess, there will likely be side effects. Alcohol may also interact negatively with prescription medications and make it difficult to diagnose other health concerns.

When drinking to excess there can be problems with:

  • Alcohol poisoning
  • Sexual dysfunction
  • Reduced inhibitions or risky behaviors
  • Inability to focus, impaired memory
  • Affected vision, reflexes, and coordination

Long-term effects of active addiction:

  • Impaired learning and/or brain development
  • Increased depression and anxiety
  • Major organ damage; increased risk for heart disease
  • Cirrhosis (chronic liver disease)
  • Cancer

How does alcohol affect mental health?

Alcohol is a depressant. Therefore, it slows down your brain and alters its chemistry. There are many effects including changes to mood, energy levels, memory, concentration, and sleep patterns.

Alcohol may also impact decision making. While drinking, a person may “do things without thinking” or say or do things they would not do or say while sober such as pushing away or hurting the people who care most about them. It can give a person courage to engage in risky situations like unsafe sexual encounters, trouble with law enforcement or getting into fights. Alcohol can contribute to life falling apart, causing withdrawal from important relationships and social situations, and even self-harm. A combination of factors along with intoxication has led to many dying by suicide.

Where do I go for help with AUD?

Talk with your primary care practitioner. There are multiple treatment options ranging from hospitalization for detox if needed, to outpatient therapy with a counselor or group, to rehabilitation or participation in an intensive outpatient program (IOP). There is also residential treatment. There are even medications that can provide support for building a sober life.

Lastly, there are many recovery communities like AA, Smart Recovery, and Women for Sobriety that provide support and assistance in learning how to live a healthy, sober life.

sources: healthline.com, headspace.org, recoverycentersofamerica.com, cdc.org, apibhs.com

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Bipolar disorder is thought to be a rare condition consisting of “mood swings” but it’s much more common and complex than that. Bipolar disorder affects 60 million people worldwide and approximately 5.7 million Americans. Of these, an estimated 51% will go untreated or misdiagnosed.

Bipolar disorder, sometimes known as manic-depressive illness or manic depression, is a mental disorder that causes an unusual shift in mood, energy, activity level, concentration, judgement, or ability to perform day-to-day tasks. The “unusual” shifts refer to uncharacteristic changes in an individual lasting days or weeks. This is known as an “episode.” A manic episode is an emotional “high,” while a depressive episode is an emotional “low.”

Manic and hypomanic episodes include three or more of the following signs:

  • Unusually upbeat, jumpy, or wired; increased activity, energy
  • Exaggerated sense of well-being or self-confidence
  • Distractibility, racing thoughts
  • Decreased need for sleep
  • Unusual talkativeness
  • Poor decision making such as excessive shopping, risky sexual behavior, etc.

Depressive episodes include five or more of the following signs:

  • Depressed mood; sad, empty, hopeless, irritable feelings
  • Insomnia or sleeping too much
  • Fatigue/loss of energy
  • Restlessness or slowed actions
  • Apathy
  • Abrupt change in weight and/or appetite
  • Decreased ability to think/concentrate
  • Feelings of worthlessness or excessive guilt
  • Thinking about or attempting suicide

Those with bipolar disorder may not recognize the changes in their behavior. Some may also enjoy the feelings of euphoria that accompany a manic episode, but an emotional crash will always follow. The signs described above are not normal or typical of young children, adolescents or adults, and should be taken seriously.

There are three different types of bipolar disorder diagnoses:

Bipolar I Disorder: Manic episodes lasting at least 7 days or manic episodes so severe that immediate hospitalization is required and depressive episodes lasting at least two weeks. Mixed features may be possible (manic and depressive episodes occurring simultaneously). Bipolar I disorder is the most severe.

Bipolar II Disorder: A pattern of depressive and hypomanic episodes (less severe mania) that last for longer periods but are less severe than bipolar I disorder.

Cyclothymia: Periods of hypomanic and depressive symptoms lasting at least 2 years. Symptoms are less severe than Bipolar I and II disorders and individuals are usually able to function in their daily life.

Bipolar disorder is commonly misdiagnosed, the main reason being that those with the disorder may also have a co-occurring disorder. These can include anxiety disorder, attention-deficit/hyperactivity disorder, substance use disorder, eating disorders, or other mental health disorders. A mental health professional will diagnose bipolar disorder by observing signs and symptoms, life experiences of the individual, and the family health history of the individual. A diagnosis typically occurs in late adolescence with the average age being 25, but those in their later adult years can also be diagnosed.

It’s important that those with bipolar disorder or those with undiagnosed symptoms to attain treatment. If left untreated, an individual’s manic and depressive episodes will not improve. Additionally, they may be at risk for drug and alcohol abuse, legal or financial troubles, impaired performance at work and school, difficulty maintaining relationships and suicide attempts. In fact, 30% of individuals diagnosed with bipolar disorder will attempt suicide at least once in their life. A diagnosis and ongoing treatment are vital.

Individuals with bipolar disorder are at higher risk of thyroid disease, migraine headaches, heart disease, diabetes and more. Treatment is highly individualized, especially when it comes to correct medication, often an antipsychotic and/or anti-depressant. Primary care visits are also important in ongoing treatment.

Treatment can include psychotherapy sessions (talk therapy) and medication taken consistently, regular exercise that benefits brain and heart health, sticking to daily routines, avoiding misuse of substances, as well as journaling for symptom tracking are recommended. Individuals with bipolar disorder can lead wonderfully healthy, functioning lives with the assistance of lifelong treatment.

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Are you feeling busy, distracted and exhausted? Even after the emotionally overwhelming year we’ve all just experienced, we haven’t slowed down and taken time for ourselves. Further, our society doesn’t value the practice of introspection, the observation of one’s own mental and emotional processes. Introspection, or self-reflection, is the willingness to recognize and determine your “old programming” that no longer serves you so that you can build new “programming.” How this can be done? With a calm mind to start.

How do I calm my mind?
Having a calm mind will allow you to concentrate and feel more relaxed. This practice will vary person to person, but here are some suggestions:

  • Take a few deep breaths; practice breath work
  • Stretch your body
  • Go for a walk; move your body
  • Journal, meditate, pray

How do I practice self-reflection?
When your mind is calm, allow yourself to draw inward and think deeply on the issue, emotion or memory at hand. To help, ask yourself:

  • What does this make me think?
  • How does it make me feel?
  • How does it hold me back?

It’s important not to judge yourself. Be honest with yourself so that you’re not tempted to imagine how you should feel. Don’t be afraid to dig deeper! You’re trying to access the root of the issue and you will most likely come across resistance. This is your ego/mind trying to protect you from uncomfortable and harmful emotions.

Additionally, you can ask yourself questions in order to get to know yourself better whether or not you’re currently working through an issue. Start with these:

  • What am I really scared of?
  • Am I holding on to something that I can let go of?
  • When did I last push passed my comfort zone?
  • What do I want most in life?
  • When was the last time I made someone smile?

Why should I practice self-reflection?
With self-reflection comes self-awareness. You’ll begin to see your thoughts, behaviors, emotions and reactions in real time as you experience them. You can determine which ones bother you, don’t serve you or harm you and learn to let them go. By slowing down, calming your mind, and asking yourself substantial questions to draw on old issues, you can then learn to shift your behaviors, thoughts and reactions to ones that better represent you, your values and beliefs.

The more you reflect, the easier you’ll be able to hold yourself accountable. This not only benefits you directly, but it also benefits those you surround yourself with. You may even inspire them to be more introspective!

What are benefits to introspection?
A self-aware person can expect myriad of benefits, but here are some that may be true for you:

  • Clarity
  • Self-control
  • Less stress and anxiety
  • Higher self-esteem and pride
  • Increased emotional intelligence
  • Easier time coping with challenges
  • Appropriate reactions to situations
  • Realize their potential and become more aligned

Remember, slowing down, calming your mind and regular self-reflection may come with resistance­­­­ from your mind, your family, even your job. Stay strong­­–this time is essential for your mental health. It’s okay to start small and always be gracious and patient with yourself. You’re in the process of changing how you think, feel, and behave. You’re changing your life!

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