Pop Up Mental Health Clinics

Pop Up Mental Health Clinic
Pop Up Mental Health Care Clinics

A pop up mental health clinic? Never heard of it? Nor had I until recently when I read an article on how pharmacies are getting into the game of mental health care. Soon, it seems, we will all be able to roll up to our local pharmacy and not only pick up our prescriptions, but see a therapist on site as well.

As a therapist myself I wondered what does this mean for not only me as a provider, but also for the patient. Certainly the pandemic over this past year has taught all of us that access to mental health care is not only necessary for everyone, but also needs to be accessible with few barriers to receiving treatment. In terms of access, rolling up to your pharmacy and having access to a therapist on the spot feels like this need is being met.

However, I have my questions. Therapy is broad with many therapists offering a range of different types of care for many different types of symptoms and upset. From anxiety to depression to severe illness such as schizophrenia, therapists treat people suffering from all of these and much much more. Given this broad range of mental health ailments, most therapists specialize in an area. The specialization comes from study, their experiences, and their interests. When someone is looking for a therapist, they are often trying to find someone who matches what their needs are.

Walking into a pharmacy, I wonder how people will be matched up. Will it run like a crisis line where whomever walks in gets the next available therapist and the meeting is for the therapy hour (45 to 50 minutes) and then the person gets up and walks away and hopefully feels better with no charge or is it going to operate like a low fee clinic, charging a low fee, and patients have a choice of whom they see and have the option of returning and seeing the therapist on a regular basis?

I also wonder will pharmacies tie people to a therapist based on their prescriptions. Let’s say someone is picking up an anti-anxiety medication and the pharmacy staff not only gives the patients their script, but also the names of therapists in their clinic that they encourage you to see alongside taking your medication. The flip side of this is a therapist who sees someone for anxiety and then sends them to an in-house medical doctor who then prescribes anti-anxiety meds that get filled right at the counter. Convenient one-stop mental health help.

Those two points, i.e. that therapists seeing patients in such pop up mental health clinics, actually have the experience to support whom they are seeing in the pharmacy and that this is not just a grab to prescribe more meds to the public, are the places where I feel concern. This article does not disclose the details of these plans, just to say this fad is coming our way.

The article lists out questions that patients should hold in mind when they meet a therapist, but, truth be told, when people want to talk to somebody such questions often go out the window as their distress is so keen, it is difficult to hold in mind who is this therapist and do I feel comfortable with her? It is then on the therapist to hold on to their minds to decide if they can serve a potential patient or not. If a therapist does not think she can, does she have the ability to not take someone on? In community mental health, that choice is often not there for the clinicians, but will it be in corporate America?

Mental health is serious and corporate America is seeing it as its own power play and grab. Ethically one needs to safe guard themselves from a fast food approach to mental health care. Yes, something is better than nothing, but sometimes fast therapy does little to change anything.

As a practicing therapist in Capitol Hill, Seattle, I believe mental health care should be available to all, but in a responsible way. There are low-cost clinics and websites where Clinicians offer their services at a deep sliding scale. Finding this type of therapist for a long-term relationship feels important as the therapist can then track alongside you your progress, setbacks, and provide a containing space that is ongoing and built on trust. I believe in this type of approach for the work we do together.

Yet! I won’t be surprised to walk into a pharmacy next time and see a line of therapists waiting to see you and me.

Dear Therapist: Pandemic Nightmares

Pandemic Nightmares
Pandemic Nightmares Are Real!

Dear Therapist,

Ever since this pandemic took over our lives I have been unable to sleep well and, when I do find sleep, I also find nightmares. Seriously, they are disturbing! Is there any way to alleviate these terrifying dreams. It’s gotten to the point where I don’t even want to fall asleep as I am scared of where my dreams will go — death, violence, isolation — this type of imagery is rampant for me. How to get good sleep during this time?

Sincerely, A Terrified Dreamer

This is so common. First, the inability to even get to sleep these days. This happens for a lot of reasons, including not maintaining one’s regular sleep regime, too many screens on too close to trying to sleep, worries and uncertainty on one’s mind — all leading to the inability to let go into an unconscious state and sleep. Which is critical to feeling rested and restored, bright and energetic to greet the next day.

Some tips on getting to sleep during this time include:

  1. Maintain your normal sleep time — when you go to bed and when you get up
  2. Turn off your screen well in advance of bedtime
  3. A better activity is actually reading a real book or working on an old fashioned puzzle with a pencil – activities that can ground
  4. If you have many worries on your mind, writing them down before sleep. In this way they become externalized. You are free to pick those worries back up again the very next morning, but writing them down and letting them breathe for the night outside of you may be helpful
  5. Engage in a ritual that will relax you like a salt bath, gentle stretching or a meditation to calm one’s self.
  6. Direct your dreams! (And this will lead into your nightmares) If there is something on your mind that you want to know about or an answer to, write it down on a piece of paper. Also, as you close your eyes, have this question on your mind and repeat it to yourself again and again. Often, this type of exercise is calling to your internal world to respond with an answer that is not conscious.

I mention this last idea of dream direction to help with the nightmares you are experiencing. All of us are carrying anxiety, worry, and, some of us, even terror over what is unfolding in our daily lives. We speak to it in a myriad of ways while we are awake during the day, and we are also speaking to it in our dreams. Deep down in the places we are not aware of, we are holding these worries and frights and they come out to haunt us in our nightmares.

I hear how terrifying they can be and that they are happening on a continual basis to the point that you do not want to even go to sleep. Engaging in steps #4 and #6 that I have noted above may help you set aside consciously the concerns you are feeling terrorized about as well as direct your mind to focus on something more interesting to you.

It will take some work to actively employ these strategies, but it may very well worth it to find not only sleep, but dreams that answer something on your mind, rather than terrorize you with worries. This is not just you — so many around the globe are being terrorized by their pandemic nightmares — you are not alone. I encourage you to take the steps above to help you sleep through this time of uncertainty that plagues us all.

Dear Therapist: Celebrating Little Victories

Woman celebrates her little victories

Dear Therapist:

I know most people mark the big things in life, work promotions, graduations, anniversaries, birthdays, and more, but I am wondering if it is selfish to celebrate the little victories we may achieve on any given day? I don’t want to be seen as self-involved, but I also want to celebrate this stuff as I go along to mark what’s unfolding in my life.

Sincerely, One Moment Away From Celebrating the Little Victories

Glad you wrote in! It’s funny how down society is on noticing the little victories of our lives and celebrating them along the way. We somehow receive the message that life is not to be marked and celebrated, except for those very big milestones, i.e. marriage, having children, work promotions, a new home, an anniversary, a Birthday and, of course, the holidays.

Outside of those parameters, life is considered ordinary time. As adults, we are given the message that we must bear the ordinary days and be “OK” without anything special happening. If we are constantly celebrating, then how will there be anything special about the big moments. Rather, keep these to yourself and don’t make a big deal.

Sort of feels like these are our Puritanical roots. Head down, do good work, don’t cause any ripples – good, bad, or otherwise — and pass on calling any attention to yourself. I say a loud and strong, “No!” to this way of living.

I think any day one has good health — ie you wake up and are not in any type of pain — that is a victory day. Do you know how many people wish they woke up to a pain free physical life? We should celebrate at the start of each day when we are healthy.

All through our ordinary days, extraordinary people, events, and kindnesses unfold and they should be celebrated and noticed. In that same spirit, many small victories are won in a day that should be marked. Some of these could include:

  • Your child is toilet trained
  • The dog no longer chews the carpet and house to bits
  • You tried a new food and enjoyed it
  • You got a rebate
  • The service call you had to make had you waiting on hold for less than a minute
  • A beloved item is returned to you
  • A presentation you deliver packs a punch and people really appreciated it
  • You got to sleep with no problem
  • You found time to make dinner
  • A letter arrives with the news you’ve been waiting to hear

Goodness! Our little victories that we experience each day are not to be discounted, but celebrated. It may feel strange given the societal norms to not make such a big deal of any number of little things. Still, to get through the ordinary time, not only should you mark your own little victories, but others as well.

Let’s start a movement!

The Therapeutic Alliance

The therapeutic alliance is a key component to good therapy.
Therapy Offers a Chance for an Alliance!

When I was in graduate school, we were often taught about the “therapeutic alliance.” That feeling the therapist extends to a client to let them know we are aligned with them and their needs, desires, hopes, fears, and anything else he is bringing into the therapy room. I am struck by how clinician-focused this term is when therapists-in-training are taught about it in school.

Yes, the therapist must align and become an ally to one who is seeking therapy, but even more important is for the client to feel an alliance with his therapist. I believe school teaches practitioners that this will happen naturally for the client if we align ourselves with them and, yet, I feel that a client must gauge for themselves if someone if therapeutically attuning to him.

How can you even know if a therapist is forming an alliance with you? And what if the therapist is doing all the right things, but it just doesn’t feel right to you?

Aha! Those are the important questions to keep in mind when creating a new relationship with a therapist. We have been taught how to form an alliance with you, but I don’t think there is much thought given to educating the public who seek therapy regarding whether someone is a good fit or not for you.

My number one suggestion to you is to gain an intuitive sense about what you are looking for in a clinician. Do you want someone direct or perhaps indirect? Do you want someone to stay silent or do you really need to have the person responding to you throughout the session? Are you interested in learning new coping skills or are you there to take a deep dive into old patterns? Depending on your answers to these types of questions, you can observe if the therapist sitting in front of you is going to form an alliance that is supportive of you and your unique self.

There is no one therapist who can meet everyone’s needs and desires. That is not even the point. As much as you the client are unique, so too are the therapists. We have been taught a particular set of skills to align with you, but it is general and not specific to any one person. The magic is when you find a therapist who does align with what you need and who you are that can make the work be wholly attuned to you.

And what if we are doing everything that seems like we are a good match and alliance for you, but you are still not feeling it? It’s completely OK to be honest about it not being the right match for you. We are always trying our best to match and align with you, and we also know it doesn’t always happen. Find your voice and say as much.

The therapeutic alliance is a must and is a golden space when we align from both sides — the Clinician and Client sides.