#JunkieLivesDontMatter

A person who struggles with a substance use disorder is choosing that life. Why interfere? (Especially when all that money could be spent saving more DESERVING lives.) “Junkies” don’t deserve second chances because #JunkieLivesDontMatter

By Cassie Jewell, M.Ed., LPC, LSATP

Disclaimer: If you happen to believe that addiction is a choice – “They’d quit if they really wanted to” or “They made the choice to use; they made the choice to die” – then scroll on to the next blog. You’d only scoff at this post because #JunkieLivesDontMatter

This blog post is inspired, in part, by a Facebook meme.

The meme said,

“So if a kid has an allergic reaction the parents have to pay a ridiculous price for an Epi pen. But a junkie who has OD’d for their 15th time gets Narcan for free? What a screwed up world we live in.”

Implications: “Junkies” don’t deserve a second chance at life. They’re a waste of resources because they lack the willpower to stop using. A person who struggles with a substance use disorder is choosing that life. Why interfere? (Especially when all that money could be spent saving more deserving lives.)

If you believe it’s screwed up for a “junkie” to have a chance at life (and recovery) because they “chose addiction,” your opinion is contrary to the National Institute of Health, the American Medical Association, the American Psychiatric Association, and decades of scientific research. You’re either ignorant (maybe willfully so) or impressively arrogant. (Alternately, you could just be a jerk.) You’re a part of the movement: #JunkieLivesDontMatter

Many have joined the movement, as evidenced by the following Facebook posts:

“Out of all of the houses, 2 hobos decided to overdose on my front steps… thank god the medics got here in time to ensure they could die another day…”

“I think we had less ODs before Narcan came on board. They realize they can be saved if gotten to in time. Maybe they need to be locked up & not let out until they attend rehab while in jail.”

“If it can be easily established that they have a recent history of drug [abuse]… then yes… withhold the lifesaving drug because they chose this. It’s harsh, but justice is not served by saving them.”

“If you don’t have it figured [out] by the 3rd overdose, you are just prolonging the inevitable and wasting tax payers money.”

“If we are repeatedly saving your life and you are not willing to change this behavior, why should we be obligated to keep saving you?”

“My personal opinion is we can’t keep letting people overdose and saving them just so they can repeat the cycle.”

“By continuously administering Narcan, sure, we’re saving their life, but are they really living? I don’t think so.”

#JunkieLivesDontMatter

“No CPR for You, Fatty — You Chose Soda and Fast Food… Now Suffer the Consequences!”

According the the American Psychiatric Association,

Addiction is a complex condition, a brain disease that is manifested by compulsive substance use despite harmful consequence. People with addiction (severe substance use disorder) have an intense focus on using a certain substance(s), such as alcohol or drugs, to the point that it takes over their life. They keep using alcohol or a drug even when they know it will cause problems.

Addiction is a scientifically proven brain disease. Despite this, many persist in the belief that it’s a choice, or worse… a moral failing. (Note: This notion comes from an early model of addiction, “the moral model,” which was deeply rooted in religion. Addiction was attributed to a sinful nature and weakness of character. Therefore, the addict must repent… or suffer the consequences of his/her actions; addiction warranted punishment, not empathy. Unsurprisingly, this created stigma. It also prevented those struggling with addiction from seeking treatment. Centuries later, many hold on to the view that an individual suffering from a substance use disorder is lazy or weak.)

Today, in the midst of the opioid epidemic, stigma’s unrelenting grip perseveres. Stigma is a poison; it’s dehumanizing. It’s easy to forget a person is a person when you view them as garbage, trash… a “junkie.” Stigma tells us, “Take out the trash.”

To fully recognize stigma’s impact, compare addiction to other diseases. Consider common medical emergencies; many are related to lifestyle. Imagine being hospitalized after your third stroke, and the doctor telling you, “This is the third time I’ve saved your life, yet you refuse to exercise. I shouldn’t be obligated to continue to provide life-saving care.” Or, imagine a long-time smoker who develops lung cancer; they’re not demeaned, called names, or denied treatment. Moreover, an EMS worker wouldn’t withhold CPR from an individual in cardiac arrest if they were obese. It’s not a debate.

If You’re Dead, You Have a 0% Chance of Recovery

We’re in the midst of an epidemic.

According to the CDC, 115 Americans die from an opioid overdose every day.

In 2016, over 42,000 individuals died from opioid overdose.

Life expectancy in America is actually declining due to an increase in fatal overdoses.

Narcan does not enable addiction. It enables life. (A dead addict can’t recover.)

#Recovery #Empathy #FightStigma #EndTheEpedemic #SaveALife


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Mental Health, Wellness, & Personal Development Blogs to Follow

(Updated 4/9/19) A list of 30+ mental health, wellness, and personal development blogs

Compiled by Cassie Jewell, M.Ed., LPC, LSATP

Creating Mind ReMake Project opened my eyes to a whole world of blogs! There are tons of informative and thought-provoking sites out there that share my “niche.” This post lists a variety of blogs related to mental health, wellness, and personal development.

  1. ACA Counseling Corner Blog

“Thoughtful ideas, suggestions, and strategies for helping you to live a happier and healthier life”

  1. Aim Hypnotherapy Blog

Therapist and blogger Aigin Larki blogs about anxiety, addiction, stress, and other mental health topics

  1. Anxiety Free World

A blog about coping with anxiety

  1. Beyond Meds

Award-winning blog written by ex-patient and mental health professional, Monica Cassani, on topics related to psychotropic meds and mental health

  1. Blue Light Blue

Amy McDowell Marlow, a 22-year survivor of suicide loss who lives with mental illness (bipolar disorder, post-traumatic stress disorder, and generalized anxiety disorder), blogs about living with mental illness

  1. Brave Over Perfect

Dr. Christine Carter and Susie Rinehart write about personal growth topics

  1. Brené Brown Blog

Personal growth and development blog

  1. David’s Blog

Dr. David Healy is a psychiatrist, psychopharmacologist, scientist, and author who blogs about pharmacology and mental health

  1. Dr. David Susman Blog

A clinical psychologist, mental health advocate, professor, and writer shares resources and inspiration for better mental health

  1. Dr. Melissa Welby Blog

Psychiatry and well-being 

  1. Dr. Sarah Ravin Blog

A clinical psychologist blogs about psychological issues and evidence-based treatments

  1. Fairfax-Falls Church Community Services Board News

If you live in Fairfax County, VA, sign up for CSB news to receive updates and links to helpful resources

  1. The Fractured Light

Living with borderline personality disorder

  1. Gardening Love

A unique wellness and lifestyle blog about enhancing mental health and well-being through gardening

  1. Healthy Place Blogs

A collection of mental health blogs

  1. Heather LeGuilloux Blog

A therapist blogs about mental health topics

  1. Info Counselling – Evidence based therapy techniques

Learn about the latest evidence-based treatments and download free therapy worksheets

  1. Kim’s Counseling Corner

Kim Peterson, a licensed professional counselor, created Kim’s Counseling Corner, a site with a variety of free downloadable resources for clinicians

  1. Love and Life Toolbox

Award-winning blog founded by Lisa Brookes Kift, marriage and family therapist, about marriages, relationships, and emotional health

  1. Mindcology

Mental health and self-help posts written by psychologists, counselors, and other mental health practitioners

  1. The Mighty

“A digital health community created to empower and connect people facing health challenges and disabilities”

  1. Momentus Institute Blog

A blog dedicated to building and repairing the social emotional health of children

  1. MQ Blog

A blog about transforming mental health care through research

  1. My Brain’s Not Broken

Living with mental illness

  1. NAMI Blog

Advocacy blog

  1. On Being Patient

Personal accounts of living with mental illness

  1. Our Parent Place

A place for parents with mental illness to connect and learn 

  1. PsychCentral Mental Health and Psychology Blogs

Blog posts by experts, professionals, and ordinary people who share their insights on a variety of mental health topics

  1. Psychology Today Blogs

A large collection of blogs on psychology-related topics, including creativity, intelligence, memory, parenting, and more

  1. SAMHSA Blog

“A place where up-to-date information including articles from SAMHSA staff, announcements of new programs, links to reports, grant opportunities, and ways to connect to other resources are located”

  1. A Splintered Mind

Douglas Scootey blogs about “overcoming ADHD and depression with lots of humor and attitude”

  1. Survival Is a Talent

“A digital platform for individuals to share their Stories of Survival relating to health and wellness”

  1. Thriving While Disabled

A blog about living with a disability

  1. Your Brain Health 

Dr. Sarah McKay, neuroscientist and blogger, writes about topics related to neurology and mental health


Also consider:

Janaburson’s Blog

A blog created to help people better understand the medication-assisted treatment of opioid addiction using either buprenorphine (Suboxone) or methadone from a physician, board-certified in Internal Medicine and Addiction Medicine

Pete Earley

Advocacy blog for mental health reform


Know of a great blog? Post in a comment!

Free Online Assessment & Screening Tools for Mental Health

(Updated 5/4/20) A list of sites with a variety of assessment tools for mental health and related issues, including mood disorders, relationship attachment styles, suicide risk, communication skills, and domestic violence. This list includes both self-assessments and screening tools for clinicians to administer and score.

Compiled by Cassie Jewell, M.Ed., LPC, LSATP

The following list will link you to a variety of mental health assessments and screenings for clinicians or for self-assessment. While an assessment cannot take the place of a clinical diagnosis, it can give you a better idea if what you’re experiencing is “normal.” (For additional screening tools to use with couples, see Marriage & Relationship Assessment Tools.)

Free Online Assessment & Screening Tools for Mental Health

The 5 Love Languages | A PDF assessment

20 Questions: Are You a Compulsive Gambler? | A short interactive self-assessment  

20 Question Self-Assessment for Healthy Boundaries | Downloadable PDF assessment created by Dr. Jane Bolton, scoring instructions not included

ACE Questionnaire | Adverse childhood experiences (ACEs) are associated with a variety of health (both physical and mental) conditions in adults. To find your ACE score, take an interactive quiz. Learn more about ACEs on the CDC’s violence prevention webpage. You can also download the international version (PDF) from the World Health Organization’s Violence and Injury Prevention webpage.

ADAA Screening Tools | The Anxiety and Depression Association of America provides links to both printable and interactive tests for depression, generalized anxiety disorder, OCD, panic disorder, PTSD, social anxiety disorder, and specific phobias. This site does not provide test results. (It’s recommended that you print your results to discuss with a mental health practitioner.) This is an excellent resource for clinicians to print and administer to clients.  

The Addiction Severity Index (ASI) – 5th Edition | PDF version, scoring instructions not included

Adult ADHD Assessment Tools | Links to a PDF toolkit for clinicians. Includes Adult ADHD Self-Report Scale-V.1.1. (ASRS-V1.1) Symptom Checklist,  Adult ADHD Self-Report Scale-V1.1. (ASRS-V1.1) Screener (English), Adult ADHD Self-Report Scale-V1.1. (ASRS-V1.1) Screener (Spanish),  Barkley’s Quick-Check for Adult ADHD Diagnosis (Sample),  Brief Semi-Structured Interview for ADHD in Adults,  Weiss Functional Impairment Rating Scale Self-Report (WFIRS-S), ADHD Medication Side Effects Checklist, Medication Response Form, Hamilton Anxiety Rating Scale (HAM-A), Hamilton Depression Rating Scale (HDRS), and CAGE Questionnaire Adapted to Include Drugs

AlcoholScreening.org | An interactive test that gives personalized results based on age, gender, and drinking patterns

Assessment Instruments Developed at the Center for Trauma and the Community | Access the Trauma History Questionnaire and the Stressful Life Events Screening Questionnaire

The Attachment Style Assessment | Interactive assessment; you must submit your email to see your results

Attachment Styles and Close Relationships | Interactive surveys to determine attachment style

Behavioral Activation for Depression Scale | PDF assessment with scoring instructions

Berkeley Personality Lab Measures

Borderline Symptom List and Scoring Instructions | (Source: University of Washington Center for Behavioral Technology) Citations: Bohus M., Limberger, M. F., Frank, U., Chapman, A. L., Kuhler, T., Stieglitz, R. D. (2007). Psychometric Properties of the Borderline Symptom List (BSL). Psychopahology, 40, 126-132.

The Brief Fear of Negative Evaluation Scale (BFNE) | A one-page PDF that can be completed online or printed, scoring instructions not included

Buss Lab Research Instruments | Assessments on friendship, sex, jealousy, etc.

Career Assessments | Self-assessments to assess interests, skills, and work values

Child and Adolescent Instruments (Bipolar Spectrum Services: University of Pittsburgh) | Assessments for mania, depression, and mood

The Clinical Anger Scale (CAS) | A PDF scale to measure anger; scoring instructions are not included

Clutter Image Rating | A PDF interactive test to assess for hoarding disorder

Columbia-Suicide Severity Rating Scale | A PDF version of the scale

Communication Research Measures | A collection of assessments

Communications Style Questionnaire | Determine if you’re an activist, a pragmatist, a theorist, or a reflector (PDF with scoring instructions)

The COPE Inventory | A PDF scale to assess the different ways people respond to stress

The Couples Satisfaction Index (CSI) | A PDF assessment to measure relationship satisfaction

CSDS DP Infant-Toddler Checklist | A PDF printable checklist for identifying early warning signs of autism

The Decision Making Individual Differences Inventory

Demographic Data Scale | (Source: University of Washington Center for Behavioral Technology) A self-report questionnaire used to gather extensive demographic information from the client. Citations: Linehan, M. M. (1982). Demographic Data Schedule (DDS). University of Washington, Seattle, WA, Unpublished work.

Depression Self-Assessment | A simple self-assessment tool from Kaiser. Results are provided on a spectrum, ranging from “None” to “Severe” depression.

Diane Poole Heller’s Attachment Styles Test | Interactive assessment; you must submit your email to see your score

Diary Cards NIMH S-DBT Diary Card NIDA Diary Card CARES Diary Card | (Source: University of Washington Center for Behavioral Technology)

Domestic Violence Screening Quiz (from PsychCentral) | Interactive test to determine if you’re involved in a dangerous abusive relationship

DrugScreening.org | An interactive test that provides feedback about the likely risks of your drug use and where to find more information, evaluation, and help

Danger Assessment Screening Tool | Clinicians can download this PDF version of the assessment, which helps predict the level of danger in an abusive relationship; this screening tool was developed to predict violence and homicide.

DBSA Mental Health Screening Center | The Depression and Bipolar Support Alliance offers screening tools for both children and adults (including versions for parents to answers questions about their child’s symptoms). Take an online assessment for depression, mania, and/or anxiety.

DBT-WCCL Scale and Scoring | (Source: University of Washington Center for Behavioral Technology) Citations: Neacsiu, A. D., Rizvi, S. L., Vitaliano, P. P., Lynch, T. R., & Linehan, M. M. (2010). The Dialectical Behavior Therapy Ways of Coping Checklist (DBT-WCCL).: Development and Psychometric Properties. Journal of Clinical Psychology, 66(61), 1-20.

Deliberate Self-Harm Inventory | Measurement of deliberate self-harm (PDF)

The Drinker’s Checkup | Interactive screening tool

Drinking Patterns Questionnaire | A 28-page PDF assessment, can be completed online or printed. No scoring instructions, find more information here

Drug Abuse Screening Test DAST-10 | For clinician use, a PDF version of the DAST-10 – does not give results or scoring instructions

EAP Lifestyle Management Self-Assessments | A small collection of screening tools

Emotional Regulation Questionnaire (ERQ) | A short PDF scale to assess emotional regulation

Family Accommodation Scale – Anxiety | Family Accommodation Scale – Anxiety (Child Report) | PDF scales, scoring instructions not included

Financial Well-Being Questionnaire | Take this 10-question interactive test and receive a score (along with helpful financial tips)

The Gottman Relationship Checkup Sign up for a free account to access the online interactive assessment

Grief and Loss Quiz (from PsychCentral) | Take this test to learn if you may be suffering from complicated grief

Grit Scale | Several versions available

Happiness Test (from Psychology Today) | A 20-minute interactive test – free snapshot report with the option to buy the full report for $4.95

Helpful Questionnaires from James W. Pennebaker | Topics are varied

The HEXACO Personality Inventory – Revised | Download either the 60-item or 100-item version to assess for six personality dimensions.

Hoarding Rating Scale | A PDF scale to assess for hoarding symptoms

Imminent Risk and Action Plan | Assessment/plan from the University of Washington Center for Behavioral Technology

Interactive Behavioral Couple Therapy Questionnaires | 5 downloadable PDF assessments for couples

Initial Trauma Review – Revised (ITR-R) | A behaviorally-anchored, semi-structured interview that allows the clinician to evaluate most major forms of trauma exposure

Instruments from Foley Center for the Study of Lives

Integrated Biopsychosocial Assessment Form | A 16-page PDF assessment form

Interpersonal Communication Skills Inventory | A PDF self-assessment designed to provide insight into communication strengths and areas for development. Includes scoring instructions.

Introversion Scale | PDF questionnaire for introversion

Inventory of Depressive Symptomatology (Self-Report) (IDS-SR) | Quick Inventory of Depressive Symptomatology (Clinician-Rated) (QIDS-CR) Two versions of the this assessment, both PDF, scoring instructions not included

Keirsey | Take this interactive assessment to learn your temperament. (There are four temperaments: Artisan, Guardian, Idealist, and Rational.) My results were consistent with my Myers-Brigg personality type. (Note: You must create an account and enter a password to view your results.)

Lamar Soutter Library: Behavioral Tests | A collection of psychiatric assessments

Learn Your Love Language | Choose your version: Couples, Children’s Quiz, Teens, or Singles. An online assessment to determine your primary love language. (You are required to enter your information to get quiz results.)

Library of Scales (from Outcome Tracker) | 25 psychiatric scales (PDF documents) to be used by mental health practitioners in clinical practice. Includes Frequency, Intensity, and Burden of Side Effects Ratings; Fagerstrom Test for Nicotine Dependence; Fear Questionnaire; Massachusetts General Hospital Hair Pulling Scale; and more. (Note: Some of the assessments have copyright restrictions for use.)

Liebowitz Social Anxiety Scale | Take an interactive self-assessment (from the National Social Anxiety Center) to assess for social anxiety (PDF version)

Lifetime – Suicide Attempt Self-Injury Count (L-SASI) Instructions Scoring | (Source: University of Washington Center for Behavioral Technology) The L-SASI is an interview to obtain a detailed lifetime history of non-suicidal self-injury and suicidal behavior. Citations: Linehan, M. M. &, Comtois, K. (1996). Lifetime Parasuicide History. University of Washington, Seattle, WA, Unpublished work.

Lineham Risk Assessment and Management Protocol | (Source: University of Washington Center for Behavioral Technology) Linehan, M. M. (2009). University of Washington Risk Assessment Action Protocol: UWRAMP, University of WA, Unpublished Work.

Love Attitudes Scale | Link to a Word version of this scale that measures different love styles

Marital Satisfaction Scale | A PDF assessment to evaluate marital satisfaction; click on link listed in “Interactive Section for Couples”

Measurement Instrument Database for the Social Sciences | A searchable database

Measure of Attachment Qualities | Measures adult attachment styles (PDF)

Measures and Scales by University of Utah Psychology Faculty

Measures from Self and Social Motivation Lab | Assessments for self-worth and compassion

Mental Health Screening Tools | Online screenings for depression, anxiety, bipolar, psychosis, eating disorders, PTSD, and addiction. You can also take a parent test (for a parent to assess their child’s symptoms), a youth test (for a youth to report his/her symptoms), or a workplace health test. The site includes resources and self-help tools.

Mid-Ohio Psychological Services, Inc. Assessment Tools | A modest collection of assessments and screening tools on aggression, family violence, sobriety, etc.

Modified Checklist for Autism in Toddlers, Revised, with Follow-Up | Free download and scoring instructions

The Mood Disorder Questionnaire | A PDF screening tool for clinicians to assess symptoms of bipolar disorder

The National Sleep Foundation Sleepiness Test | An interactive test to assess if you are more or less sleepy than the general population

Need to Belong Scale | Link to a PDF version of this short assessment for measuring the need to belong

NORC Diagnostic Screen for Gambling Disorders Self-Administered (from the National Council on Problem Gambling) | An interactive 10-question test to assess gambling behaviors

Non-Suicidal Self-Injury Assessment Tool Brief Version | Full Version | Assessment tool created by Cornell Research Program on Self-Injury and Recovery

Open Source Psychometrics Project | This site provides a collection of interactive personality and other tests, including the Open Extended Jungian Type Scales, the Evaluations of Attractiveness Scales, and the Rosenberg Self-Esteem Scale. On the whole, I’m doubtful of the scientific accuracy of the assessments. (For example, I took the site’s DISC assessment; my score did not match the score I received when I took the certified test through my employer.) Furthermore, the site’s “About” section maintains, “[The site] exists to educate the public… and also to collect research data.” (Collect research data? For who/what?) I would recommend using the site mainly for entertainment purposes (or not at all if you’re concerned about how your personal data is handled).

Parental Affect Test | (Source: University of Washington Center for Behavioral Technology) The Linehan Parental Affect Test is a self-report questionnaire that assesses parent responses to typical child behaviors. Citations: Linehan, M. M., Paul, E., & Egan, K. J. (1983). The Parent Affect Test – Development, Validity and Reliability. Journal of Clinical Child Psychology, 12, 161-166.

Patient Health Questionnaire Screeners | This is a great diagnostic tool for clinicians. Use the drop down arrow to choose a PHQ or GAD screener (which assesses mood, anxiety, eating, sleep, and somatic concerns). The site generates a PDF printable; you can also access the instruction manual. No permission is required to reproduce, translate, display or distribute the screeners.

Perceived Stress Scale (PSS) | Links to Word version of this assessment and scoring information

Personal Anger Assessment | An online interactive assessment to determine your anger style. (You must enter your personal information to view the results.)

Personality Scales | 2 Word-document assessments

Personality Tests | A collection of assessments

Project Implicit | A variety of interactive assessments that measures your hidden biases

Psychological Tests from Delroy L. Paulhus | A modest collection of tools

Psychology Scales from Stephen Reysen | Topics are varied

Psychology Tools | Online self-assessments for addiction, ADHD, aggression, anxiety, autism spectrum, bipolar, depression, eating disorders, OCD, and personality.

Reasons for Living Scale Scoring Instructions | RFL Scale (long form – 72 items) | RFL Scale (short form – 48 items) | RFL Scale (Portuguese) | RFL Scale (Romanian) | RFL Scale (Simplified Chinese) | RFL Scale (Traditional Chinese) | RFL Scale (Thai) | (Source: University of Washington Center for Behavioral Technology) The RFL is a self-report questionnaire that measures clients’ expectancies about the consequences of living versus killing oneself and assesses the importance of various reasons for living. The measure has six subscales: Survival and Coping Beliefs, Responsibility to Family, Child-Related Concerns, Fear of Suicide, Fear of Social Disapproval, and Moral Objections. Citations: Linehan M. M., Goodstein J. L., Nielsen S. L., & Chiles J. A. (1983). Reasons for Staying Alive When You Are Thinking of Killing Yourself: The Reasons for Living Inventory. Journal of Consulting and Clinical Psychology, 51, 276-286.

Recovery Assessment Scales | A variety of assessments for individuals recovering from psychiatric illnesses

Relationship Assessment Scale | PDF assessment with scoring instructions; pages 11-13 of the PDF

Revised Gratitude Resentment and Appreciation Test | Access Word versions of the revised or short GRAT to measure dispositional gratitude

Risk-Taking Test (from PsychTests) | Self-test to assess your risk-taking behaviors – Receive a snapshot report with an option to buy the full report

Romantic Attachment Quiz (from PsychCentral) | A 41-item quiz to help you determine your romantic attachment style in relationships

Rosenberg Self-Esteem Scale | PDF scale with scoring instructions; interactive version here

SAMHSA Screening Tools | Valid and reliable screening tools for clinicians. This sites links you to PDF versions of assessments/screenings for depression, drug/alcohol use, bipolar disorder, suicide risk, anxiety disorders, and trauma.

The SAPA Project | SAPA stands for “Synthetic Aperture Personality Assessment.” This online personality assessment scores you on 27 “narrow traits,” such as order, impulsivity, and creativity in addition to the “Big Five” (Agreeableness, Conscientiousness, Extraversion, Neuroticism, and Openness). You’re also scored on cognitive ability. This test takes 20-30 minutes to complete and you will receive a full report when finished.

Saving Inventory – Revised | A PDF interactive inventory to assess for hoarding

Scales from the Motivated Cognition Lab

SCOFF (A Quick Assessment for Eating Concerns Based on the SCOFF) | A screening tool for eating problems

Screening and Brief Interventions Tools | Several PDF screening tools for substance use

Self-Compassion Scale | Links to a PDF version of the SCS (which assesses self-kindness, self-judgment, mindfulness, and more)

Self-Injury Questionnaire | To assess self-harm (PDF, assessment in appendix)

Severity Assessment | A PDF assessment tool from the Cornell Research Program on Self-Injury and Recovery to assess the severity of non-suicidal self-injury

Sexual Addiction Screening (from PsychCentral) | A brief screening measure to help you determine if you are struggling with sexual addiction

Shyness Scale | Measures shyness (PDF)

Shyness Surveys | Several assessments

Similar Minds | A fun site for personality tests (for entertainment purposes only!)

Sleep Assessments from Sleep and Chronobiology Center (University of Pittsburgh) | Download PDF versions of instruments to assess sleep quality, including the Pittsburgh Sleep Quality Index and the Insomnia Symptom Questionnaire

Sleep Disorders Screening Survey | A short, interactive test to screen for sleep disorders

Social Anxiety Questionnaire for Adults | A PDF questionnaire to assess for social anxiety

Social History Interview (SHI) | (Source: University of Washington Center for Behavioral Technology) The SHI is an interview to gather information about a client’s significant life events over a desired period of time. The SHI was developed by adapting and modifying the psychosocial functioning portion of both the Social Adjustment Scale-Self Report (SAS-SR) and the Longitudinal Interview Follow-up Evaluation Base Schedule (LIFE) to assess a variety of events (e.g., jobs, moves, relationship endings, jail) during the target timeframe. Using the LIFE, functioning is rated in each of 10 areas (e.g., work, household, social interpersonal relations, global social adjustment) for the worst week in each of the preceding four months and for the best week overall. Self-report ratings using the SAS-SR are used to corroborate interview ratings. Citations: Weissman, M. M., & Bothwell, S. (1976). Assessment of social adjustment by patient self-report. Archives of General Psychiatry, 33, 1111-1115. Keller, M. B., Lavori, P. W., Friedman, B., Nielsen, E. C., Endicott, J., McDonald-Scott, P., & Andreasen, N. C. (1987).  The longitudinal interval follow-up evaluation: A comprehensive method for assessing outcome in prospective longitudinal studies. Archives of General Psychiatry, 44, 540-548.

Social Interaction Anxiety Scale (SIAS) | A one-page PDF assessment, scoring instructions not included

Social-Personality Psychology Questionnaire Instrument Compendium (QIC) | A collection of assessments and screening tools

Social Phobia Scale (SPS) | A one-page PDF assessment, scoring instructions not included

SOCRATES | A PDF version of the Stages of Change Readiness and Treatment Eagerness Scale for clinicians to assess readiness to change in alcohol users

Somatoform Dissociation Questionnaire | A PDF assessment, scoring information here

Sorenes Self-Esteem Test | A PDF assessment with scoring instructions

The Spann-Fischer Codependency Scale | A 16-item scale (PDF) to measure codependency

Stanford Medicine WellMD | Self-tests for altruism, anxiety, burnout, depression, emotional intelligence, empathy, happiness, mindfulness, physical fitness, PTSD, relationship trust, self-compassion, sleepiness, stress, substance use, and work-life balance

The Strengths and Difficulties Questionnaire | Links to several downloadable versions of the SDQ, which is designed to measure behavioral issues in children ages 4-17

Stress Self-Assessments (from The American Institute of Stress) | A variety of self-assessments to measure stress

Stress Test (from PsychCentral) | A 5-minute interactive test to measure your stress level

Substance Abuse History Interview | (Source: University of Washington Center for Behavioral Technology) The SAHI is an interview to assess periods of drug use (by drug), alcohol use, and abstinence in a client’s life over a desired period of time. The SAHI combines the drug and alcohol use items from the Addiction Severity Index (ASI) and the Time Line Follow-back Assessment Method to collect information about the quantity, frequency, and quantity X frequency of alcohol and drug consumption. Citations: McLellan, A. T., Luborsky, L., Woody, G. E., & O’Brien, C. P. (1980). An improved diagnostic evaluation instrument for substance abuse patients: The Addiction Severity Index. Journal of Nervous and Mental Disease, 168, 26-33.

Suicidal Behaviors Questionnaire | SBQ with Variable Labels | SBQ Scoring Syntax | (Source: University of Washington Center for Behavioral Technology) The SBQ is a self-report questionnaire designed to assess suicidal ideation, suicide expectancies, suicide threats and communications, and suicidal behavior. Citations: Addis, M. & Linehan, M. M. (1989). Predicting suicidal behavior: Psychometric properties of the Suicidal Behaviors Questionnaire. Poster presented at the Annual Meeting of the Association for the Advancement Behavior Therapy, Washington, D.C.

Suicide Attempt Self-Injury Interview (SASII) SASII Instructions For Published SASII | SASII Standard Short Form with Supplemental Questions | SASII Short Form with Variable Labels | SASII Scoring Syntax | Detailed Explanation of SPSS Scoring Syntax | (Source: University of Washington Center for Behavioral Technology) The SASII (formerly the PHI) is an interview to collect details of the topography, intent, medical severity, social context, precipitating and concurrent events, and outcomes of non-suicidal self-injury and suicidal behavior during a target time period. Major SASII outcome variables are the frequency of self-injurious and suicidal behaviors, the medical risk of such behaviors, suicide intent, a risk/rescue score, instrumental intent, and impulsiveness. Citations: Linehan, M. M., Comtois, K. A., Brown, M. Z., Heard, H. L., Wagner, A. (2006). Suicide Attempt Self-Injury Interview (SASII): Development, Reliability, and Validity of a Scale to Assess Suicide Attempts and Intentional Self-Injury. Psychological Assessment, 18(3), 303-312.

Suicide Risk Screening Tool | One-page PDF screening tool for clinicians (from the National Institute of Mental Health)

Supervisory Relationship Questionnaire (SRQ) | PDF scale with scoring instructions

Survey Instruments and Scales | (Source: CAPS) To assess risky sexual behaviors

Talkaholic Scale | Measures compulsive communication (PDF)

Therapist Interview | (Source: University of Washington Center for Behavioral Technology) The TI is an interview to gather information from a therapist about their treatment for a specific client. Citations: Linehan, M. M. (1987). Therapist Interview. University of Washington, Seattle, WA, Unpublished work.

The Toronto Empathy Questionnaire | Click the link to access a Word version of this assessment

Treatment History Interview | Appendices | (Source: University of Washington Center for Behavioral Technology) The THI is an interview to gather detailed information about a client’s psychiatric and medical treatment over a desired period of time. Section 1 assesses the client’s utilization of professional psychotherapy, comprehensive treatment programs (e.g., substance abuse programs, day treatment), case management, self-help groups, and other non-professional forms of treatment. Section 2 assesses the client’s utilization of inpatient units (psychiatric and medical), emergency treatment (e.g., emergency room visits, paramedics visits, police wellness checks), and medical treatment (e.g., physician and clinic visits). Section 3 assesses the use of psychotropic and non-psychotropic medications. Citations: Linehan, M. M. &, Heard, H. L. (1987). Treatment history interview (THI). University of Washington, Seattle, WA, Unpublished work. Therapy and Risk Notes – do not use without citation. For clarity of how to implement these items, please see Cognitive-Behavioral Treatment of Borderline Personality Book, Chapter 15.

TTM Measures from the HABITS Lab | To assess for self-efficacy, decision-making, process of change, etc.

University of WA Suicide Risk/Distress Assessment Protocol | (Source: University of Washington Center for Behavioral Technology) Reynolds, S. K., Lindenboim, N., Comtois, K. A., Murray, A., & Linehan, M. M. (2006). Risky Assessments: Participant Suicidality and Distress Associated with Research Assessments in a Treatment Study of Suicidal Behavior. Suicide and Life-Threatening Behavior (36)1, 19-33. Linehan, M. M., Comtois, K. A., &, Ward-Ciesielski, E. F. (2012). Assessing and managing risk with suicidal individuals. Cognitive and Behavioral Practice, 19(2), 218-232.

Wellness Self-Assessment | A PDF-version of Princeton University’s tool to measure your wellness in seven dimensions (emotional, environmental, intellectual, occupational, physical, social, and spiritual) – Calculate your results and then create an action plan.

Work-Life Balance Scale | An online interactive tool to assess your work-life balance

The World Sleep Study | Take this short test to learn your sleep score and then answer additional questions to create a sleep profile

Yale Food Addiction Scale | PDF scale and scoring instructions


If you know of a free online assessment for mental health that’s not listed in this post, please share in a comment! Contact me if a link is not working.

3 Reasons We Keep Toxic People in Our Lives

Why do we keep toxic people in our lives? Despite the emotional costs, many people chose to remain in toxic relationships. This post explores the emotional reasoning behind not letting go.

By Cassie Jewell, M.Ed., LPC, LSATP

Recently, an acquaintance told me about breaking up with his girlfriend. Listening to his story, I both cringed and laughed at the sheer ridiculousness of it. (Think The Break-Up meets Fatal Attraction.) His humorously-told narrative left me wondering, how on earth did it get to that?

It began when his at-the-time girlfriend “secretly” moved in with him. At first, she’d stay for a night or two, which eventually turned into weeks at a time, until all her stuff was there and my friend found himself with a live-in girlfriend. (It’s worth mentioning he’d seen a few “red flags” early on, but chose to ignore them… as we often do under the spell of infatuation.) Now living with her, he couldn’t turn a blind eye to the fact that she had some serious mental health and interpersonal issues. Furthermore, the relationship had taken a turn for the worse; they were constantly fighting.

So, my friend (wisely) broke up with her and told her to get out. And… she refused. (Really??) She claimed there was a law permitting her to stay since she’d been there for X amount of time. (Note: This is also when he found out she was homeless.)

He kicked her out of the bedroom (and she slept on the couch). To “encourage” her to leave, he took her parking pass, along with her new iPhone (which he undoubtedly bought in a more amiable era). To further “motivate,” he even shut off her cell service.

Despite his efforts, weeks stretched on; she continued to live (rent-free) on his couch.

To make a long story short… she eventually left. (Otherwise, I wouldn’t be writing this blog post) … but not until the apartment manager and police got involved. (It turned out her tenant rights claim, while valid, was not actually applicable to her situation.)

My initial reaction to the whole fiasco was incredulity – Seriously, how could he let it go that far? – but after reflecting on past relationships… it was suddenly very easy to understand. (I’ve made my fair share of relationship mistakes.)

The reality is, it’s never as simple as “it’s over, get out.” Relationships require a certain level of emotional investment and commitment. Plus, there are multiple factors (such as debt, illness, or infidelity) that contribute to a relationship’s complexity.

Back to my friend… to be fair, the reason he remained in a toxic relationship was her refusal to vacate the apartment; his options were limited… but, instead of allowing it drag on, he could have taken action earlier.  Anyway, the story has a happy(ish) ending (for my friend, probably not his ex). He has his place back (hopefully a lesson learned) and got free blog inspiration. This post is 100% inspired by my friend’s toxic relationship. (Thank you for letting me share!)

(Apart from “tenant rights”) what are reasons we allow toxic or difficult people (friends, family, and/or romantic partners) to remain in our lives? Why is it so hard to let go?

  1. Either you need them (or you can’t ignore them)

A recent study suggests we keep toxic people around simply because their lives are intertwined with ours. For example, your aging mother-in-law, who degrades and insults you, lives at your home, despite the negative impact this has on your life. Your options are limited because your husband is unwilling to put her in a nursing home (and you may also depend on her for things, like childcare or help with the bills).

Another example would be toxic co-workers; you don’t have a lot of choice when it comes to your boss or colleagues, and you can’t entirely avoid them or refuse to talk about work-related stuff (unless you’re okay with losing your job). If pursing a new position isn’t practical, your next best option is to find a way to effectively deal with workplace toxicity.

That being said, you don’t have the power to change anyone else. To manage your reactions and interactions with toxic people, acknowledge the need for self-adjustment, including attitude and role. Examine your personal views. Lower expectations for others; accept that people will do and say things you don’t agree with… and it’s not something you can control. Once you’ve reached the point of radical acceptance, follow guidelines for effective communication (i.e. active listening, avoiding blame, being aware of tone and body language, reflecting for clarity, etc.) in conversations with toxic people, whether it’s your mother-in-law or your boss. By being proactive, you’re doing your part to avoid getting caught up in others’ toxicity.

In the face of unavoidable toxicity, I find switching to a “counselor role” to be a tremendous asset; I set aside my personal viewpoint, opening myself to alternative views, while seeking to understand (not judge) behavior. (You don’t have to be a counselor to do this!) I view individuals in terms of “what happened to you?” instead of assuming they’re malicious or intentional. (People act the way they do for some reason.) I don’t know what’s happening in a “toxic” person’s life or what they’ve been through. (Maybe that snarky co-worker is in an abusive relationship and lives in fear. Or maybe her son is in the hospital with brain cancer. Or, it’s possible she grew up in a home where her parents yelled and disrespected each other, shaping her view of relationships. The snarky attitude makes sense when viewed through different lenses.) While it’s never okay to be an asshole, I can understand why people are jerks. Somehow, this knowledge serves as an immunity when encountering a toxic person. Their behavior is the result of something bad that happened to them; it has nothing to do with me and I can choose whether or not to engage. They don’t have power to negatively impact me unless I give it up.

  1. It feels better to stay

When Joe Strummer of the Clash sang the question, “Should I stay or should I go now?”; he knew the answer. (Note: Firm boundaries and healthy decisions aren’t the stuff of chart-topping hits.) We stay in unhealthy relationships or continue to hang out with toxic friends because it feels good (at times, at least). The boyfriend who yells at you can also be incredibly sweet and caring. Or your gossipy friend who talks about you behind your back also happens to be the most fun person you know. Despite the sense that it’s unhealthy, you (like Strummer) can’t resist. And like my friend, you ignore the red flags because you crave the rush or the intensity… or maybe what you desire most is the feeling of being wanted. (Despite the toxicity, it’s worth it, just to feel wanted… or is it?)

Beyond just feeling good, it’s entirely possible to deeply love a toxic person (no matter how wrong they are for you). You don’t want to give up on the person they could be; maybe you’re in love with their potential (or an idea of what the relationship could be). You believe it’s better to sacrifice your happiness (your dignity, your well-being, your independence) than to be without the person you love.

On the flip side, some people stay in toxic relationships because deep down, they believe they can’t do any better and/or the abuse is a preferable alternative to being alone. It could also mean they believe they deserve to be punished (which sometimes happens when a person remains in an abusive relationship for a long time). Or, they may reason that it’s better to hang out with a “mean girl” than sit and stare at the walls on a Friday night (with only the cat for company).

If you can relate to staying in a toxic relationship because it feels good or are afraid of being alone, carefully consider and weigh out the long-term costs of a toxic relationship. There are far worse and more damaging things than being alone. If the idea of being alone terrifies you, maybe it’s an indication that something’s not right… that you’re not okay. It could be a sign of low self-worth or could point to an intense fear of abandonment. It may also signify a lack of understanding of what it means to be in a healthy relationship. Lastly, an intense fear of being alone is associated with some of the personality disorders and/or could be the result of trauma.

  1. It’s (So Much) easier to stay

Breaking up is messy and uncomfortable. In my experience, most people avoid conflict when possible. Despite conflict being a natural, everyday occurrence, it can feel unpleasant, even for those with expert conflict resolution skills. However, avoiding conflict in relationships does more harm than good. In a healthy relationship, it’s necessary to address problems in order to resolve them, thereby strengthening the relationship.

In a toxic relationship, conflict should not be avoided, but for different reasons. It may be easier to ignore the reality of your situation than to get honest, but this is detrimental (not only to you, but to your partner, who will never have the opportunity to change so long as you enable the toxicity to continue).

You may wish to avoid the emotional drain that accompanies confrontation, but in the long run, you’ll lose more emotional energy if you remain in a toxic relationship. (A steep, one-time payment is preferable to the ongoing, daily emotional sacrifices/abuses associated with toxicity; you’re slowly poisoned as time goes on.)

If you choose to end a toxic relationship, be realistic; it’s not going to be easy… and it’s going to hurt. A lot. You may love this person a great deal (and maybe you’ve long held on to the hope they’d change). Go into it with low (or no) expectations. When things feel unbearable, remember that the easy things in life matter little; the difficult stuff is what leads to personal growth, success, and resilience.

In closing, I’m sure there are multitudes of reasons people have for staying in toxic relationships; this post is by no means comprehensive. I’m also certain, whatever the reason, it seems justifiable to them. People don’t choose toxicity without some sort of justification (if not for others, than at least for themselves). Unfortunately, rationalizations don’t offer protection from harm. No matter the reason for remaining in a toxic relationship, it’s not worth the cost.

What are other reasons people have for staying in a toxic relationship? Why is letting go so hard? Share your thoughts in a comment!


References

Bar-Ilan University. (2018, January 17). Why we keep difficult people in our lives. ScienceDaily. Retrieved July 14, 2018 from http://www.sciencedaily.com/releases/2018/01/180117152513.htm

Offer, S., & Fischer, C.S. (2017). Difficult people: Who is perceived to be demanding in personal networks and why are they there? American Sociological Review, 000312241773795, DOI: 10.1177/0003122417737951

8 Types of Liars

Read about 8 common types of liars ranging on a spectrum from the very worst (the pathological liar) to the well-meaning tactful liar.

By Cassie Jewell, M.Ed., LPC, LSATP

updated 8 types of liars.png


I find the psychology of lying fascinating. So, while browsing research devoted solely to falsehoods (on which I’ll write a future post), I started to reflect on different sorts of liars I’ve met throughout the years.

This led to a Google search (“types of liars”) to see if it’s a thing. And it is… kinda – for example, sociopathic liars vs. occasional liars vs. white liars are all types of liars.

However, I’d been thinking about classifying liars on different terms. I conceptualize them on a spectrum, ranging from pathological (the worst type) to tactful (the least-harmful type), while taking into consideration the various reasons people lie.

In this post (which is not based on scientific research), I describe the 8 types of liars I’ve encountered, both as a professional counselor and in my personal life.

1. The pathological liar

This person lies constantly, for any reason, or for no reason at all. They don’t know when they’re lying and they’re incapable of being honest with not only others, but with themselves. Due to this, it’s impossible to have an authentic relationship with the pathological liar; their reality fluctuates and evolves on a whim.

What I consider pathological lying is what others may refer to as sociopathic. In the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), repeated lying is a criterion for diagnosing antisocial personality disorder (formerly known as sociopathy or psychopathy).

The pathological liar isn’t necessarily dangerous or cruel, but they’ll never be someone you can trust. The pathological liar, providing they have other redeeming qualities, is a suitable acquaintance, but never a loyal friend, partner, or spouse.

2. The intentional liar

This type of liar enjoys pushing your buttons. They lie for the fun of it or for the sake of entertainment. It makes them feel powerful and in control. The people they lie to are their pawns. They often desire an audience.

While the intentional liar is similar to the pathological liar in some ways, they differ in that they’re fully aware of their untruths. The intentional liar is the high school quarterback who asks the least popular girl to prom… and then tells her it was just a joke – in front of all his friends.

Sometimes, the intentional liar poses as a jokester, but they’re malicious and cruel.

They fib to get a reaction and then say (in a mean-spirited way), “I was just f—ing with you!” Sometimes, the intentional liar poses as a jokester, but they’re malicious and cruel. The only reason they’re not at the very end of the spectrum is that by possessing awareness, they at least have the capacity to change.

 3. The manipulative liar

They lie to get what they need (or want). They have an end goal and will do or say whatever it takes to achieve it.

They often use flattery or say what they think you want to hear in order to get a promotion, make a sale, get elected… or get in your pants.

Like the pathological liar, you won’t know where you stand with the manipulative liar. (Does she think you’re witty? Or does she like free drinks?) The manipulative liar is not malicious, but they can still cause harm. They have no place in your life.

4. The protective liar

They’ll go to any length to protect a secret, be it the murder of their lover’s wife or a demotion at work.

This type of liar is at times dangerous, but can also be perceived as noble; it all depends on what (or who) they’re protecting. They’ll go to any length to protect a secret, be it the murder of their lover’s wife or a demotion at work. They have no moral objections to lying as long as it serves their purpose.

They may protect your secrets as well, making them a loyal friend or spouse.

The danger lies in who or what they choose to protect. This type of liar may carry dark, terrible secrets that would shake you to the core if revealed. You’ll never know what they keep hidden and therefore, you’ll never (fully) know who they are. Their secret could be as benign as a childhood stutter… or it could be devastating and unspeakable, a sexual predator who victimizes vulnerable youth or a secret affair with your brother.

5. The avoidant liar

Instead of being straightforward, they make excuses or dance around the truth.

They strive to avoid something they find unpleasant; instead of being honest, they offer partial truths or deflect. It could be that the avoidant liar is evading conflict or doesn’t want to complete a particular task. Maybe they don’t want to be judged. Instead of being straightforward, they make excuses or dance around the truth.

For example, the avoidant liar who opts out of a family dinner because they can’t stand their mother-in-law pleads a migraine. Or the avoidant liar who oversleeps and is late to work tells their boss they got a flat tire. And the avoidant liar who drunkenly spills red wine on your white carpet blames it on the dog.

Avoidant liars are frustrating because they don’t say what they mean; you can never be sure if you’re getting the truth, a half truth, or a made-up excuse.

6. The impressive liar

They aim to impress. This person may not see themselves as a liar; they may not even realize they’re being deceitful. They fabricate to gain the approval of others. They may stretch the truth to make a story a bit funnier. They could fake a feeling to seem more self-assured than they are.

Lying to impress is more of a habit than a conscious act. The impressive liar believes their own stories after telling them so many times. (For example, after multiple retellings of a bar fight, the impressive liar begins to believe that he knocked out three bikers, when in reality, he broke his fist attempting to punch the bouncer.)

Impressive liars are mostly harmless, but can be annoying, especially when it’s obvious they’re fibbing. They pose little risk, but why spend time with someone who feels the need to pretend to be something they’re not?

7. The lazy liar

Sometimes, speaking candidly requires a lengthy explanation. The lazy liar streamlines the truth because it’s less complicated than giving the full narrative.

The lazy liar doesn’t leave out important details; instead, they opt to recount the movie version of the truth instead of the 700-page book version.

For example, saying, “I was late because I grabbed the wrong report” is easier than “I’m late because after I grabbed the report, I realized one page was missing, and when I went back, I had to reprint the entire report because the page numbers were off and the heading wasn’t on a separate sheet.”

Lazy lying is harmless. The lazy liar doesn’t leave out important details; instead, they opt to recount the movie version of the truth instead of the 700-page book version. (The only time lazy lying can be problematic is when the lazy liar deems a detail unimportant when it is, in fact, imperative.)

8. The tactful liar

They are considerate and well-meaning. They offer overly-optimistic reassurances when things aren’t going well and find themselves saying things like, “It wasn’t that bad” (even when it was indeed that bad).

They’re pleasant to be around. Your plus-sized butt will never look fat in jeans and your disastrous dye job will be “edgy,” not “traffic-cone orange.”

What they lack in candor, they make up for in amiability.

You also won’t know when there’s spinach in your teeth, if your fly is down, when your breath is bad, if the PowerPoint presentation you put together for work is dull, or if it might be considered clingy to send 19 texts (including “heart eyes” emoticons) to your new boyfriend who’s at the game with the guys.

The tactful liar has the best of intentions; they don’t want to upset you or hurt your feelings. What they lack in candor, they make up for in amiability.

An honorable mention for the heroic (self-sacrificing) liar. This type of liar is exceedingly rare, which is why they’re not included with the eight more common types. The heroic liar is similar to the protective liar in that they’ll go to extremes to protect, but in their case, they lie to defend (or safeguard) someone they love (or to save a stranger even, if they believe it’s the right thing to do).

For example, if two children (brothers) are playing, and the youngest breaks a lamp, the older (heroic liar) will take the blame to save the younger from a spanking.

The heroic liar’s place on the spectrum would be past the well-meaning liar, on the very end.

Can you relate to any of the above liars? Maybe you’re personally acquainted with one (or several) of them?



Share your thoughts in the comments section!


Where Can I Find Help?

Where can you find the help you need? While there are plenty of resources out there for mental health and recovery, they’re not always easy to find… or affordable. (Plus, the Internet is full of scams!) This article is a starting point for getting help when you aren’t sure where to turn. This post offers practical guidelines; all of the resources in this article are trustworthy and reliable… and will point you in the right direction.

By Cassie Jewell, M.Ed., LPC, LSATP

This post is not comprehensive; rather, it’s a starting point for getting the help you need. There are plenty of resources out there for mental health and recovery, but they’re not always easy to find (or affordable). The resources in this post are trustworthy and reliable… and will point you in the right direction.

If you need treatment for mental health or substance use, but aren’t sure how to find it…

If you have insurance, check your insurer’s website.

For substance use and mental health disorders, you can access the SAMHSA treatment locator. You can find buprenorphine treatment (medication-assisted treatment for opioid addiction) through SAMHSA as well.

Consider using Mental Health America’s interactive tool, Where to Get Help. NeedyMeds.org also has a locator to help you find low-cost mental health and substance abuse clinics.

Additionally, you could contact your local Mental Health America Affiliate for advice and/or referrals.

If you can’t afford therapy…

EAP (employee assistance programs) frequently offer free (time-limited) counseling sessions.

At campus counseling centers, grad students sometimes offer free or low-cost services.

You could look into community mental health centers or local churches (pastoral counseling).

In some areas, you may be able to find pro bono counseling services. (Google “pro bono counseling” or “free therapy.”) You may also be able to connect with a peer specialist or counselor (for free) instead of seeing a licensed therapist.

As an alternative to individual counseling, you could attend a support group (self-help) or therapy group; check hospitals, churches, and community centers. The DBSA peer-lead support group locator tool will help you find local support groups. Meetup.com may also have support group options.

Additional alternatives: Consider online forums or communities. Watch or read self-help materials. Buy a workbook (such as The Cognitive Behavioral Workbook for Depression: A Step-By-Step Program) from amazon.com. Download a therapy app.

Lastly, you could attend a free workshop or class at a local church, the library, a college or university, a community agency, or a hospital.

If you’re under 18 and need help, but your parents won’t let you see a counselor (or “don’t believe in therapy”)…

Some, but not all, states require parental consent for adolescents to participate in therapy. Start by looking up the laws in your state. You may be able to see a treatment provider without consent from a legal guardian. If your state is one that mandates consent, consider scheduling an appointment with your school counselor. In many schools, school counseling is considered a regular educational service and does not require parental consent.

Self-help groups, while not a substitute for mental health treatment, provide a venue for sharing your problems in a supportive environment. (If you suffer from a mental health condition, use NAMI to locate a support group in your state. If you struggle with addiction, consider AA or NA.)

Alternatively, you could join an online forum or group. (Mental Health America offers an online community with over 1 million users and NAMI offers OK2Talk, an online community for adolescents and young adults.)

You could also contact a Mental Health America Affiliate who would be able to tell you about local resources and additional options.

If you’re in crisis, call the Boys Town Hotline at 1-800-448-3000 or the National Suicide Prevention Hotline at 1-800-273-TALK. Alternatively, you can text HOME to 741741 to text with a trained crisis counselor.

Lastly, consider talking with your pastor or a trusted teacher, reading self-help materials, downloading a therapy app, journaling, meditation or relaxation techniques, exercising, or therapy podcasts/videos.

If a loved one or friend says they’re going to kill themselves, but refuses help…

Call 911. If you’re with that person, stay with them until help arrives.

If you are thinking about or planning suicide…

Call the National Suicide Prevention Lifeline or Veterans Crisis Line. Alternatively, you can text HOME to 741741 to text with a trained crisis counselor. Call 911 if you think you might act. 

If you are grieving…

Check local hospitals and churches for grief support groups; some areas may have nonprofits that offer free services, such as Let Haven Help or Community Grief and Loss Center in Northern Virginia.

Additionally, a funeral home or hospice center may be able to provide resources.

If you are a veteran, you and your family should be able to access free counseling through the VA.

The Compassionate Friends offers support after the loss of a child. Call for a customized package of bereavement materials (at no charge) or find a support group (in-person or online).

GRASP is a grief and recovery support network for those who have lost a loved one through substance use. You can find suicide support groups using the American Association of Suicidology’s directory or the American Foundation for Suicide Prevention’s support group locator.

Hello Grief provides resources and education for children and adolescents who are grieving.

There are also online communities, forums, and support groups, including groups for suicide survivors such as Alliance of Hope and Parents of Suicides – Friends and Families of Suicides.

If you are a victim of sexual assault or domestic violence…

If you are sexually assaulted, call 911 or the National Sexual Assault Hotline at 1-800-656-4673 (or live chat). Find help and resources at National Sexual Violence Resource Center.

For male survivors of sexual abuse: MaleSurvivors.org

For domestic violence: The National Domestic Violence Hotline

For gender-based violence: VAWnet

For teen dating abuse: LoveIsRespect or Break The Cycle

LGBTQ: National Coalition of Anti-Violence Programs for LGBT Communities

If you’re a victim of sex trafficking…

Access Coalition to Abolish Slavery and Trafficking or call National Human Trafficking Hotline at 1-888-373-7888 (or text 233733).

 

If you’re a victim of or stalking…

If you believe you are in immediate danger, call 911. Find help and info at Stalking Resource Center and Stalking Awareness Month.

 

If you can’t stop gambling…

Call or text the National Problem Gambling Helpline at 1-800-522-4700. Access screening tools and treatment at National Council on Problem Gambling. Attend a Gamblers Anonymous Group or other support group for problem gambling.

If you or a loved one has an eating disorder…

If you want to approach a loved one about his or her eating disorder, start by reading some guidelines (such as Helping Someone with an Eating Disorder from HelpGuide.org).

Contact the National Eating Disorders Helpline at 1-800-931-2237. (Alternatively, there’s a “live chat” option.) For support, resources, screening tools, and treatment options, explore the National Eating Disorder Association site.

Find support groups, recovery tools, and local treatment centers at Eating Disorder Hope.

Attend an Eating Disorders Anonymous meeting (in-person or online). You may also want to consider an Overeaters Anonymous meeting.

 

If you are engaging in self-harm and can’t stop…

Call 1-800-DONT-CUT or attend an online support group, such as Self Mutilators Anonymous.

Read personal stories, learn coping skills, and access resources at Self-injury Outreach and Support.

Join an online community like RecoverYourLife.com.

Try one of these 146 things to do instead of engaging in self-harm from the Adolescent Self Injury Foundation.

 

If you’re concerned about the drinking or drug use of a friend or family member, but they don’t want help…

If you’re considering staging an intervention, know that there’s little to no evidence to support the effectiveness of this tactic. 

Instead, read guidelines for approaching the issue (like What to Do If Your Adult Friend or Loved One Has a Problem with Drugs or How to Talk about Addiction). Learn everything that you can about addiction. Explore treatment centers in the area; if your loved one changes their mind, you’ll be prepared to help.

Explore Learn to Cope, a peer-led support network for families coping with the addiction of a loved one. Alternatively, you could attend Al-Anon or Nar-Anon.

Keep in mind that it’s almost impossible to help someone who doesn’t want it. You can’t control your loved one or force them into treatment. Instead, find a way to accept that there’s no logic to addiction; it’s a complex brain disorder and no amount of pleading, arguing, or “guilting” will change that.

If a friend or family member overdoses on heroin or other opioid…

Call 911 immediately.

How to recognize the signs of opiate overdose: Recognizing Opiate Overdose from Harm Reduction Coalition

You can receive free training to administer naloxone, which reverses an opioid overdose. Take an online training course at Get Naloxone Now. You can purchase naloxone OTC in most states at CVS or Walgreens.

For more information about how to respond to an opioid overdose, access SAMHSA’s Opioid Overdose Prevention Toolkit (for free).

 

If you want to quit smoking…

In addition to talking to your doctor about medication, the patch, and/or nicotine gum, visit Smoke FreeBe Tobacco Free, or Quit.com for resources, tools, and tips.

Call a smoking cessation hotline (like 1-800-QUIT-NOW) or live chat with a specialist, such as LiveHelp (National Cancer Institute).

Download a free app (like QuitNow! or Smoke Free) or sign up for a free texting program, like SmokefreeTXT, for extra support.

Attend an online workshop or participate in a smoking cessation course; your insurance provider may offer one or you may find classes at a local hospital or community center. You could also contact your EAP for additional resources.

If you or a loved one have a hoarding problem…

Read guidelines for approaching a hoarding issue with someone such as Hoarding: How to Help a Friend.

Learn more about hoarding and find help (support groups, treatment, etc.) at Hoarding: Help for Hoarding.

 

If your therapist is making unwanted sexual remarks/advances…

Contact the licensing board to file a complaint. Each state has a different licensing board. Additionally, contact the therapist’s professional association (i.e. American Counseling AssociationAmerican Psychological Association, etc.) Provide your name, address, and telephone number (unless filing anonymously). Identify the practitioner you are reporting by his or her full name and license type. Provide a detailed summary of your concerns. Attach copies (not originals) of documents relating to your concerns, if applicable.

Read NAMI’s How Do I File a Complaint against a Mental Health Care Facility or Professional?

 

If you want to take a confidential online assessment for mental health or substance use disorders…

Free and anonymous screenings: Screening for Mental Health, Inc. or Depression and Bipolar Support Alliance Mental Health Screening

For additional sites, self-help guides, literature, etc., check out the resource page.

If you know of a great resource, post in the comments below!


Guest Post: The Toll Diabetes Takes on My Mental Health

Diabetes can take a toll on anyone. Michele Renee was diagnosed with type 2 diabetes at the age of 22. In this post, she describes her experience with the disease, including how it affected her mental health. She also shares the key to finding peace with her illness.

By Michele Renee from Life With Michele Renee

Diabetes can take a toll on anyone, if not taken care of properly. When it comes to mental health though, diabetes is known to affect certain aspects of day to day life.

I first found out I had diabetes type 2 when I was 22 years old. I was overly stressed and eating my feelings way more than I should have. The stress and unhealthy lifestyle were what triggered my diabetes symptoms.

I have always dealt with depression and low self-esteem, but once my symptoms were triggered, I started to deal with memory loss, and a foggy brain. The best way to describe that experience is like you learn something that doesn’t quite make sense, but you could see where the concept is headed but you still can’t figure it out.

Then five minutes later you completely forget the meaning of the concept and where it was headed. I dealt with this constantly. I was in college during this time, and I ended up failing quite a bit of classes because I just couldn’t understand what I was learning. Also, on a test day, I would forget almost everything that I had studied.

How I Manage Diabetes Day to Day

I started having to keep an ongoing list of “To Do’s” and would have to revisit the list four or five times before I remembered to finish the “To Do” item.

This crossed over into my conversations with my friends and loved ones as well. Some days I wouldn’t remember what I said in a conversation from the day before. The short-term memory loss was horrible!

But once I started eating according to a diabetes diet, the fogginess and memory loss started to go away.

I also dealt with insomnia and poor sleep, and in a lot of ways that was a result of the foods I was eating. Once I changed my diet, and started exercising more, I slept a lot better.

Diabetes and Other Mental Health Issues

On top of diabetes, I also have a few other mental illnesses. One of them being bipolar disorder, rapid cycling. My highs would go for a week, then I would feel normal, then I would be low for another week, in terms of mood.

During my highs, I would often forget to eat, and that would leave me feeling shaky (a result of low blood sugar) and anxious. Some days, I would forget to eat for hours because I wanted to finish whatever inspiring project I was working on at the minute.

On my low mood swings, I would feel so depressed and sad, and sometimes even numb that I would binge eat. The binge eating would either be fast food or sugary foods (both of which I HAVE to avoid). This would cause me to feel nauseous and I would often get horrible migraines (a result of high blood sugar).

Insecurities From Diabetes

Dealing with both diabetes and my other mental health issues caused me to gain a ton of weight in the last fours years. I have gone through times where I lost the weight, then gained it back six months later.

It left me feeling very insecure, and like I had a bigger body than I actually do. I stopped taking photos of myself, and was mortified everytime I took a group photo with my friends. I found myself disgusted by my looks.

This led me to judge myself harshly when I deviated from my diet, and honestly probably pushed me to deviate more and more. The bad food was my comfort from my harsh criticism. It became a vicious cycle.

Healthy Living

Now, I try not to judge myself as harshly anymore. After beating myself up for so many years, I came to realize that I can find peace in this illness. I have managed it with diet alone and that is honestly a huge feat.

Most people who are diagnosed have to take either insulin shots or an insulin pill. I have pushed myself to find a healthy lifestyle that works for me. Once I did that, I started practicing accepting my flaws.

That is the hardest part of learning to love yourself, in my opinion. I also gathered a really strong support system that I go to almost every day when I am feeling super low or when I am feeling extremely insecure.

I also remind myself that no one is perfect, and we are all a work in progress. I have started putting little affirmations anywhere I can; I even made wallpaper affirmations for my phone!

Mental health is hard to handle when you are diabetic, but if you learn to love yourself, the process of managing it gets easier.

Read more of Michele’s inspiring posts at Life With Michele Renee, a lifestyle and wellness blog!

9 Myths & Misconceptions About Mental Illness

Are mentally ill people violent? Can mental illness be overcome through willpower? Is addiction a choice? This post addresses some of the myths and misconceptions about mental illness.

By Cassie Jewell, M.Ed., LPC, LSATP

In this post, I’ll address some of the myths and misconceptions about mental disorders. There continues to be stigma attached to mental illness; and the media is partly to blame. Every time (yet another) mass shooting occurs, the media attributes the act of violence to mental illness. This message is repeated by various news sources and then spread through social media.

Acts of senseless violence are for sure a “sickness,” but they’re not criteria for a diagnosable mental disorder. It’s not fair to compare violent criminals to individuals who struggle with depression, anxiety, schizophrenia, etc.

Mental illness misconceptions run rampant, even within the healthcare professional field. For example, I know a surgeon who believes mental illness isn’t real and a neurologist who uses words like “crazy” and “retarded.” I came across a substance abuse counselor (on Facebook) who believes addiction is a moral failing. I know a social worker who believes that severely mentally ill individuals are more likely to be violent.


Ignorance is at the root of stigma. The more you know, the less you fear, and the less you’ll stigmatize. Read on to learn what’s myth versus fact.

1. Bad parenting causes mental illness.

Even today, there is no single identified cause when it comes to mental illness. Instead, there are multiple risk factors that contribute to mental disorders. The biggest risk factor is genetics. Genes frequently determine whether or not a person develops schizophrenia, depression, substance use disorder, etc. Physiological factors (such as abnormalities in the brain) are a second risk factor.

Environmental factors, such as fetal exposure to a toxin or childhood abuse, are a third risk factor. Childhood abuse undoubtedly falls into the “bad parenting” category, but as a standalone, it can’t cause mental illness.

It’s more likely that a combination of risk factors will lead to the development of a mental disorder.

2. Mental illness is not a medical disease.

Heart disease affects the heart. Colon cancer affects the colon. Autoimmune disorders affect the immune system. Brain disorders (i.e. mental illness, addiction) affect the brain.

You can’t “see” mental health symptoms the way you can see physical health symptoms, but mental illness is without a doubt physiological in nature.

Like other organs, the brain can become diseased, and it manifests as symptoms of mental illness. You can’t “see” mental health symptoms the way you can see physical health symptoms, but mental illness is without a doubt physiological in nature.

3. All sociopaths are dangerous.

The term “sociopath” (or psychopath) is frequently associated with serial killers. The reality is that you probably know a sociopath and he/she isn’t a murderer.

In fact, “sociopathy” and “psychopathy” are no longer recognized diagnoses in the mental health world due to negative connotations. The correct term is “antisocial personality disorder” (ASPD), a mental illness characterized by an ongoing disregard for and violation of the rights of others. An individual with ASPD may also be exceptionally charismatic. (Some of the most charming and engaging clients I’ve ever worked with had ASPD.)

However, research indicates that an individual with ASPD is more likely to become involved in criminal activity,to have a substance use disorder, and to be aggressive; about 50% of individuals with ASPD have some sort of criminal record. While it’s a misconception to say all individuals with ASPD are dangerous, the link between ASPD and crime is not unfounded.

4. Mental illness can be overcome with willpower.

This is 100% myth and a huge pet peeve of mine. It goes hand-in-hand with the belief that mental illness is not a “real” medical condition. A mental disorder typically requires treatment, such as medication and therapy, and ongoing illness management. 

All the willpower in the world won’t help someone “overcome” heart disease. And it doesn’t work that way with mental illness either.

5. Addiction is a choice.

Substance use disorder is no more of a choice than diabetes or cancer. Like most diseases, addiction develops when a combination of genetic, physiological, and environmental factors are present. Lifestyle choices also play a role. Unfortunately, the myth that addiction is a moral failing persists.

An individual who struggles with addiction receives more blame than someone with a heart condition, even though lifestyle choices heavily impact both disorders. I’ve even heard it said that addicts who overdose shouldn’t be revived because it was their “choice” to use. If that’s the logic, then should we stop providing life saving care to someone who’s having a heart attack or to a smoker with lung cancer? Of course not. At times, we all make poor decisions. For someone with a predisposition for addiction, the choice to drink may lead to alcohol use disorder. For the person with a predisposition for diabetes, eating an unhealthy diet or living a sedentary lifestyle will result in consequences.

Furthermore, once a person develops a substance use disorder, physiological and structural changes in the brain dissolve the element of choice. The brain misinterprets a craving for drugs or alcohol. (Remember the last time you experienced extreme thirst? That’s what it’s like to be addicted to something.)

Having a substance use disorder is miserable, lonely, and shameful. No one would choose that.

6. People with mental illness are violent.

A person with mental illness is no more likely to be violent than someone in the general population. In fact, acts of violence are not diagnostic criteria for any of the known mental disorders.

If I had to choose someone to hold a loaded gun, I’d pick the person with schizophrenia over someone who’s prone to anger or has poor self-control.

I work with clients who hear “command” voices (auditory hallucinations that tell them to harm or kill); yet I’ve never felt unsafe. In my experience, it’s uncommon for an individual to obey the voices. If I had to choose someone to hold a loaded gun, I’d pick the person with schizophrenia over someone who’s prone to anger or has poor self-control.

While the media would have us believe that mental illness is at the root of every mass shooting, that isn’t the case. (Not to say that mental illness can’t play a role, but it’s not always the trigger.) The biggest risk factor for violence is a history of violence, especially domestic violence, or crime.

Regarding violence, what’s true is that individuals with mental illness are more likely to die by suicide. Persons with schizophrenia have higher rates of suicide than the general population. Depression, bipolar disorder, and borderline personality disorder are also linked to suicide.

Don’t confuse mental illness with a lack of morals.

A mental disorder is a medical condition; having weak morals is a personality trait, and while it seems mentally sick, it’s not fair to compare a lack of morals to a condition like depression or anxiety.

7. Mental illness is the same thing as mental retardation.

I’m friends with a nurse who didn’t even know the difference (until I pointed it out). A person with a mental illness may seem less intelligent due to various factors, but mental illness is not comparable to mental retardation. Today, we refer to mental retardation as intellectual disability (due to the negative connotations attached to the word “retarded”).

A person with an intellectual disability (ID) struggles to understand, comprehend, and/or form memories. A person with mental illness, on the other hand, may have superior intelligence, but could seem “slow” due to distractions brought on by their illness. (For example, it’s difficult to focus on a conversation when you’re having racing thoughts or hearing voices.)

8. A person with schizophrenia has multiple personalities.

Nope; total myth. In fact, multiple personality disorder (MPD) doesn’t exist (technically). What was formally known as MPD in the DSM-IV TR (the previous version of the Diagnostic and Statistical Manual) is now termed disassociative identity disorder [DID]. A person with DID has at least two distinct personality “states” and suffers from gaps in memory. DID is incredibly rare.

A person with schizophrenia, on the other hand, has one personality state. However, he/she may hear voices that take on distinct identities.

In addition to auditory hallucinations, someone with schizophrenia may experience visual hallucinations, delusions, disorganized thoughts, cognitive deficits, and/or what’s referred to as “negative” symptoms. (A negative symptom is a lack of something that’s typically present in someone without schizophrenia. For example, a person with schizophrenia may be socially withdrawn or he/she may seem very “flat” [without emotion]).

9. Alcohol makes you depressed because it’s a depressant.

Yes, alcohol is a depressant; but as a “depressant,” it depresses your central nervous system, leading to slurred speech, trouble with coordination, etc. The “depressant” effects of alcohol are unrelated to clinical depression.

However, heavy alcohol use is associated with depression and other mental disorders. Someone who is struggling with depression or anxiety may drink as a way to self-medicate. Alternatively, someone with an alcohol use disorder may develop depression, as alcohol upsets the chemical balance in the brain. The lifestyle of someone with alcohol use disorder may also lead to intense guilt, shame, and/or hopelessness, which can in turn lead to depression.


Please help end the stigma attached to mental and substance use disorders by sharing this post!


What Counseling Has Taught Me (Part Two)

Learn to be more effective in your personal and professional life! This is the second installment of how counseling has led to a better understanding of people. Working with addiction and mental illness has gifted me with the capacity to better recognize why people do what they do, which in turn enhances how I relate to others.

By Cassie Jewell, M.Ed., LPC, LSATP

This is the second installment of how counseling has led me to a better understanding of people. (In Part One, I discussed calmness, silence, active listening, partial truths, and hidden agendas.)

Working with addiction and mental illness has gifted me with the capacity to better recognize why people do what they do, which in turn enhances how I relate to others. As a result, I’m more effective in my personal and professional life. I have a sense of peace and “okayness” in the world.

One thing I hadn’t previously considered was brought up by Quora user and mental health professional, G. Bernard (MA Counseling); he shared that counseling revealed the truth about change. “It has really reinforced that idea that people who want change will work harder to achieve it; those who are forced (legally, by parents, spouse etc.) probably won’t.” I agree with this 100%. People can’t be forced into change; and when they are, their efforts lack fortitude and it doesn’t last. Those who are internally motivated will fight for change, making it worthwhile and enduring.

Here are some additional truths and realizations that I gained through my counseling career.

What counseling has taught me (the second installment):

1. A new perspective

The DSM – Diagnostic and Statistical Manual (the “Bible” for mental health professionals) – uncovered a whole new world for me. Sure, I was familiar with mental illnesses like depression, PTSD, and anxiety before grad school. I took Abnormal Psych in college and even before that, I’d read books on schizophrenia, eating disorders, and other mental disorders. (Guess who did their middle school science project on schizophrenia? Me!) But my fleeting knowledge was laughable compared to what I found in the DSM; it provided me with information on every single diagnosable mental disorder. When I started working with clients, I was able to see how mental illness manifests in real life.

The more I learned (and saw), the more I was able to make sense of behaviors. Consequently, this led to me looking back on people I’ve encountered throughout the years. I realized how many of them had been struggling with a mental illness. (At the time, I probably just thought they were just a jerk, or acting inconsiderately.)

I also became more aware of the prevalence of severe mental illness and the way it presents in society. This led to increased tolerance and patience regarding behaviors I’d previous found annoying; I learned to recognize them for what they were.

Mental illness can easily be interpreted as something it’s not. By having an awareness, I’m more compassionate. Instead of judging, I observe. Someone who seems snobby may have social anxiety. That coworker who calls out sick every Monday may be struggling with addiction. A friend who never wants to go out anymore could be depressed.

Mental illness is everywhere if you know what to look for. I strive to give everyone the benefit of the doubt, which is better for my mental health.

2. Don’t give money to the homeless

I knew a client at a residential program with a talent for making clever signs. He’d use markers to write his message (“Will dance for food!”) on a piece of cardboard before grabbing his pail to hit the streets. He didn’t need the money; he received government benefits (funded by taxpayers). The money he earned panhandling funded his K2 habit or the occasional beer.

Many of the “homeless” people you meet are not homeless; they’re con men (or women) who make a profit on your sympathy. Most are either addicted to drugs/alcohol and/or severely mentally ill; they need treatment, not the crinkled dollar bill in your pocket. Giving your spare change isn’t helping that person. Instead, offer to buy a meal, give them a pair of socks, or hand them a bottle of water.

3. Telling someone what to do is not helpful

Giving advice rarely leads to lasting change.

There are a few different reasons why advice, no matter how well-meaning, isn’t helpful. Firstly, it doesn’t account for the person’s full experience or struggle; it could seem ignorant or insensitive. (For example, “Why don’t you just get a divorce?” is not helpful to a woman struggling with her husband’s infidelity; the problem is more complex than just getting a divorce. Children could be involved. Maybe she’s financially dependent on her husband. Maybe she’s still in love with him. Or maybe it’s against her religious beliefs.)

Advice also robs a person of the ability to solve their own problem. We need to learn to find solutions in life in order to grow and to be effective. If someone is always told what to do, they’re not going to learn to function independently.

Lastly, if advice is taken, and it works, the credit goes to the advice giver, not the taker. The results are less meaningful. Alternatively, if advice is taken and it doesn’t work, it becomes the advice giver’s fault. Advice deprives a person of being able to take full ownership of their actions.

If you own your decision and fail, the blame falls on you (helping you to grow as a person) or if you succeed, the triumph is yours alone. Either way, you’re better off finding your own solutions; this allows you to feel capable and you’ll become better at solving problems in the future.

4. The value of transparency and honesty

People like to know what’s happening and what to expect. I get better reactions from clients when I explain why I’m doing or saying what I am. I’m honest, and when I can’t be (or believe it would be inappropriate to do so), I tell clients exactly that. For example, if a client asks about my religion, I’d let them know I don’t feel comfortable sharing personal aspects of my life.

Personally, I prefer the company of others who are straightforward. I don’t like having to guess if someone is upset with me. I don’t like it when someone is nice to my face, but gossips when I’m not around. Those types of games are played by people who are insecure or who are attempting to manipulate you. Life is complicated enough. With me, you’ll know if your fly is down, and if you ask for my opinion, you’ll get it. (There’s much to be said for tact though!) Gentle truths are worth more than flattery. 

5. You can’t demand respect

It’s something that’s earned through words and actions, not freely given. Forced respect is not true respect; it’s fear or deception. And while I believe in treating everyone with respect, I don’t truly respect someone until I know what kind of person they are.

Furthermore, I’ve learned that if someone chooses to disrespect me, it’s not a threat. Respect is powerful, but disrespect? Feeble and pathetic. If someone is disrespectful, it won’t harm you or make you less of a person (unless you give it that control).

Throughout my career, I’ve been disrespected on many, many occasions by clients who don’t want to be in treatment (and even by colleagues with differing opinions). But my sense of self-worth is not dependent on how others treat me. As a result, disrespect from angry clients (or rude salespersons or drivers who cut me off, etc.) doesn’t faze me.

In sum, being a counselor is life-changing. I imagine many professions are to a degree, but I can’t picture any other job leading to such a deep understanding of humanity. Entering the mental health field is like having horrible vision and then finally getting glasses (except it happens over the course of years). I have an enhanced awareness of who I am along with an unforeseen sense of serenity. 

Every single client who’s shared a piece of their story has contributed to my awareness (and to my own personal growth), and I owe them each a gratitude. I’m more cautious in life, yes, but I’m also more compassionate. Instead of having high expectations, I have high hopes. I don’t attempt to control things I have no control over; and I don’t get angry over the decisions, views, or actions of others. Instead, I channel my energy into something more productive; I’m passionate and I’m an advocate. My beauty pageant answer to the stereotypical question is not “world peace”; it’s for everyone to have a deeper understanding of each other.

What insights have you gained from your chosen career? Please share in a comment!

What Are the Characteristics of an Effective Therapist?

Are you in therapy or have you sought counseling in the past? Are you currently practicing as a therapist or counselor? This article explores what makes a therapist effective (or not).

By Cassie Jewell, M.Ed., LPC

For readers less familiar with counseling as a profession, I’ll briefly review the mission, values, and ethics established by the American Counseling Association (ACA) to guide professional counselors. The ACA’s mission is “to enhance the quality of life in society by promoting the development of professional counselors, advancing the counseling profession, and using the profession and practice of counseling to promote respect for human dignity and diversity.”

 Professional values include the following:

  1. enhancing human development throughout the life span
  2. honoring diversity and embracing a multicultural approach in support of the worth, dignity, potential, and uniqueness of people within their social and cultural contexts
  3. promoting social justice
  4. safeguarding the integrity of the counselor–client relationship
  5. practicing in a competent and ethical manner

Ethics include autonomy, nonmaleficence, beneficence, justice, fidelity, and veracity.

The ACA outlines professional values and ethics, but for the purpose of this article, I wanted to learn about current perceptions and views. Also, how do counselors exemplify the code in their practices? Using social media (Reddit and Quora) as a survey tool, I reached out to mental health professionals and therapy participants; I also browsed through older threads and posts on the topic.

I read about traits (like active listening and compassion) that are important to both therapy participants and clinicians. Additionally, I learned about negative experiences, which was disheartening. So what makes a good (or bad) clinician?

An effective therapist is someone who…

Actively listens

Is kind and compassionate

Practices honesty

Is transparent

Puts a lot of thought into what they say

Educates their clients (coping skills, symptoms, stress management, etc.)

Conveys warmth

Reflects and validates feelings

Understands human behavior and mental disorders

Is non-judgmental

Sets and adheres to healthy boundaries

Is genuine (and genuinely cares for their clients)

Has a wide range of techniques and a variety of tools

Is humble (and gives advice sparingly)

Creates a safe place for healing

Is knowledgeable (evidence-based practices, current research, etc.) and intelligent

Possesses emotional intelligence

Is respectful

Experiences and conveys empathy

Has a sense of humor

Is curious

Has patience

Is trustworthy

Recognizes and values other perspectives

Interestingly, a few responders took into account a therapist’s personal values and views (not just how they conduct themselves in a session). As a counselor, this resonated. For example, a therapist can’t be genuine if they’re empathetic with their clients, but rude or nasty otherwise. Being a counselor means fully embracing the code of conduct. Consider how it would feel to discover your therapist treats restaurant staff poorly or gets hammered and then drives. It would likely leave a bad taste in your mouth. A good clinician is a role-model. Furthermore, it’s important for a counselor to be emotionally stable and self-aware, which is something I’ll explore shortly.

Some personal values/traits for effectiveness include…

Resilience
Optimism
Faith in humanity
Courage
Self-acceptance
Holding others and self accountable
Self-awareness
Seeking to improve self and grow, both personally and professionally
Self-esteem and acceptance
Practicing self-care

Regarding professional development, it was noted by Lazar_Milgram (Reddit user) that a counselor must commit to “relearning,” meaning re-reading text books, literature, and research to prevent it from fading. As humans, we forget things. We need to go back to the original source of knowledge now and again. It’s not enough to go to grad school; a counselor must commit to a lifelong education. Along those lines, Lazara_Milgram reported that an effective counselor re-visits his/her failures. If we were unable to help a client for one reason or another, it’s worth it to review their file and our records, consult, and then learn from our mistakes.

On self-awareness, Reddit user Valirony, a marriage and family therapist, shared it’s important for a therapist to be aware of “[his/her] own existing issues and [be] either well-processed on those fronts and/or very capable of compartmentalizing the baggage that is less well-processed.”

To expand on this, consider the experience of emotional anguish. An empathetic person who has experienced a personal tragedy may consequently feel a desire to ease suffering in others. Naturally, they’re drawn to the counseling profession; but if their wounds haven’t healed, they lack the capacity to help their clients.

Sadly, some counselors enter the profession seeking to “fix” others as an attempt to compensate for being unable to face their own issues. In contrast, an effective therapist recognizes his/her limitations as a counselor, especially in the face of personal tragedy. They recognize when it’s their own “stuff” (and not the client) triggering a reaction. They leave the past where it belongs and carry little to no emotional baggage. This allows them to be fully present and engaged.

Valirony (Reddit user) also discussed constructive criticism. It’s essential for the effective therapist to remain open to constructive feedback in order to grow. Valirony explained, “I see a lot of defensiveness in some of my colleagues during consultation; I’m no saint and I feel defensive here and there, but I always take a look at that defensiveness for whatever it is in me that I need to change.” Defensiveness is a clue that something’s not right. On constructive feedback, Reddit user Lazar_Milgram suggested, “Embrace criticism – every criticism is a 50/50 package of perceptual information about you. 50% tells something about you and 50% tells something about client.” Providing it’s thoughtful and well-presented, criticism can inspire insight or provide a new way of looking at something.

Ann Veilleux, a private-practice psychotherapist and Quora user, identified emotional intelligence as a trait for effectiveness. “Intelligence comes to mind first, emotional intelligence certainly, a curiosity and interest in people [as] more [than] machines or plants.” Emotional intelligence is innate; it can’t be developed the way a skill can. Furthermore, a good clinician is curious, but their interest is attached to the well-being of their clients. Veilleux pointed out that an effective therapist must possess interest and ability – not one or the other – in order to sustain the level of investment therapy demands. It’s the “interest and ability to have intimate relationships with many people at the same time and not to tire of that.”

The Therapeutic Relationship

With regard to the client-counselor dynamic, an effective therapist recognizes that the relationship is central to the therapeutic process; it’s the key to healing and growth. A client must trust the counselor before they feel safe enough to share their pain or humiliation or guilt. Traits like warmth, humor, and transparency foster an honest and caring relationship. Counseling skills are important, but can only go so far without a trusting relationship.

To promote a supportive relationship, Reddit user RedYNWA suggested that counselors practice empathy without being overly emotional. RedYNWA described how they felt when their therapist cried in session. “I believe my topic brought up something personal for her. The minute she cried. I stopped talking, and changed the topic. I felt she was unable to hold my topic, and I felt a responsibility to ease her distress. It changed our relationship, I felt like the therapist, and it restricted my ability to divulge deep emotions. It was unintentional on her side. However, it destroyed the therapeutic relationship.”

In the above situation, a counselor’s emotional reactivity upset the balance of the therapeutic relationship. Unintentionally, the therapist sent a strong message. The message was that she was too fragile to hear her client’s pain. If the therapist can’t be strong, how can the client? A counselor who breaks that easily can’t be a source of unwavering support. It’s the client’s job to cry; the therapist’s job is to remain calm, to maintain a safe environment, and to instill hope.

I am acquainted with therapists (colleagues and former peers) who occasionally cry in sessions. Sometimes, it’s an instinctive reaction to hearing the horrors clients have gone through; the discrimination, the trauma, the abuse, and worse. There was a time I cried while facilitating a group, but it wasn’t related to anything being said. That morning, I had learned a former client died by suicide. He shot himself in the head. He was only 22. I felt vulnerable and self-conscious about crying in front of my clients. Later, my supervisor helped me to understand that crying can make a therapist seem more human and authentic, which has the potential to strengthen the counseling relationship while conveying empathy.

Some clients will feel closer to a therapist who cries; others will feel uncomfortable. There’s no right or wrong. Quora user Philippe Gross, Assistant Professor of Psychology at University of Hawaii, pointed out that even with all the right qualities, a therapist will not be a good fit with every client. When this happens, Gross stated that “an effective therapist should be able to recognize this soon and refer the client to a more appropriate therapist.”

One Reddit user and professional counselor, ForeverJung, touched on the importance of not getting caught up in their clients’ pain to the point it becomes their own (also known as vicarious trauma). It’s having “the ability to care deeply and then shut it off,” which can be difficult, especially for new counselors. ForeverJung also shared that an effective counselor must be able to listen, while at the same time “synthesizing data,” and then provide a constructive response that the client will be able to make sense of.

Redddit user blueybluel shared about a therapist they described as absolutely wonderful. “She was incredibly empathetic and patient with me, almost to a fault I felt like sometimes. But it really helped me a lot with my self-hatred, self sabotage and suicidal thoughts because for the first time ever, I was regularly associating with a person who was so soft with me. She genuinely thought I was a great person just the way I was, and that I didn’t have to accomplish and be perfect all the time just to have worth and to deserve to live.”

Similarly, Gatopajama (Reddit user) described positive interactions with their current therapist, who shares their odd sense of humor. “[My therapist] is serious when the topic calls for it, but usually a session with her feels very comfortable and laid back, like having coffee with a girlfriend. She also shares a little bit about herself sometimes (not in an inappropriate or TMI way) — it makes me feel like I’m talking to a real person and not a human psychology textbook. Plus, she’s got a gigantic bowl of moonsand in her office. Sometimes I plop that thing on my lap and play with it the whole hour to keep my hands busy if I’m trying to talk about something difficult.”

What are the traits or characteristics of an ineffective therapist?

While some traits (such as having a gigantic bowl of moonsand!) positively impact the counseling process, others contribute to nonproductive (or even harmful) therapy. When I elicited feedback on effectiveness, I learned about some horribly ineffective and disturbing practices.

An incompetent clinician lacks self-awareness and insight in addition to the required knowledge and skill. They may have entered the field for all the wrong reasons. They’re rigid and closed to new ways of thinking. Most importantly, they don’t listen to their clients. Ssdgmok, a Reddit user, described a bad clinician as “someone who talks about themselves each session, poor listening and ‘giving advice.’” Contrary to popular belief, a counselor’s role is not to advise the client. A therapist is more like a collaborative partner who leads the client to their own insights while providing the tools for change.

To give a personal example of a therapist who talked too much (although not about herself) and didn’t listen, I’ll use myself – but in the role of the client, not the clinician. I was in my late teens and it was one of my first experiences seeing a counselor (a middle-aged woman). The therapist had apparently just finished a session with a young woman who had attempted suicide. And the therapist proceeded to tell me all about it. Meanwhile, I was bursting with pain and self-doubt; and the therapist continued to talk about the client who had just left her office. She went on and on about how she couldn’t believe “that little girl” swallowed an entire bottle of Tylenol. It was like she didn’t hear a word I said, and I left feeling even worse. (Luckily, that experience didn’t poison my view of the profession or dissuade me from entering the field a decade later.)

A Reddit user shared about expressing thoughts of suicide to their therapist

Jwaggin
“Therapist: Are you suicidal
Me: Yea…
Therapist: You hate your mom?
Me: uhhh no
Therapist:Well if you kill yourself your mom would be very hurt
Me: uhhh ok (thanks for the guilt)”

If this happened, it’s clear that the therapist lacked not only empathy, but a basic understanding of mental illness. An effective therapist never shames or “guilts” a client. The client is already in pain (which is what brought them to therapy in the first place). Also, when a client says they’re suicidal, it’s the therapist’s responsibility to explore this with the client while ensuring the client’s safety. An effective therapist helps the client to identify what (if anything) would prevent them from killing themselves; the clinician won’t admonish the client for their hopelessness. To do so would be demeaning, with a disregard to human dignity.

Reddit user blueybluel shared, “When I told [the therapist] all my struggles, she seemed empathetic, but then got on this weird shtick of telling me to do homework of writing down things I like about myself, in an aggressive, demanding, pull yourself up by your bootstraps kind of way, and said, “Can you do that for me? By next week?” I canceled the next appointment and never saw her again.”

There’s no room for aggression in this profession. A good therapist is gentle; they don’t give orders. Instead, they explore, listen, and ask questions. It’s a respectful partnership between client and counselor.

After tragically losing their infant son, a Reddit user sought therapy 

wonder-maker
“I explained my situation about having lost my infant son in a tragic household accident. She asked me to wait a moment, got up, walked to the front desk, came back with a sticky note from the receptionist and told me to come back and see a different therapist at a later date, then refused to make eye contact with me.
The next therapist said to my face ‘Boohoo, your kid died, get over it.'”

In the above example, the first therapist was a woman in her early 40s and the second was a male in his 60s. I’m disturbed by what happened to wonder-maker (Reddit user); and I’m horrified that these “helpers” are out there providing counseling services. The female therapist’s reaction could be explained by lack of experience or skill; alternatively, hearing about the accident could have triggered her (which is why self-awareness is so important). However, there is no excuse or explanation for what the male clinician said. You don’t have to be a therapist to feel empathy or compassion (but you do have to be a jerk to tell a grieving parent to “get over” the loss of a child).

Final Thoughts

In summary, there are many things that positively impact a counselor’s effectiveness, while opposite traits are related to incompetent practice. An effective counselor is an active listener, expresses empathy and compassion, and is genuine and transparent. They promote healing and self-exploration. The therapeutic relationship is also important. An effective clinician creates a safe environment for building trust while providing support. Additionally, to be effective, a therapist must commit to a lifelong pursuit of knowledge to learn new techniques and evidence-based practices, to understand how scientific developments will change the counseling profession, and to keep up-to-date on relevant research.

In contrast, a therapist who is uncaring, uninterested, and who doesn’t listen will never be effective. A counselor who constantly advises their clients or who shames their clients is incompetent and unethical. Furthermore, the absence of emotional intelligence greatly impacts a clinician’s counseling abilities.

Regarding personal values and lifestyle choices, there’s a gray area. Can a therapist who gossips or who abuses sleeping pills provide effective services? What about a marriage counselor who cheats on his wife? While a few therapy participants and mental health professionals emphasized the importance of a therapist’s personal integrity, most responders viewed effectiveness in the context of therapy alone.

Lastly, therapy participants who reported unproductive or even damaging experiences received services from therapists who did not adhere to the ACA code. Conversely, positive and effective experiences were related to ACA values.

Were there any surprises in this post? Were any important traits not mentioned? Please provide feedback in the comments section!