Interview: We Only Get One Body in Life

“We only get one body in life, so it makes sense to treat it well by fueling it with nutritious foods.” An interview with Dr. Lisal Folsom, who discusses optimal health, nutrition, and sustainable weight loss.

Interviewer: Cassie Jewell, LPC

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An Endocrinologist’s Thoughts On Health and Sustainable Weight Loss

On a typical day, what are your patients’ complaints and how do you resolve them?

As an endocrinologist, I care for patients with all types of gland and hormone disorders. The most common reasons patients come to see me include diabetes (both type 1 and type 2), concerns about growth and puberty, thyroid dysfunction, hirsutism (unwanted hair growth), polycystic ovarian syndrome, and adrenal disorders. I also provide gender-affirming hormone therapy for transgender individuals. Depending on the patient’s symptoms and diagnosis, I may order lab tests and/or radiology studies such as thyroid ultrasounds or bone age xrays as part of my evaluation. Once we have a diagnosis, I work with the patient to create a personalized plan for treatment and follow up.

What about common questions or concerns?

Regardless of the reason they’ve come to see me, many patients are concerned about fatigue and weight gain. Everyone loves to blame these symptoms on the thyroid gland, but there are many other possible contributors to both fatigue and weight gain, including lack of quality sleep, sleep apnea, suboptimal eating habits, and infrequent exercise.

How does diet impact health?

A balanced diet and good nutrition are essential for optimal health. The only way to nourish and fuel our bodies is through food, and multiple studies have shown the benefits of good nutrition on health. People who eat a diet composed of fruits and vegetables, whole grains, and lean proteins have lower blood pressure, better cholesterol, and decreased risk of obesity than those who follow a typical Western diet. There is a lot of research going on right now investigating the health effects of switching to a whole foods plant-based diet. A study comparing gut bacteria found that individuals following vegan and vegetarian diets had a more diverse selection of microbes in the intestines, which can lead to better health. Another study published in Clinical Nutrition this year found that people with high cholesterol had improvement in their cholesterol numbers when they followed a whole foods plant-based diet. Their cholesterol worsened when they switched back to a diet containing animal products and refined carbohydrates. We only get one body in life, so it makes sense to treat it well by fueling it with the healthiest, most nutritious foods.

What are the main risk factors for diabetes?

Type 2 diabetes is an acquired metabolic disease associated with insulin resistance and high blood sugars. Until relatively recently this was a disease of adults, but in the past few years more and more children have been diagnosed with type 2 diabetes as well, partly because of the increase in obesity. Risk factors for developing type 2 diabetes include being overweight or obese, carrying extra weight in the abdominal area, lack of regular physical activity, a family history of type 2 diabetes, and being diagnosed with prediabetes. Gestational diabetes during pregnancy is also a risk factor for developing type 2 diabetes later on. A person will not necessarily develop type 2 diabetes just by eating a lot of sugar, but a long-standing pattern of unhealthy eating, lack of exercise, and weight gain will certainly increase the risk of developing type 2 diabetes down the road.

Can diabetes be treated with lifestyle changes?

Lifestyle changes are vital in diabetes treatment! Medicines can help to lower blood sugar, but the underlying cause of type 2 diabetes is insulin resistance, which is exacerbated by weight and lack of regular activity. We know that people who exercise on a regular basis tend to have lower blood pressure, better cholesterol, and are more likely to be at a weight considered to be healthy, than people who don’t exercise often. Part of the reason for this is that exercise improves the body’s sensitivity to insulin. When we exercise, our bodies don’t have to work as hard to turn the food we eat into energy and fuel for our cells. Studies have shown that people with type 2 diabetes who exercise after a meal have lower blood sugar levels than those who don’t. Exercise and a healthy diet are important for everyone, but these elements are especially crucial for people who are looking to improve their health.

Which is worse: Fat or sugar?

Ooh – tough question. I would say both and neither. Both fats and sugars come in healthy and unhealthy forms. Omega-3, polyunsaturated, and monounsaturated fatty acids help lower cholesterol and decrease the risk of heart disease. These healthy fats are found in nuts, peanut butter, avocados, flaxseed, and olive, canola, and soybean oils. Some eggs contain omega-3 fatty acids as well, depending on whether the chickens that laid them were given supplementation. Unhealthy fats include saturated and trans fats. These types of fats are found in fatty cuts of meat, poultry skin, fried foods, high fat dairy products, processed and prepackaged foods, and solid oils such as shortening and lard.

Healthy sugars include those occurring naturally in fruits and vegetables. A good rule of thumb is to try to choose foods that are as close to their natural state as possible. For example, when you eat an apple, rather than drinking apple juice, you get the added benefits of the fiber from the apple, and vitamins from the skin. These added health benefits of eating whole fruits and vegetables allow the sugars to be absorbed more gradually by your body, and are lost when foods are processed.

What is one food you’d never eat and why?

Cracklins. This southern delicacy consists of fried pieces of pork fat and skin, flavored with Cajun spices. Although I’m sure they’re very tasty, they’re also oozing with saturated and trans fats, contain almost 500 calories per serving, and are high in sodium. You could eat an entire avocado and two slices of whole wheat toast for fewer calories. This alternative snack is not only delicious, it also comes with the added benefits of healthy fats, whole grains, and fiber.

If given the opportunity, is there anything you’d change about the current dietary recommendations?

The current dietary guidelines are a good place to start. They recommend eating a variety of fruits and vegetables, making at least half of our grains whole, and limiting saturated and trans fats, added sugars, and sodium. I wish they went a little further though, by emphasizing the health benefits of whole rather than processed foods, and offering alternative options for people looking to follow a plant-based diet. There are some really great dairy alternatives out there, including nut milks (almond, cashew, macadamia), soymilk, plant protein products, and tofu. Many of these are made without added sugar, and are fortified with calcium and vitamin D, so the nutritional content is quite similar to the animal-based versions.

What are your thoughts on the obesity epidemic in America?

Obesity is a growing problem in our country, and it’s going to keep getting worse unless we as a society make some major changes. Obesity is a multifactorial disease, with many different levels of influence. Personal dietary choices have a role of course, but so does the environment in which people live. If a family lives in a food desert, and the only place to buy groceries is the convenience store where one banana and a 6-pack of ramen noodles each cost $1, parents are veritably forced to choose the less healthy, but inexpensive and filling options to feed their children. Many children in the U.S. eat both breakfast and lunch at school through the federally subsidized National School Lunch Program. This program is underfunded, and as such is unable to provide the highest quality, most nutritious food for the children who need it most. There are so many barriers to optimal health that exist at societal and cultural levels; it’s going to take a lot of work to tackle obesity. It’s possible, but change will need to happen from the top down.

What advice do you give to patients who are trying to lose weight?

At the end of the day it’s all about math: Energy in = energy out. If we put more calories into our bodies than we burn, our weight will go up. Alternatively, if we burn more calories than we eat, our weight will go down. Metabolism plays a role, certainly, and we all know people who can eat a dozen donuts without gaining a pound, which is just not fair, but overall consistent, purposeful, portion control is the key to sustainable weight loss. Exercise helps, but it’s really hard to burn enough calories by exercising to offset what we eat. A typical adult woman walking on a treadmill for 30 minutes burns around 150 calories. As a comparison, a pint of Ben & Jerry’s Chunky Money contains 1,160 calories. You would need to spend nearly 4 hours on the treadmill to burn off that pint of deliciousness, and nobody has time for that. It makes more sense to limit your total calorie intake through portion control and careful meal planning. Everyone should have a treat now and then, just plan for them ahead of time and pay attention to the nutrition label including serving size.

What’s one thing you wish everyone knew about hormones?

It’s probably not your thyroid. Seriously though, endocrinology is an amazing branch of medicine. Since our glands make hormones that then flow into the bloodstream, they have effects on so many different parts of the body. Endocrinologists have to consider the entire person when making a diagnosis, and this makes the field both challenging and exciting.

As an endocrinologist, what are the most useful things you’ve learned?

Weight loss is hard, but possible. Diabetes sucks, but you are strong, so don’t let it take over your life. Everybody loves to talk about food. Patients and physicians work best as a team. Good health is priceless.


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Dr. Lisal Folsom is a board-certified physician who specializes in endocrinology, diabetes, and metabolism. She also provides gender-affirming hormone therapy for transgender individuals. Dr. Folsom’s medical research has been published in the academic journals Endocrine Practice, The Journal of the South Carolina Medical Association, Current Osteoporosis Reports, Journal of Adolescent Health, and Endocrinology & Metabolism Clinics. She has been practicing for nine years.

Sleep Deprivation: What Dreams May… Cure?

What happens to your mind and body when you’re sleep-deprived? Poor-quality sleep is linked to a variety of health conditions, including obesity and heart disease. Poor sleep leads to cognitive impairment and poor judgment. A lack of sleep can even lead to schizophrenia-like symptoms! Learn why sleep is essential for health and well-being.

By Cassie Jewell, LPC

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According to the American Academy of Sleep Medicine, about 10% of Americans struggle with chronic insomnia and up to 35% of Americans experience insomnia at least occasionally. I’m part of the 10%. I’ve spent countless nights tossing and turning, dreading the obnoxious sound of “quantum bells” (my cell phone alarm) as daylight slowly creeps in. Due to this, I’ve done quite a bit of research on the subject. (And as a clinician, it’s important for me to know the relationship between restful sleep and mental health so I can educate my clients.)

Sleep recharges us; it makes it possible for us to remember what we learned throughout the day.

We all know that basic sleep hygiene is essential (i.e. having a regular sleep schedule, refraining from watching TV or reading in bed, avoiding alcohol before bedtime, etc.) And if you struggle with insomnia, you’ve probably heard of sleep medications and supplements like Ambien, trazodone, or melatonin. We also know how vital sleep is to health and wellness. Sleep significantly impacts mood, energy levels, and overall well-being. Sleep recharges us; it makes it possible for us to remember what we learned throughout the day.

Knowing how crucial sleep is for both physical and mental fitness, I set out to explore what happens when we don’t get enough. What exactly does a lack of sleep do to a person? I sifted through the research to learn more about the impact of sleep deprivation. This post explores how sleep deprivation affects physical health, perceptions, memory, and critical thinking.

SLEEP AND YOUR PHYSICAL HEALTH

Sleep deprivation is associated with signs of aging

Sleep deprivation has been linked to aging skin. One study found that poor-quality sleepers had more fine lines, uneven pigmentation, and reduced elasticity.

It makes sense that chronic sleep deprivation is associated with signs of aging; sleep is needed for overall rejuvenation (mind and body), which includes skin cell renewal. For smooth and supple skin, high-quality sleep is essential.

Snoring and sleep deprivation are linked to obesity

A 2016 study looked at the relationship between sleep characteristics and body size/weight. Snoring was associated with having a higher BMI, a larger waist, and more body fat. (It should be noted that snoring doesn’t cause obesity; the two are simply related.)

Poor sleep quality and shorter durations of sleep were linked to larger body size and more body fat. The relationship between sleep and obesity is further explored in the next few paragraphs.

Sleep deprivation is related to weight loss and appetite

If you’re dieting, you’re more likely to lose body fat when you’re getting adequate sleep. Researchers studied participants who slept for either an average of seven and a half hours or five and a quarter hours per night over a 14-day period. Calorie consumption was the same; participants lost similar amounts of weight. However, when participants slept more, they lost more body fat; in fact, about half of the weight they lost was fat. Sleep-deprived participants lost only a pound of fat; the other five pounds were fat-free body mass. Furthermore, it was found that sleep helps with appetite control; this is due to ghrelin, a hormone that stimulates appetite and promotes fat storage. Sleep-deprived participants had higher levels of ghrelin.

If you’re watching what you eat, incorporate healthy sleep habits to maximize your efforts; adequate sleep is needed for optimal weight loss.

Sleep affects our food choices

Other studies have examined specific the ways sleep deprivation affects food choices and calorie intake. Sleep deprivation is associated with especially poor food choices the day following poor-quality or no sleep. One study found that sleep deprivation led to strong cravings for junk food. The researchers measured increased activity in the part of the brain that responds to rewards, but decreased activity in the “decision-making” part of the brain. Study participants choose unhealthy items (i.e. pizza, donuts) over fruits and vegetables.

Another study looked at total calorie intake; sleep-deprived participants consumed an extra 385 calories per day. They also ate higher-fat foods. Additionally, researchers found that a sleep-deprived person purchased items that were higher in calories when grocery shopping.

A 2016 study looked at the relationship between sleep deprivation and the consumption of high-calorie, sugar-sweetened caffeinated beverages in a sample of 18,000 adults. It was found that adults who averaged less than five hours of sleep per night were more likely to consume sugary drinks like soda or energy drinks than their well-rested counterparts. The researchers weren’t able to determine whether drinking caffeinated beverages caused people to sleep less or whether being sleep-deprived caused people to crave more sugar and caffeine; it’s likely that both are true.

Without high-quality sleep, it’s difficult to lose body fat.

Regarding obesity, sleep deprivation plays a significant role. A lack of sleep causes us to feel hungry. We crave junk foods and consume more calories. At the same time, sleep deprivation promotes fat storage while decreasing our energy levels. Without high-quality sleep, it’s difficult to lose body fat.

If you struggle with chronic insomnia, make an active decision to make healthy eating a habit; you’ll be less likely to submit to your cravings. Visit the grocery store only when you’re well-rested. Know that you may not feel like exercising; practice determination. Be mindful to counter some of the health risks associated with sleep deprivation.

Sleep deprivation is related to heart disease, hypertension, and stroke (especially if you’re a woman)

In addition to obesity, sleep deprivation is associated with heart disease, high blood pressure, diabetes, and stroke. A lack of sleep takes a toll on the heart. In a recent study, researchers looked at 24-hour shift workers. It was found that sleep deprivation led to a significant increase in cardiac contractility, blood pressure, and heart rate. Furthermore, study participants experienced thyroid changes and an increase in cortisol (the stress hormone).

Research also indicates that chronic sleep deprivation and disrupted sleep are linked to an increased risk of developing or dying from coronary heart disease or stroke. Diabetes and hypertension are associated with sleep deprivation as well.

A lack of sleep may impact women more than men. Researchers found that women who got less than eight hours of sleep per night were at a higher risk of heart disease and other heart-related problems when compared to men who got the same amount of sleep.

Chronic sleep deprivation is related to reduced immune function

Have you ever noticed that you heal slowly or get sick more often when you’re sleep deprived? According to research, chronic sleep deprivation is associated with reduced immune function. If you’re not regularly getting at least six to seven hours of sleep, you’re more susceptible to illness. Your immune system won’t be as effective at eliminating viruses and bacterial infections.

Chronic sleep deprivation is associated with bone loss

Sleep even affects your bones. One study found that chronic sleep deprivation was associated with a loss of bone mass (in rats, at least). The rats underwent sleep restriction measures for three months. A lack of sleep led to significant decreases in bone density, volume, and thickness.

SLEEP AND YOUR BRAIN

Sleep deprivation is associated with increased pain sensitivity

The first part of this post examined sleep’s impact on physical health; the next half will explore how sleep affects the mind, including the way we sense and perceive the world around us. Research indicates that sleep deprivation and/or disruption increase sensitivity to pain. Interestingly, in one study, stimulants like caffeine had the ability to “normalize” the pain sensation (meaning it would feel the way it would with adequate sleep).

Sleep and chronic pain seem to be intricately connected, but the relationship is not fully understood; up to 88% of individuals with chronic pain report sleep issues and nearly 50% of individuals with insomnia have chronic pain..

A lack of sleep affects the way you hear and process sounds

In addition to the sensation of touch, sleep deprivation affects the perception of sound. A lack of sleep impairs central auditory processing (CAP). CAP is crucial for aspects of hearing such as language comprehension, identifying sounds, and recognizing patterns.

In one study, participants took a longer time identifying sounds after being deprived of sleep for 24 hours. It appeared there was a “transfer delay” (from hearing to identifying and then interpreting). To be effective, CAP requires alertness and concentration.

Sleep deprivation affects the formation of memories

We know that sleep deprivation causes cognitive impairment; the brain can only store so much information before it must recalibrate. During sleep, memories are encoded; the brain “consolidates” memories by strengthening them and transforming them from short-term into long-term memories. Without sleep, long-term memories can’t form. Short-term memories are lost and/or altered. Even procedural memories are impacted by sleep deprivation. A lack of sleep leads to forgetfulness and an inability to retain new information.

Sleep affects the way we interpret emotions

Sleep deprivation impairs your ability to interpret facial expressions. A recent study found that a lack of sleep made it difficult for participants to recognize the facial expressions of happiness or sadness. Interestingly, the ability to detect anger, fear, surprise and disgust was not affected. This suggests we’re biologically wired to recognize the emotions related to survival. The researchers hypothesized that the brain preserves functions that perceive life-threatening stimuli while sacrificing functions associated with empathy, bonding, and friendship.

“Real life” implications: If you’re majorly sleep-deprived, you could misinterpret the intentions of others, negatively impacting relationships with co-workers, family, friends, and others. Furthermore, you could read people wrong or miss important social cues; you might not respond appropriately or you could seem lacking in empathy.

When someone is sleep deprived, they’re slower to adopt another’s perspective

In addition to perception and memory formation, sleep deprivation impacts decision-making skills and thoughts, including the ability to accurately assess a situation.

If you have chronic insomnia, you might experience interpersonal problems.

In 2015, researchers hypothesized that sleep deprivation would impair the capacity to recognize sarcasm. Study results didn’t support the hypothesis, but the research generated an unexpected outcome. It was found that someone who was sleep-deprived was slower to adopt another person’s perspective. Implications? If you have chronic insomnia, you might experience interpersonal problems.

Sleep deprivation affects our moral judgment

Sleep deprivation affects moral judgment. In one study, participants were sleep deprived (awake for 53 continuous hours) and then faced with moral dilemmas. They had difficulty solving the dilemmas and making appropriate judgments. Other studies support this as well; a lack of sleep is related to decreased moral awareness. When you’re faced with a tough decision, especially one that involves ethics or morals, be sure to get adequate sleep. You can’t always trust your moral compass.

Sleep deprivation is linked to impaired decision making

Moral decisions are taxing if you’re sleep deprived… the opposite is true with risky ones. Sleep deprivation alters areas in the brain that assess positive and negative outcomes; sensitivity to rewards is enhanced while attention to negative consequences is diminished.

If you haven’t slept, tough decisions can wait.

Researchers found that when gambling, sleep-deprived individuals were more optimistic about their odds of winning. Another study found that sleep deprivation made it difficult for study participants to come to a quick decision when pressured. Sleep-deprived participants also made more mistakes. If you haven’t slept, tough decisions can wait.

A lack of sleep affects optimism

If you’re not getting enough sleep, you could lose your ability to remain positive-minded. Research indicates that individuals with insomnia have lower rates of self-esteem and optimism. In 2017, researchers found that sleep-deprived study participants were less likely to focus on positive stimuli. An inability to think positively is also a symptom of depression.

A lack of sleep can lead to schizophrenia-like symptoms

Sleep deprivation can lead to perceptual distortions, cognitive disorganization, and anhedonia (an inability to feel pleasure).In a 2014 study, participants experienced psychosis after staying awake for 24 hours. The sleep-deprived individuals reported attention deficits and being more sensitive to light, color, and brightness. They exhibited disorganized speech, which is a common symptom of schizophrenia. Participants also reported an altered sense of time and smell. Some of them actually believed they were able to read thoughts; others noticed an altered body perception. Implications? If you miss a night (or two) of sleep, don’t be surprised when you hear voices or when your reality is somewhat altered.

In conclusion, sleep deprivation, especially when it’s chronic, is detrimental to your health. Based on my review of the research, poor-quality sleep can adversely impact your skin, your weight, your cardiovascular system, your immune system, and your bones. (It should be noted that I barely skimmed the surface of an immense body of scientific data on sleep.)

Sleep is also related to brain health. Sleep deprivation impairs sensory perceptions, memory formation, the ability to assess your environment, moral awareness, critical thinking skills, and mood. Sleep deprivation can even induce psychosis.

If you’re like me (the one out of 10 Americans with chronic insomnia), in addition to practicing good sleep hygiene, go ahead and Google “CBT for sleep.” Research suggests that for some, CBT is more effective and longer-lasting than sleep medication. Do a little bit of research. CBT is not a quick fix for insomnia, but it’s worth a try; and your health and wellness are definitely worth it!

References

Alexandre, C., Latremoliere, A., Ferreira, A., Miracca, G., Yamamoto, M., Scammell, T. E., &, Woolf, C. (2017). Decreased alertness due to sleep loss increases pain sensitivity in mice. Nature Medicine, 23(6), 768–774. http://doi.org/10.1038/nm.4329

American Academy of Sleep Medicine. (2009, June 16). Cognitive Behavioral Therapy Is An Effective Treatment For Chronic Insomnia. ScienceDaily. Retrieved February 21, 2018 from www.sciencedaily.com/releases/2009/06/090609072709.htm

American Academy of Sleep Medicine. (2007, March 2). Sleep Deprivation Affects Moral Judgment, Study Finds. ScienceDaily. Retrieved March 10, 2018 from www.sciencedaily.com/releases/2007/03/070301081831.htm

Cappuccio, F., Cooper, D., D’Elia, L., Strazzullo, P., &, Miller, M. (2011). Sleep duration predicts cardiovascular outcomes: A systematic review and meta-analysis of prospective studies. European Heart Journal, DOI: 10.1093/eurheartj/ehr007

Chapman, C., Nilsson, E., Nilsson, V., Cedernaes, J, Rångtell, F., Vogel, H., Dickson, S., Broman, J., Hogenkamp, P., Schiöth, H., &, Benedict, C. (2013). Acute sleep deprivation increases food purchasing in men. Obesity, DOI: 10.1002/oby.20579

Deliens, G., Stercq, F., Mary, A., Slama, H., Cleeremans, A., Peigneux, P., &, Kissine, M. (2015). Impact of acute sleep deprivation on sarcasm detection. PLoS ONE, 10(11). e0140527. http://doi.org/10.1371/journal.pone.0140527

Diering, G., Nirujogi, R., Roth, R., Worley, P., Pandey, A., &, Huganir, R. (2017). Homer1a drives homeostatic scaling-down of excitatory synapses during sleep. Science, DOI: 10.1126/science.aai8355

eLife. (2016, August 23). How sleep deprivation harms memory. ScienceDaily. Retrieved March 10, 2018 from www.sciencedaily.com/releases/2016/08/160823125219.htm

Finan, P., Goodin, B., &, Smith, M. (2013). The association of sleep and pain: An update and a path forward. The Journal of Pain: Official Journal of the American Pain Society, 14(12), 1539–1552. http://doi.org/10.1016/j.jpain.2013.08.007

Gharib et al. (2017). Transcriptional signatures of sleep duration discordance in monozygotic twins. Sleep, DOI: 10.1093/sleep/zsw019

Greer, S., Goldstein, A., &, Walker, M. (2013). The impact of sleep deprivation on food desire in the human brain. Nature Communications, 4 DOI: 10.1038/ncomms3259

Havekes, R., Park, A., Tudor, J., Luczak, V., Hansen, R., Ferri, S., Bruinenberg, V., Poplawski, S., Day, J., Aton, S., Radwańska, K., Meerlo, P., Houslay, M., Baillie, G., &, Abel, T. (2016). Sleep deprivation causes memory deficits by negatively impacting neuronal connectivity in hippocampal area CA1. eLife, 5 DOI: 10.7554/eLife.13424

Johns Hopkins Medicine. (2017, February 2). Sleep deprivation handicaps the brain’s ability to form new memories, mouse study shows: Chemical recalibration of brain cells during sleep is crucial for learning, and sleeping pills may sabotage it. ScienceDaily. Retrieved March 10, 2018 from www.sciencedaily.com/releases/2017/02/170202141916.htm

Khatib, H., Harding, S., Darzi, J., &, Pot, G. (2016). The effects of partial sleep deprivation on energy balance: a systematic review and meta-analysis. European Journal of Clinical Nutrition, DOI: 10.1038/ejcn.2016.201

Killgore, W., Balkin, T., Yarnell, A., &, Capaldi, V. (2017). Sleep deprivation impairs recognition of specific emotions. Neurobiology of Sleep and Circadian Rhythms, 3(10) DOI: 10.1016/j.nbscr.2017.01.001

King’s College London. (2016, November 2). Sleep deprivation may cause people to eat more calories. ScienceDaily. Retrieved March 10, 2018 from www.sciencedaily.com/releases/2016/11/161102130724.htm

Knutson, K. (2012). Does inadequate sleep play a role in vulnerability to obesity? American Journal of Human Biology, 24(3), 361. DOI: 10.1002/ajhb.22219

Liberalesso, P., D’Andrea, K., Cordeiro, M., Zeigelboim, B., Marques, J., &, Jurkiewicz, A. (2012). Effects of sleep deprivation on central auditory processing. BMC Neuroscience, 13(83). http://doi.org/10.1186/1471-2202-13-83

Mitchell, M. D., Gehrman, P., Perlis, M., &, Umscheid, C. A. (2012). Comparative effectiveness of cognitive behavioral therapy for insomnia: A systematic review. BMC Family Practice, 13(40). http://doi.org/10.1186/1471-2296-13-40

Perelman School of Medicine at the University of Pennsylvania. (2017, July 17). You’re not yourself when you’re sleepy. ScienceDaily. Retrieved March 10, 2018 from www.sciencedaily.com/releases/2017/07/170717120048.htm

Petrovsky, N., Ettinger, U., Hill, A., Frenzel, L, Meyhofer, I., Wagner, M., Backhaus, J., &, Kumari, V. (2014). Sleep deprivation disrupts prepulse inhibition and induces psychosis-like symptoms in healthy humans. Journal of Neuroscience, 34(27): 9134 DOI: 10.1523/JNEUROSCI.0904-14.2014

Prather, A., Leung, C., Adler, N., Ritchie, L., Laraia, B., &, Epel, E. (2016). Short and sweet: Associations between self-reported sleep duration and sugar-sweetened beverage consumption among adults in the United States. Sleep Health, DOI: 10.1016/j.sleh.2016.09.007

Radiological Society of North America. (2016, December 2). Short-term sleep deprivation affects heart function. ScienceDaily. Retrieved March 10, 2018 from www.sciencedaily.com/releases/2016/12/161202100943.htm

Universität Bonn. (2014, July 7). Sleep deprivation leads to symptoms of schizophrenia, research shows. ScienceDaily. Retrieved March 10, 2018 from www.sciencedaily.com/releases/2014/07/140707121415.htm

University Hospitals Case Medical Center. (2013, July 23). Sleep deprivation linked to aging skin, study suggests. ScienceDaily. Retrieved March 10, 2018 from www.sciencedaily.com/releases/2013/07/130723155002.htm

University of Arizona. (2017, March 23). Sleep deprivation impairs ability to interpret facial expressions. ScienceDaily. Retrieved March 10, 2018 from www.sciencedaily.com/releases/2017/03/170323132524.htm

University of California – Berkeley. (2013, August 6). Sleep deprivation linked to junk food cravings. ScienceDaily. Retrieved March 10, 2018 from www.sciencedaily.com/releases/2013/08/130806145542.htm

University of California – San Francisco. (2016, November 9). Shorter sleep linked to sugar-sweetened drink consumption: Treating sleep deprivation could potentially help reduce sugar intake. ScienceDaily. Retrieved March 8, 2018 from www.sciencedaily.com/releases/2016/11/161109112553.htm

University of Chicago Medical Center. (2010, October 5). Sleep loss limits fat loss. ScienceDaily. Retrieved March 10, 2018 from www.sciencedaily.com/releases/2010/10/101004211637.htm

University of Warwick. “Lack Of Sleep Could Be More Dangerous For Women Than Men.” ScienceDailywww.sciencedaily.com/releases/2009/07/090701083523.htm

University of Warwick. (2011, February 8). Sleep deprivation: Late nights can lead to higher risk of strokes and heart attacks, study finds. ScienceDaily. Retrieved March 10, 2018 from www.sciencedaily.com/releases/2011/02/110208091426.htm

University of Washington Health Sciences/UW Medicine. (2017, January 27). Chronic sleep deprivation suppresses immune system: Study one of first conducted outside of sleep lab. ScienceDaily. Retrieved March 10, 2018 from www.sciencedaily.com/releases/2017/01/170127113010.htm

Washington State University. (2017, December 20). Seeing gene influencing performance of sleep-deprived people. ScienceDaily. Retrieved March 10, 2018 from www.sciencedaily.com/releases/2017/12/171220153055.htm

Washington State University. (2015, May 7). Sleep loss impedes decision making in crisis, research shows. ScienceDaily. Retrieved February 21, 2018 from www.sciencedaily.com/releases/2015/05/150507165432.htm

Whitney, P., Hinson, J., Jackson, M., &, Van Dongen, H. (2015). Feedback blunting: Total sleep deprivation impairs decision making that requires updating based on feedback. SLEEP, DOI: 10.5665/sleep.4668

Wiley. (2013, September 5). Sleep deprivation increases food purchasing the next day. ScienceDaily. Retrieved March 6, 2018 from www.sciencedaily.com/releases/2013/09/130905113711.htm

Wiley-Blackwell. (2012, April 17). Lack of sleep is linked to obesity, new evidence shows. ScienceDaily. Retrieved March 10, 2018 from www.sciencedaily.com/releases/2012/04/120417080350.htm

Xiao, Q., Gu, F., Caporaso, N., &, Matthews, C. (2016). Relationship between sleep characteristics and measures of body size and composition in a nationally-representative sample. BMC Obesity, 3(1).

Xu, X., Wang, L., Chen, L., Su, T., Zhang, Y., Wang, T., &, Zhang, Y. (2016). Effects of chronic sleep deprivation on bone mass and bone metabolism in rats. Journal of Orthopedic Surgery and Research, 11(87). http://doi.org/10.1186/s13018-016-0418-6

Free Online Education for Mental Health Professionals

A list of online education courses and trainings for mental health clinicians (some offering free CEs!)

Compiled by Cassie Jewell, LPC, LSATP

Updated March 8, 2019

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Are you looking to expand your clinical knowledge or do you need CEs to renew your license? In-person workshops and seminars are ideal for learning up-to-date practices and the latest research, but they’re often expensive and/or require travel. And while there are plenty of online programs that offer CEs, most charge a fee.

The following list is comprised of over 50 sites that offer free online courses and webinars. Please note that only a few of the sites offer CEs. However, all of the courses offer opportunities to grow as a clinician and expand your knowledge.

6-Module DBT Course

An educational course designed for professionals to learn the basic principles for the diagnosis and treatment of borderline personality disorder. There are six 20-minute modules.

Addiction Treatment Forum: Online Continuing Education Free Training Modules

Trainings on Hepatitis/HIV/AIDS and medication-assisted treatment for opioid addiction

The American Institute of Stress

The AIS Learning Center offers videos and online courses.

American Society of Addiction Medicine

Addiction medicine webinars

Anxiety and Depression Association of America

Free monthly webinars. You can access archived webinars. You can also watch a six-part series for professionals on treating anxiety disorders.

Battered Women’s Justice Project

Access recorded webinars on sexual violence prevention and policy.

Brain & Behavior Research Foundation

A variety of webinars. (Sign up for the newsletter to be notified when new webinars are available.)

CDC Train

Over 1,000 public health training opportunities, many offering free CEs. Create an account to access a variety of online courses.

CME/CE Courses on Topics Related to Opioid and Substance Use Disorders from the National Institute on Drug Abuse

Courses on opioids, opioid overdose, and opioid prescribing

DSM-5 Online Training Course

Free course through Relias Learning

Eating Disorders HOPE

View recorded webinars on topics related to eating disorders.

Free Mental Health Webinars

SocialWork.Career posts a list of free webinars every month

Free Online Psychology Courses from Top Universities

LearningPath.org provides links to a variety of psychology courses

FUTURES Without Violence

View recorded webinars on topics relating to violence against women and children.

Health e Knowledge

Free online courses on a variety of topics including clinical supervision, substance use, and behavioral health. You must create a free account and login to access the courses.

Healthy Minds

A public television series on mental health (and ending stigma)

Homeless Resource Center

A SAMHSA site. Register to access free trainings on topics related to homelessness and behavioral health. Free CEUs offered for NAADAC after passing the post-course quiz.

Indiana Prevention Resources Center

Webinars and online modules on drug education and treatment. You must register to access the courses. Free CEUs.

Institute for Research, Education, and Training in Addictions

Register for a free account to access web-based training (webinars and online courses) on addiction and recovery topics. Free CEUs for NAADAC and Social Work.

International Society for Bipolar Disorders

Free webinars. The site also offers videos and tools for clinicians.

Interpersonal and Social Rhythm Therapy

IPSRT is an evidence-based treatment for bipolar disorder. With registration, this course offers a free 8-hour online training.

Knowledge Application Program (KAP) E-Learning

A SAMHSA site with free courses for mental health professionals. CEUs offered for NAADAC. You must register to access the trainings.

Magellan Health E-Learning Center

Professional learning opportunities. Many of the continuing education courses offer free CEs approved by the following organizations: APA, ASWB, NBCC, and NAADAC.

Massachusetts General Hospital Psychiatry Academy

Free education (CE credits) for mental health, primary care, and nursing professionals. Create a free account to access online learning programs.

Mental Health America

Recorded webinars on various mental health topics

Mental Health Professionals’ Network

Australia-based site. Webinars on topics ranging from complicated grief, complex trauma, anxiety, LGBT issues, and more.

Mental Health Recovery

On-demand webinars on using WRAP – Wellness and Recovery Action Plan.

Military Cultural Competence – Free Online Course

75-minute interactive course

Mindfulness-Based Stress Reduction

Learn mindfulness with this free 8-week course

NAADAC

Webinars on addiction

National Center for PTSD

Training materials, online courses, information, and tools for professionals

National Center on Domestic Violence, Trauma, and Mental Health

Free webinars and seminars. (You must register for the webinars.) The site also provides free toolkits and other resources.

National Center on Substance Abuse and Child Welfare

Sign up for free online tutorials. (An access key will be sent via email you register.) CEUs offered for NAADAC professionals.

The National Child Traumatic Stress Center Network: TheLearning Center

Online courses and webinars on childhood trauma. CE’s for social workers, counselors, and psychologists

National Council for Behavioral Health

Webinars on various topics related to behavioral health

National Institute of Mental Health

The multimedia section has a variety of webinars and recorded series.

National Institute on Drug Abuse

Videos and CE opportunities

National LGBT Health Education Center

Free webinars on LGBT health issues

National Resource Center for Mental Health Promotion & Youth Violence Prevention

Access the learning portal for online learning modules and webinars, along with supporting materials and related resources.

National Sexual Violence Resource Center

Online learning campus

NEARI Press & Training Center Webinars

View webinars on topics related to the prevention of sexual abuse

OMNI Behavioral Health Webinars

Offers both free and paid Webinars on a variety of topics, some offering CEs

Pathways to Positive Futures (Research and Training Center)

Pathways aims to improve the lives of young people with severe mental illness. Register for upcoming webinars or access previous webinars on-demand.

PsychArmor

Free courses on military cultural competence, PTSD, combat stress, and other related issues.

SBIRT for Health and Behavioral Health Professionals: How to Talk to Patients about Substance Use

A 3.5-hour self-paced course on screening, brief intervention, and referral to treatment for substance use. Offers free CEs for NAADAC and NBCC (among others).

SOAR Works! (SOAR Online Course)

A free 20-hour course with seven comprehensive classes that teaches how to navigate the SSI/SSDI application process with clients with mental illness, who are at risk of homelessness, have a medical impairment, or a co-occurring disorder. CEUs offered for NASW.

Stalking Resource Center

Archived webinars

Stanford Center for Continuing Medical Education

Free health and medical courses

Suicide Prevention Resource Center

Online courses on suicide prevention

YMSM & LGBT

Access archived webinars on topics related to treatment services for the lesbian, gay, and transgender population. You can also access a monthly webinar series held on the 4th Friday of each month. CEs may be offered.

Zero Suicide

Readings, tools, videos, and webinars


If you know of a site that offers free courses or trainings, please list in the comments section!

19 Unique Ways to Be More Charitable

Ideas for charity contributions that are easy, cheap (or free!), and fun. An awesome list for people who may not have a lot of money or time, but still want to give back.

By Cassie Jewell, LPC

updated 19 unique ways to be more charitable (1).png

To build self-esteem, one must do “esteemable” acts.

I’m not sure who originally said this, but it’s something I (as a substance abuse counselor) often told my clients. I worked with adults who were worn down or broken from their battle with addiction; an individual with a substance use disorder often feels tremendous guilt and shame.

One of the best things a person can do to build self-esteem or live a more meaningful life is to help others…

I taught my clients to cherish themselves, to forgive, and to find a purpose in life. One of the best things a person can do to build self-esteem or live a more meaningful life is to help others; random acts of kindness, volunteering at a homeless shelter, reading to children at a library, donating toiletries or blankets to someone who has lost their home in a fire… There are countless ways to help. Research indicates that practicing compassion and volunteering build self-esteem.

Unfortunately, not everyone has the time to volunteer (or the resources to donate). The purpose of this list is to provide ideas for charity contributions that are easy, cheap, and fun. I created this list for people who may not have a lot of money or time. I found some awesome ways to give back that aren’t time-consuming; many of the ideas require minimum effort and/or are 100% free. Build them into your life and feel happy about helping those in need!


UNIQUE AND FUN

1. Purchase Who Gives A Crap toilet paper. 

Products are environmentally friendly and 50% of profits go to help build toilets and improve sanitation in the developing world.

2. Donate your wedding dress for a cause.

Here are a few of my favorites:

Wish Upon A Wedding: A nonprofit organization that grants weddings and vow renewals for couples facing serious illness or a life-altering circumstance.

Adorned in Grace: All proceeds are used to promote awareness and prevention of sex trafficking as well as crisis prevention for trafficked victims.

Cherie Amour: Proceeds from dress sales help low income individuals get jobs.

Fairytale Brides: Net proceeds from all sales are donated to charitable organizations supporting women’s empowerment programs.

3. Save a life by joining a marrow registry such as Be The Match or Gift of Life. 

Your donation may save the life of a person with a blood cancer like leukemia and lymphoma. You must be in good health and you must be prepared to spend 20-30 (non-consecutive) hours of your time if you are chosen. Not everyone is chosen; according to Be The Match, about 1 in 430 members goes on to donate marrow or peripheral blood stem cells. If you join Gift of Life, you have a 1 in 250 chance of being a match, but then only a 20% chance of donating.

You can also donate blood at a blood drive. O-negative is the universal donor type because it is compatible with any blood type, but only about 5% of the U.S. population have this blood type. There’s a great need for O-negative donations (Source: https://www.redcrossblood.org/learn-about-blood/blood-types.html)

4. With Kiva, lend as little as $25 to help a borrower start or grow a business, go to school, access clean energy or realize their potential. 

100% of every dollar goes to a loan. You can browse through different categories and attributes. According to Kiva, 97% of loans are repaid, but there’s no guarantee. You can read the borrower’s story before you submit your loan. (I loaned $25 to a woman in El Salvador to help her buy a sewing machine. Update: I received full repayment within three months.)

5. Help the homeless.

Keep a pack of bottled water in your car. Alternatively, you can provide someone in need with a small bag filled with toiletry items, socks, tissues, granola bars, etc. (Take the extra shampoo, lotions, and soap when you’re at a hotel and put them to use!) If the weather is cold, buy gloves or hats from the dollar store to hand out. Give $5 gift cards for Burger King or Taco Bell. Personally, I choose to not give cash. (Many of the “homeless” individuals you see are panhandlers.) However, if I’m in an area with a large homeless population, I buy a pack of cigarettes; when someone asks for change, I offer a cigarette instead. Lastly, because of the work I do, I have business-sized cards with a crisis line, a phone number for local resources (including shelters), and a number for a substance use program, which I pass out if needed.

6. Host a closet swap party!

Exy Castellanos, a social worker from Chattanooga, Tennessee, provided this idea. “My friends and I have a closet swap party. We swap clothes and stuff and whatever is left over we donate to a local thrift store (not Goodwill).”

7. Volunteer with Idealist.

It’s free to sign up, to search for opportunities, and to connect with others. Idealist is a global network of people and organizations that connects individuals with advantages to work, volunteer, or intern. To give you a better idea, here are examples of some volunteer opportunities: Reading partner at an under-resourced elementary school, judging a local competition, playing with homeless children one night a week, coaching a sports team, volunteer zoo guide, volunteering at a museum, cleaning up a national park, and interpreter.

8. Run (or walk/march/bike) for charity!

Pick a cause and raise funds.

9. An Internet search led me to Helping Hands: Monkey Helpers for the Disabled, which helps adults with spinal cord injuries and other mobility impairments in the U.S. to live more independent and engaged lives. 

This is accomplished by providing the individuals with unique service animals (at no cost): Highly trained service monkeys to help with daily tasks.

10. Janelle Bennett from Michigan suggested Charity: Water, a great organization bringing people clean water. 

100% of donations go to actually helping people. You can start a fun campaign to raise funds; one guy actually rented his face and let a stranger shave his beard on the street to raise money.

11. Every time you buy concert tickets, donate to charity.

At one point in my life, I decided that if I could afford concert tickets, I could afford a small donation ($25) for a good cause. (And it doesn’t have to be concert tickets; it can be anything you want! Buying a piece of jewelry, purchasing an electronic device, dinning out, etc.)

EFFORTLESS

12. Instead wedding favors, make a donation to your favorite charity for each guest. 

At my wedding, my husband and I picked a lung cancer nonprofit to honor his father, who passed away from lung cancer. You can buy cards on Etsy or, just make them yourself with pearl cardstock paper! (See photo from my wedding.)


13. Tabs for a Cause is a free browser extension.

Every time you open a new tab, a donation is made to your favorite charity.

14. Lyft has a “round up and donate” setting; opt in, and your fare will round up automatically with each ride. 

There are a variety of causes to choose from.

15. “Click to give” at GreaterGood. 

It’s completely free. You can click once per day, and there are multiple causes to choose. I first discovered GreaterGood through The Animal Rescue Site; a single click helps to provide food and shelter to animals in need. (You can also do some shopping and a percentage of the item’s retail price is donated to a cause. I bought a beautiful handbag with a jungle print!)

16. Shop at AmazonSmile at no extra cost, and Amazon will donate a portion of the purchase price to your favorite charitable organization.

You can choose from nearly 1 million charities, including local charities.

17. If you use Swagbucks, you can donate your Swagbucks to various charitable causes instead of redeeming for a gift card or cash. 

Similarly, some airlines will allow you to donate your miles to a cause.

18. If you’re a runner, download the Charity Miles app to earn money for charity for the miles you run. 

You can also earn money for walking and biking.

19. Play free vocabulary games at Free Rice and for each correct answer, 10 grains of rice are donated to World Food Programme to help end hunger.

Free Rice has two goals: To provide free education and to end world hunger

Additional Ideas: 

Wands for Wildlife: Donate old mascara wands! They’re used to gently remove fly eggs and larva from the fur of wild animals. (Wash in soap and warm water before mailing.)

Coin Up: Download the app to round up on credit or debit card transactions. Your “spare change” is then donated to the charity of your choice each month.

CoinStar Coins That Count: Take your change to a CoinStar kiosk to donate to a charity of your choice. A printed receipt will be provided.

Rake a neighbor’s yard or shovel their driveway. 

Pay for a stranger’s coffee, dinner, grocery item, etc. 


 

Before making a donation, you can check a charity’s credibility (including a financial breakdown of funds) at the BBB Wise Giving Alliance. Alternatively, you can use Charity Watch, which grades charities and includes “red flag” information. The site also provides a list of the top charities. Also, Charity Navigator, which includes guides and tips for donating items, volunteering, informed giving, and more.


What are some creative and unique ways to donate to charity? Leave an answer in the “Comments” section!

Updated June 22, 2018



Karche, M. (2009). Increases in academic connectedness and self-esteem among high school students who serve as cross-age peer mentors. Professional School Counseling, 12(4), 292-299.

Mongrain, M., Chin, J., &, Shapira, L. (2011). Practicing compassion increases happiness and self-esteem. Journal of Happiness Studies, 12(963).

von Bonsdorff, M.B. &, Rantanen, T. (2011). Benefits of formal voluntary work among older people: A review. Aging Clinical and Experimental Research, 23(162).

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, LPC

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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.

christian-stahl-313383-unsplash

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

Interview: Breakfast Beers, Bloating, and Blackouts

“Every night, I would drink until I passed out, often fully clothed with a beer in hand. I would then wake up, brush my teeth and immediately vomit. I would brush my teeth again and then go to work.” This was the daily routine for JMS, who wore his alcoholism as a badge and didn’t plan to live past 30. In this interview, a recovering alcoholic discusses addiction, sobriety, what everyone should know about alcoholism, and why you might be a jerk if you believe a common myth.

Interviewer: Cassie Jewell, LPC

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JMS, a recovering alcoholic, has been sober for nearly six years. He started drinking at the age of 13. He continued to drink throughout his 20s, a “dark and miserable existence,” and didn’t think he’d live to be 30. In 2012, a suicide attempt nearly claimed his life. He woke up in a psych unit, having no memory of what happened, and decided he wasn’t ready to die.

JMS’s “official” recovery date is July 5, 2012. The following is an interview about how he got sober, why AA isn’t for everyone, and why you’re a shitty person if you believe addiction is a choice.


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What’s your definition of recovery?

JMS: I don’t see recovery as an end goal. To me, recovery is a path towards my end goal, which is contentment. I have found that I will never be content and happy with my life if I am using some sort of substance. For me, recovery is complete sobriety from all mentally and physically altering substances. I have tried and learned that I cannot pick and choose what to use. It does not work for me. More than just abstinence, recovery is a way of life. It is about being accountable for your actions, admitting when you are wrong, trying your best, and letting things go. Just trying to be a better person than I was yesterday.

  

Is alcoholism a disease?

It is difficult for people to accept that alcoholics suffer from a disease and are not just a bunch of selfish degenerates that don’t care about their lives.

JMS: I feel the word “disease” can be quite polarizing when discussing addiction. Alcoholism is chronic, progressive, and fatal. Much like diabetes, alcoholism is a relapsing disorder that needs a lifetime of monitoring and treatment. Based on these facts, yes, alcoholism is a disease. I feel this is a difficult idea for people to swallow. Much of addiction has been seen as a moral issue or a failing of willpower. It is difficult for people to accept that alcoholics suffer from a disease and are not just a bunch of selfish degenerates that don’t care about their lives.Obesity holds a similar stigma, though fat shaming has started to catch a bad rap.



When did you realize you had a drinking problem?

I knew for a long time that I was unable to stop drinking, but I didn’t care. I never had any intention of making it to 30 years old

JMS: Hmm, that’s a tough question to answer. My gut response here is to say when I went to jail for my 3rd DUI in 2010, which is when I started to actually try to get sober. But if I am honest with myself, I was well aware that there was a problem years before that. I knew for a long time that I was unable to stop drinking, but I didn’t care. I never had any intention of making it to 30 years old.I lived a really dark and miserable existence for most of my 20s. I could identify story after story about when I should have realized that there was a problem. Destroyed friendships, arrests, hospital visits, blackouts, poor choices, breakfast beers, etc. The truth is, I knew that I drank differently from my friends when I was a kid. When we would wake up hung over after a party, I was the one that would sneak vodka shots. So, I think somewhere in there, I was always aware that it was a problem. I come from a family of alcoholics. My father, his sisters, and his parents are/were all alcoholics. So it was almost a badge of honor to be another alcoholic [last name].



In active addiction, how did alcohol affect your health and appearance?

I learned that it is not normal to have diarrhea everyday for 10+ years.

JMS: I lost 60 lbs. when I stopped drinking. I changed absolutely nothing other than cutting out beer and dropped 60 lbs. I looked and felt a lot less bloated. I also learned that it is not normal to have diarrhea everyday for 10+ years. Honestly, the biggest physical change I experienced, that I am still grateful for today, is acid reflux. While drinking, I kept TUMS in business. I never went anywhere without them. Today, I need to eat some TUMS when I eat pizza or spicy food… you know, like a normal person. I never noticed the impact that drinking had on my sleep until I was no longer drinking. The first few months I really struggled to sleep well since I never had healthy sleep hygiene. Allow me to paint you a picture. Every night, I would drink until I passed out, often fully clothed with a beer in hand. I would then wake up, brush my teeth and immediately vomit. I would brush my teeth again and then go to work. Shower or not, I always reeked of alcohol, so showering was not a top priority. I always thought that I never got hangovers, but once sober I realized that I only thought that because being hung-over was my normal and I was experiencing them every morning. Ugh, the physical impact that had on my life is really something I do not miss.



How (and why) did you get sober? Who and/or what helped? Also, share about some things that were not helpful to you.

JMS: I got sober because I did not want to die. I tried to kill myself the last time that I drank. I do not remember what happened, but I remember waking up in a psych unit in the hospital. There are a bunch of people that were integral to the success of my sobriety at this time. My family is number one. They never gave up on me, despite the hell I put them through. I moved back into my mom’s house when I got out of the hospital. She and my siblings were nothing but supportive of me then and still to this day. I do not know if I would be sober today without their unconditional love and support.There are four other people that I owe my life to at this point. My therapist, my addiction counselor, Bob, my friend Alex, and my friend Jon.  I had been working with my therapist for a few years prior to my last drinking adventure. She has always been willing to challenge me and has been a safe space for me to work through some of my biggest fears. She has really helped me understand the nature of my addictions and helped me reframe my thinking and processing of my emotions.

I didn’t buy into [AA].

I have been through multiple addiction treatment programs in my life and none of them stuck. I always approached them with a cynical eye and was just going through the motions to get my family or the courts off my back. A condition of my discharge from the hospital was to enroll in an intensive outpatient program. This is where I met Bob. I figured this was another bullshit program that I was going to have to work through to keep people off my back. Bob was different. He encouraged us to go to 12-step meetings. Of course, I refused. I didn’t buy into those programs. Bob challenged me here. He asked that I attend one meeting in the coming week and write a list of everything that I hated in the meeting. I gladly did this and came back and an entire 8.5×11 sheet of paper full of my gripes. Bob listened to my list and challenged me to go to another one the next week and make a new list with different complaints. I rose to this challenge and did it again, glad to prove my point that AA was stupid and not for me. Bob again listened to my list (without arguing against any complaints) and provided another challenge. Bob asked me to go to another meeting and make a list of the things that I liked from the meeting. I did and, as any alcoholic can tell you, you are bound to hear things in an AA meeting that resonate with you, whether you buy in to the program or not. Bob continued to challenge me to go to meetings, not to go and drink the kool-aid and say some prayers, but to see what I can find that I like. There were other aspects of Bob that I couldn’t figure out why I liked him until one day, I walked into an AA meeting and he was sitting at the front table leading the meeting. Bob is an alcoholic. In that moment I knew that he understood my struggle. Bob was sober and doing meaningful work. Bob was ok. I wanted to be like Bob.

I owe my life to Alex.

I met Alex in the IOP [program] that Bob ran. Alex and I came from different worlds (he was smoking crack on the streets in Baltimore [and] I was drinking in bars in DC), but we had the same reality of sobriety or death. Alex went with me to those AA meetings [around the time that] Bob was challenging me. Alex also brought me to the meeting that would become my home group and introduced me to the people that would soon be my AA family. I owe my life to Alex. I would be remiss not to pay homage to Alex. Alex was murdered in an Oxford house a year in to our sobriety. Alex died sober, which was something he never believed would happen. I miss him every single day.

Finally, my friend Jon; he and I started drinking together as kids. He and I lived together after college and blossomed into the full fledged alcoholics we became. And he and I got sober around the same time on different coasts of the country. When I got out of the hospital, Jon moved back east from California and moved into my mom’s basement. He and I went to AA meetings daily, often more than just one each day. We then spent that first year of sobriety living together trying to figure out how to live.

I did not give a damn about anything while in my active addiction, so telling me you were going to breakup with me or I was going to lose my job did not matter.

What was not helpful? Counselors who tried to tell me about sobriety that clearly did not understand addiction. Ultimatums also did not help. I did not give a damn about anything while in my active addiction, so telling me you were going to breakup with me or I was going to lose my job did not matter. Probation was useless. The biggest impact the state had on my drinking was when I was sent to jail.



What prevents you from going back to drinking?

There is nothing in your life that a drink can’t make worse.

JMS: My life now. I love the person I am today. When I was drinking, I hated myself. I never want to be that person again, and I don’t have to be as long as I don’t drink. I have come to the realization that my worst day sober is infinitely better than my best day drinking. I don’t attend AA meetings anymore, but many of the slogans still bounce around in my head. The most important one I ever heard was, “There is nothing in your life that a drink can’t make worse.” I’m not going to lie and say that now I am sober, life is easy and happy and super fun all the time. It’s not. However, I am better equipped to handle the bullshit in life with a clear head. I would be lying to say that I don’t experience cravings but I know that a drink is not the solution to life’s problems.



What’s something you wish you had known before you became addicted to alcohol? (If you could go back in time and have a word with your younger self, what would you say?)

JMS: I feel like most people will expect me to say something like, “I would slap that first drink out of my hand!” That is not true for me at all.I am the person I am today because of my history with drinking. I am proud of the person I have become and I am not sure I would be who I am without the struggles I went through. I would want to assure myself that it was going to turn out okay and that I would not be that miserable forever. I do wish I had understood and cared about (at the time) the severity of the pain and worry I put my mom and siblings through.



What something you wish everyone knew about alcoholism?

JMS: It is not a choice. Alcoholics don’t drink the way they do because they don’t care about you or their families. They drink the way they do because they cannot control the cravings and urges and are overcome by guilt/shame/fear/pain. I am fairly confident that if every alcoholic could “just stop drinking” they would. Alcoholism is exhausting.

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What are your thoughts on AA?

JMS: AA can save lives. I attribute my sobriety to the teachings of, and people I met in, AA. That being said, AA does not work for everyone. I like to [view] AA [as] a religion. AA meetings are akin to going to church, the Big Book is the bible, and sobriety is heaven. Some people need to go to church daily to find their way to heaven. Others only need to read the text to understand the tenets of the religion to find their way there. And some people find their way into heaven following other religious texts or none at all. There is no wrong way to get sober. I do have complaints about AA and I feel there are aspects of it that prevent people from finding their way to sobriety. The focus on actual religion in AA is a major turn-off for people. While AA espouses that it is non-denominational and that we alcoholics are welcome to choose the God of our understanding, we are then thrown into a prayer circle to recite the Lord’s Prayer at the end of the meeting. For a low-bottom newly sober person, it is difficult to believe that there is a God that would allow us to sink so low and experience so much pain. But as I mentioned above in my story about Bob, he challenged me to find what I hated (and you better believe that GOD was written in huge letters on that first sheet of paper) and taught me to focus on what I liked.

If you are struggling, try it.

So, my thoughts? If you are struggling, try it. Ignore the God part for now. Listen to other people tell your story and see that it is possible to get better.

How do you feel when people drink around you?

JMS: In a word, annoyed. Slurred speech, glassy eyes, stumbling, and repetitive stories are not a cute look for anyone. I often feel embarrassed for the people I am around as well. It is always a nice reminder of why I don’t drink. I see absolutely nothing attractive to it and I am glad I don’t do that to myself anymore.

What’s the worst thing about being in recovery? The best?

JMS: The worst part [about] being in recovery is trying to explain to people that they don’t have to behave differently around me once they find out. I can’t count the number of times people have asked me if it is okay to drink around me or warned me that there was going to be alcohol at their house. You don’t ask a person with Diabetes if it is okay if you eat a Twinkie, you don’t have to ask me if it is ok for you to have a beer.

There is just an indescribable freedom that comes along with [sobriety].

The best part is being free. I was a slave to my addictions for years. I do not have that struggle anymore. I do not have to worry about where I will find money to buy alcohol. It is a huge struggle in my life that does not exist anymore. There is just an indescribable freedom that comes along with it.

In your opinion, what’s the biggest misconception out there about addiction?

[If you believe addiction is a choice], that just makes you a shitty person.

JMS: I mentioned it above; that addiction is a choice. That idea is closed-minded and short-sighted. And I think it speaks volumes about the person [who] believes that. I cannot fathom believing that someone would do this voluntarily. It is not fun, it does not feel good, and does not make us proud. In my eyes, the belief that this is a choice tells me that you could choose to behave in this manner if you wanted to, and that just makes you a shitty person.

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Please share your thoughts on addiction and recovery in a comment!


161 Questions to Explore Values, Ideas, and Beliefs

Open-ended questions are important in therapy. They allow a client to explore his/her values, ideas, and beliefs. A list of 161 questions for group therapy, journal prompts, conversation starters, icebreakers.

By Cassie Jewell, LPC

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The questions in this post ask about recovery, spirituality, personal growth, and other relevant topics. As a counselor, I’ve used the questions with adults who struggle with mental illness and addiction, mostly in a group setting. Asking open-ended questions is a basic counseling skill. Open questions invite the client to explore his or her thoughts, beliefs, and ideas. In contrast, closed questions can be answered with a yes or no.

The first section, “Conversation Starters,” is comprised of questions that can be used as icebreakers, at a party, or even on a date.  In a clinical setting, use a “Conversation Starter” as a group check-in. It provides an opportunity for group members to engage and to learn about their peers.

Additional ideas for groups

Choose 10-15 questions and either print them out or write them on small pieces of paper. Fold the paper slips and place in a container. Clients can take turns drawing and answering questions. Alternatively, they can choose questions for each other.

Select up to 20 questions. Pair the clients and have them take turns interviewing each other.

Select 5-10 questions. Each client writes out his or her answers. Read the answers to the group and have group members take turns guessing who wrote what.

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Conversation Starters

  1. What is the most interesting thing you heard this week?
  1. What’s the one thing you really want to do but have never done, and why?
  1. Would you take a shot if the chance of failure and success is 50-50?
  1. Which one would you prefer; taking a luxurious trip alone or having a picnic with people you love?
  1. If your life was a book, what would the title be?
  1. If you could be any animal, what would you be and why?
  1. What is your favorite day of the week and why?
  1. What do you do when you’re bored?
  1. Shoe size?
  1. Favorite color?
  1. Favorite band (or artist)?
  1. Favorite animal?
  1. Favorite food?
  1. One food you dislike?
  1. Favorite condiment?
  1. Favorite movie?
  1. Last movie you saw in a theater?
  1. Last book read?
  1. Best vacation?
  1. Favorite toy as a child?
  1. One item you should throw away, but probably never will?
  1. Superman, Batman, Spiderman, or Wonder Woman?
  1. Chocolate or vanilla?
  1. Morning person or night owl?
  1. Cats or dogs?
  1. Sweet or salty?
  1. Breakfast or dinner?
  1. Coffee or tea?
  1. American food, Italian food, Mexican food, Chinese food, or other?
  1. Clean or messy?
  1. What is your favorite breakfast food?
  1. What vegetable would you like to grow in a garden?
  1. Tell about a childhood game you loved.
  1. What’s your favorite dessert?
  1. What’s your favorite day of the week and why?
  1. Who is your favorite celebrity?
  1. Which celebrity do you most resemble?
  1. If you could go anywhere in the world, where would you go and why?
  1. Share about one of your hobbies.
  1. What’s a unique talent that you have?
  1. Introvert or extrovert?
  1. Describe yourself in three words.
  1. Tell about a happy childhood memory.
  1. Name three things (or people) that make you smile.

Mental Health and Addiction Questions

  1. On a scale from 1 to 10, where are you at in your recovery and what does that number mean to you?
  1. Tell about a healthy risk you have taken this week.
  1. What brought you to treatment?
  1. How has your life changed since getting clean and sober?
  1. What do you miss the most about drug/alcohol?
  1. What would your life be like if you weren’t addicted to something?
  1. What makes your addiction possible?
  1. What are your triggers?
  1. Name at least three ways you can cope with cravings.
  1. Name three of your relapse warning signs.
  1. Tell about someone who is supportive of your recovery.
  1. What’s one thing you wish everyone knew about mental illness?
  1. Is it okay to take medications if you’re in recovery?
  1. Is it possible to get clean/sober without AA or NA?
  1. Do you have a sponsor? What’s helpful and what’s not?
  1. Do you think you’re going to relapse?
  1. What’s the difference between helping and enabling?
  1. Tell about a time you were in denial.
  1. Do you have an enabler? Explain.
  1. Is it possible for someone in recovery for drugs to be a social drinker?
  1. How have drugs and alcohol affected your health?
  1. Is addiction a disease?

Personal Development and Values

  1. Are you doing what you truly want in life?
  1. What are your aspirations in life?
  1. How many promises have you made this past year and how many of them have you fulfilled?
  1. Are you proud of what you’re doing with your life or what you’ve done in the past? Explain.
  1. Have you ever abandoned a creative idea that you believed in because others thought you were a fool? Explain.
  1. What would you prefer? Stable but boring work or interesting work with lots of workload?
  1. Are you making an impact or constantly being influenced by the world?
  1. Which makes you happier, to forgive someone or to hold a grudge? Explain.
  1. Who do you admire and why?
  1. What are your strengths?
  1. What are your weaknesses?
  1. Are you doing anything thatmakes you and people around you happy?
  1. Tell about a short-term goal you have.
  1. Tell about a health goal you have.
  1. Tell about a long-term goal you have.
  1. Tell about a value that is currently important to you.
  1. What do you like most about yourself?
  1. What do you like least about yourself?
  1. What in life brings you joy?
  1. What are you grateful for?
  1. Who is the most influential person in your life and why?
  1. Tell about one dream you have always had, but are too afraid to chase.
  1. What is something you want to change about yourself and what are two things you can do to accomplish this?
  1. Describe your perfect world. (Who would be in it, what would you be doing, etc.)
  1. Where were you one year ago, where are you now, and where do you want to be a year from today?
  1. Share about a character flaw you have.
  1. What kind of a person do you want to be?
  1. When is the last time you helped someone and what did you do?
  1. Tell about a problem you have right now. What can you do to solve it?

Family and Relationship Questions

  1. Have you ever failed anyone who you loved or loved you? Explain.
  1. Who is your favorite person?
  1. What was it like growing up in your family?
  1. What makes someone a good friend?
  1. What happens when you’re rejected?
  1. What makes a relationship healthy or unhealthy?
  1. Would you rather break someone’s heart or have your heart broken?

Education and Career

  1. As a child, what did you want to be when you grew up?
  1. Tell about something you do well.
  1. What’s your dream job?
  1. What are your career goals?
  1. What classes would you be most interested in taking?
  1. Tell about a job you would hate doing.
  1. Would you prefer to work with people or by yourself?
  1. Would you ever do a job that was dangerous if it paid a lot of money?
  1. Would you still work if you didn’t have to?
  1. What do you want to do when you retire?
  1. If you have a job, what do you like about it? Dislike?
  1. How do you deal with difficult co-workers?
  1. What qualities would you like your supervisor to have?

Emotions

  1. When was the last time you laughed, and what did you laugh at?
  1. If happiness was a currency, how rich would you be?
  1. How do you express happiness?
  1. What are three healthy ways you can cope with anger?
  1. What are three healthy ways you can cope with anxiety?
  1. What does being happy mean to you?
  1. If your mood was a weather forecast, what would it be?
  1. Tell about a time you were happy.
  1. Tell about a time you were heartbroken.
  1. What is the difference between guilt and shame?
  1. Is guilt a healthy emotion?
  1. Can guilt be excessive?
  1. Is there a such thing as “healthy shame”?
  1. What makes you happy?
  1. What makes you mad?
  1. When do you feel afraid?
  1. When do you feel lonely?
  1. Share about the last time you felt guilty.
  1. What embarrasses you?

Spirituality

  1. How does one practice forgiveness (of self and others) from a religious point of view and from a non-religious point of view?
  1. What does it mean to forgive?
  1. Do you have to forgive to move forward?
  1. What brings you meaning in life?
  1. How do you define spirituality?
  1. What’s the difference between religion and spirituality?
  1. When do you feel most at peace?
  1. Do you meditate? Why or why not?

Additional Thought-Provoking Questions

  1. If you could travel to the past in a time machine, what advice would you give to the 6-year-old you? Would you break the rules because of something/someone you care about?
  1. Are you afraid of making mistakes? Why or why not?
  1. If you cloned yourself, which of your characteristics would you not want cloned?
  1. What’s the difference between you and most other people?
  1. Consider the thing you last cried about; does it matter to you now or will it matter to you 5 years from now?
  1. What do you need to let go of in life?
  1. Do you remember anyone you hated 10 years ago? Does it matter now?
  1. What are you worrying about and what happens if you stop worrying about it?
  1. If you died now, would you have any regrets?
  1. What’s the one thing you’re most satisfied with?
  1. If today was the end of the world, what would you do?
  1. What would you do if you won the lottery?
  1. If you could change one thing about yourself, what would it be?
  1. How do you think others see you?
  1. What is your biggest fear?
  1. How do you get someone’s attention?
  1. What masks do you wear?
  1. Tell about a poor decision you made.
  1. When is the last time you failed at something? How did you handle it?

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