How Counseling Helps


When the same things keep happen over and over, and you realize you’re in a rut but don’t know how to get out, talking with a counselor, can shed light on complex situations, and reveal why you’re not getting the results you expect, untangle the knots, and start solving the solvable parts.

The tools we use every day may not be enough to get us through difficult situations. With our existing habits we may even be increasing conflict, and reducing our own satisfaction without realizing it. Counseling helps us review our present patterns, and find out what works and what doesn’t. Perhaps we need to renew and revitalize old lessons we already know.

With a counselor we can brainstorm on options we hadn’t thought of or don’t know. By giving us information and coaching, counselors can show us how to manage anger, communicate our needs more clearly, negotiate for change, and soothe our own anxieties.

We may not realize how much we contribute to the situations and feelings that bother us. Our old patterns are so familiar and so deeply engrained they are invisible. And we’re so close to the situation we tend to lose sight of our options. Counseling helps us turn the spotlight first onto understanding our role, and then onto the things we can change. Through this process we extend our focus from what’s happening to us, to what we can do about it.

One of the fastest and best ways we can learn about ourselves is by remembering how we got where we are. Remembering the past opens our eyes to insights about the present. By integrating the story of our self, including our family and childhood we become more whole and integrated. By learning who we are, we can work to become who we want to be.

One of the mysteries we can reveal about ourselves is to understand our own feelings. Many of us don’t have clear labels for our feelings, and without knowing our feelings we may unknowingly be driven by them. Putting words to our emotions can help us decipher our own actions, as well as improve our communication with others.

When we’re alone with complex and troubling issues we may not think as clearly and effectively as we would like. A counselor is a supportive ally, a hired member of our support team who can give us assistance when we need it.

We’re only inside one person, and our vision of ourselves is limited by our blind spots and perspectives. When we describe our situation to a counselor, we open ourselves to another point of view. With a counselor we explore every aspect of what we’re going through in greater detail than we would with other people. And because the counselor is not a player in the drama, he or she has no personal stake in one side or another. The reflection of such an impartial observer shines a spotlight on the things we’re trying to understand, and helps us see ourselves from a more universal perspective than we could do on our own.

When we get stuck in a difficult situation with a mate, a child, or a co-worker, often the parties don’t feel their side has been heard. Counseling coaches us to communicate more clearly, so we can be less defensive, and productively help each other resolve issues.

Self help books, workshops and tapes offer powerful ideas for growth. And yet, because these ideas are new and different from the way we have thought or behaved, we may have difficulty applying these principles in our own lives. Counseling can help us accelerate this process, working with us to fit new ideas into our world.


Decisions in Recovery: Treatment for Opioid Use Disorder


SAMHSA, U.S. Department of Health and Human Services January 2017

Decisions in Recovery: Treatment for Opioid Use Disorder


The Substance Abuse and Mental Health Services Administration (SAMHSA), in collaboration with individuals in recovery, clinicians, researchers, and other subject matter experts, has developed a person-centered, recovery-oriented decision support tool for individuals with opioid use disorder. Decisions in Recovery: Treatment for Opioid Use Disorder (Decisions in Recovery) is an online interactive aid for people who want information about the role of medications in treating opioid use disorder. The web-based tool and its accompanying handbook are designed to help people with opioid use disorder: (1) learn about medication-assisted treatment (MAT); (2) compare treatment options; (3) decide which options are best for them and their recovery; and (4) discuss their preferences with a provider. The target audiences for this tool are primarily individuals in or seeking recovery from opioid use disorder and their service providers. Secondary audiences include administrators, planners and policymakers, members of national and community advocacy organizations, researchers, and others interested in promoting quality community behavioral health care. This decision support tool includes a number of exciting features: • Easy to understand information from the literature about three primary medications used for MAT, along with their outcomes, risks, and benefits • Tools to assist the person in recovery to identify and consider personal values and preferences in relation to the available options • Brief videos of recovery stories that provide a range of views and lived experiences from individuals in various stages of recovery and providers • Downloadable worksheets to assist anyone in their recovery journey Decisions on Recovery is an important resource to further the aim of the 2016 Surgeon General’s Report titled Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health to prevent and treat substance use disorders. The purpose of this decision support tool is to make objective, research-based information accessible to individuals facing specific decisions about medication for opioid use disorder, rather than to promote any single treatment option. In addition, SAMHSA emphasizes that scientific evidence demonstrates medications are best used in combination with recovery support, lifestyle changes, and professional treatment. Decisions in Recovery supports shared decision-making between individuals in or seeking recovery and their providers. By providing accurate, easy to understand information, first person testimonials, and worksheets to help individuals weigh their options and communicate their preferences and values effectively to providers, Decisions in Recovery can support individuals and providers in developing treatment plans that are the best possible fit for their values, preferences, needs, and recovery goals.


What is Decisions in Recovery: Treatment for Opioid Use Disorder (Decisions in Recovery)? Decisions in Recovery is an innovative multimedia tool for people who want information about the role of medications in treating opioid use disorder. It includes a printable handbook that mirrors the web-based content. Decisions in Recovery is person-centered and recovery-oriented. It focuses on “whether” medication-assisted treatment (MAT) is an informed treatment choice by a person in or seeking recovery from an opioid use disorder; and if so, “which” medication is the best fit for that person. Decisions in Recovery is designed to help individuals: (1) learn about MAT; (2) compare treatment options; (3) decide which options are best for them and their recovery; and (4) discuss their preferences with a provider. Who developed Decisions in Recovery? This decision support tool was developed with funding from the federal Substance Abuse and Mental Health Services Administration (SAMHSA). The Center for Social Innovation with Advocates for Human Potential, Inc. prepared this tool under Bringing Recovery Supports to Scale Technical Assistance Center Strategy (BRSS TACS); contract number HHSS 280201100002C, SAMHSA, U.S. Department of Health and Human Services (HHS). Cathy Nugent, Marsha Baker, Wanda Finch, Sharon Amatetti, and Deepa Avula served as the Contract Officer Representatives. SAMHSA worked in collaboration with people in recovery from substance use disorder, researchers, clinicians, and other experts to develop this innovative webbased tool. Who can benefit from Decisions in Recovery? This resource can benefit individuals facing important decisions about their own recovery. It also supports service providers by enhancing communication with the individuals that they serve, clarifying information, and promoting informed, collaborative decision-making. In addition, Decisions in Recovery is a useful resource for administrators, planners and policymakers, members of national and community advocacy organizations, researchers, and others interested in promoting quality community behavioral health care. Who is the focus audience for the tool? The focus audiences for this tool are primarily individuals in or seeking recovery from opioid use disorder and their service providers. Secondary audiences include administrators, planners and policymakers, members of national and community advocacy organizations, researchers, and others interested in promoting quality community behavioral health care. How does Decisions in Recovery differ from other medication-assisted treatment resources? The Decisions in Recovery: Treatment for Opioid Use Disorder tool is based on the model of shared decision-making. Shared decision-making is a collaborative process that allows 4 individuals to make informed choices about their treatment in partnership with their providers, taking into account the best scientific evidence available, as well as individual values, preferences, and lifestyle. Shared decision-making honors both the provider’s expert knowledge and the individual’s right to be fully informed of all treatment options and their potential risks and benefits. Unlike other MAT resources, Decisions in Recovery is a tool that helps both providers and patients to share information about treatment options, preferences, and next steps. Decisions in Recovery can help structure dialogue and enhance communication and treatment decision-making. When used in conjunction with other innovative resources, such as SAMHSA’s new MATx app, Decisions in Recovery can enhance the ability of providers to offer evidence-based information and resources to the individuals that they serve. How can agencies, organizations, and treatment providers use the tool in their practice? The Decisions in Recovery tool is an important resource to further the aim of the 2016 Surgeon General’s Report titled Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health to prevent and treat substance use disorders. In addition, the tool can facilitate the interactive process of shared decision-making by supporting a person in recovery from an opioid use disorder in making informed choices about MAT as a treatment choice to aid their recovery from a substance use disorder. How does recovery fit into MAT? Decisions in Recovery offers a wide variety of resources on recovery, recovery support, and opioid use disorder treatment. It offers a framework for individuals and practitioners to consider treatment as an important part of recovery and to recognize recovery as a process of change. Decisions in Recovery encourages people in or seeking recovery from opioid use disorder to talk with their providers about the treatment options that will work best for their unique needs and recovery goals. What are the main features of Decisions in Recovery? This decision support tool includes a number of exciting features: • Easy to understand information from the scientific literature about the three primary medications used for MAT in the United States, along with their outcomes, risks, and benefits • Tools for people in recovery to identify and consider personal values and preferences in relation to the available treatment options • Brief videos of recovery stories that provide a range of views and lived experiences from individuals in various stages of recovery and providers • Downloadable worksheets to assist individuals in making decisions about treatment options with a provider • A downloadable PDF companion handbook that reflects information from the web-based multimedia tool Where can I find the tool? 5 There are a number of places to locate the Decisions in Recovery tool or the companion handbook on the SAMHSA website. After December 15, 2016 – options for accessing the Decisions in Recovery tool and companion handbook include: • To access Decisions in Recovery, please go to the SAMHSA website at and click on Decisions in Recovery: Treatment for Opioid Use Disorder. • To download the handbook, please go to the SAMHSA website at and click on Decisions in Recovery Handbook. • More information about Decisions in Recovery: Treatment for Opioid Use Disorder is available on the SAMHSA/BRSS TACS website at How can I learn more about Decisions in Recovery? You can participate in a SAMHSA webinar to better understand the information in the new resource, navigate the web-based tool, and download worksheets for personal or provider use. To register for the Recovery LIVE! – Opioid Use Disorder, Medication, and Recovery webinar – please cut-and-paste the following URL into a web browser: Can I reproduce or copy material from the tool for use in my practice? All material in Decisions in Recovery is in the public domain and may be reproduced or copied without permission from SAMHSA. Citation of the source is appreciated. However, this material may not be reproduced or distributed for a fee without the specific written authorization of the Office of Communications, SAMHSA, U.S. Department of Health and Human Services. What is the recommended citation for the tool? Substance Abuse and Mental Health Services Administration. (2016). Decisions in Recovery: Treatment for Opioid Use Disorder. (Electronic Decision Support Tool) (HHS Pub No. SMA- 16-4993), 2016. Available from:

Forgiveness: What it is and Isn’t



“Resentment is like taking poison and hoping the other person dies.” ~Augustine of Hippo

What It Is . . . and Isn’t

Regardless of whether forgiveness is a worthy virtue, a moral duty or something altogether different, in psychological studies, it happens that forgiveness is closely correlated with increased happiness and improved mental health. It seems that most of us would welcome happiness and better mental health. Right? Well, like everything else, that would depend on the personal cost involved:


  • Am I required to condone the behavior of the perpetrator?
  • Does it mean that the behavior was okay? (I should put up with it, because there was no real injury.)
  • • Must I develop selective amnesia and simply forget all about it . . . or at least pretend to?
  • • Must I pardon this person—allowing him/her to continue causing more damage?
  • • Must I reconcile with this person? Or get back into a relationship, where I’ll get hurt all over again?

NO. The answer is no to all of them.

Forgiveness: it is a voluntary decision to acknowledge the offense, move through the resultant feelings, set aside the resentment, and release the anger, so you may move on with your life. You need not condone, excuse, forget, or reestablish a relationship with the perpetrator.

Pardoning: It is problematic when forgiveness is coupled with, or equated to, pardoning. Freedman and Enright (1996) believe that a person can forgive, yet still expect justice. As they view forgiveness and justice to be in harmony with each other—both inviting and provoking change and growth.

Condoning: Forgiving the perpetrator for his/her action(s) does not mean you stop judging the deed. Freedman and Enright (1996) posit that condoning denies the resentment and the offense, which is likely to exacerbate and complicate the hurt and injury. In contrast to denial, forgiveness vanquishes the resentment with love and compassion.

  • You forgive the person, not the action.
  • Forgiveness allows you to live in the present and leave the past behind.
  • Forgiveness will bring you peace. 

Reconciliation: It is possible to accept, even love a person and still choose not to be in a personal relationship with him or her?

 Aponte states, “Reconciliation is distinct from the moral decision to forgive. The choice to forgive [only] opens the door . . . to reconciliation, if safe, prudent, and right.”

Freedman and Enright (1996) believe forgiveness can take place when the offended gives up feelings of hatred or resentment.

Many people, including clergy members, philosophers, psychotherapists, and psychologists, erroneously believe that full forgiveness requires the victim to accept the perpetrator back into the relationship.

Worksheet Forgiveness Myths:

Read each of the following Myths around Forgiveness. Then choose the one the one that stands out the most for you and answer:  Why you chose the one you did • How  do you identify with the myth.

  1. If I forgive this person, it means that I’m condoning the behavior of the person I’m forgiving.
  2. • If I forgive this person, then my relationship with him/her will certainly improve.
  3. • If I forgive this person, then I won’t be angry about what happened.
  4. • If I forgive, I give up my right to feel hurt, angry, or sad. • I haven’t really forgiven that person when I remember what happened.
  5. • I should only have to forgive once (i.e., once I do it, I’ll never have to think about it again).
  6. • I forgive, not for me, but for the sake of the other person.
  7. • If I forgive this person, I must remain in a relationship with this person

Worksheet: Stages of Forgivenes

Stage One: Identify Perpetrator and Transgression

  1. I know who it was that has affected me negatively.
  2. • I know what specific behavior(s) it was that has been physically, emotionally, or spiritually damaging to me.

Stage Two: Identify, Experience, and Process the Emotions

  • • I have felt the emotions associated with the offensive, damaging behavior. I have found a safe place to process these feelings.
  • • If it was safe to do so, I have spoken to the person regarding the adverse effects I endured as a result of his/her behavior.
  •  If it was not safe to do so, I was able to do it in therapy using an imaginary technique (e.g., role playing, psychodrama, the empty chair, etc.).

Stage Three: Understand the Need for Forgiveness

  • I understand the benefits of forgiveness
  • I have reached a point where I recognize what has transpired, have begun developing compassion for myself, and am now able to see the perpetrator as a human being.

Important Distinction: Many people, including clergy members, philosophers, psychotherapists, and psychologists, erroneously believe that full forgiveness requires the victim to accept the perpetrator back into the relationship. What is actually required of the victim is that (s)he accept the perpetrator back into the human race (i.e., (s)he is no longer stripped of his/her humanity, regardless of whether the victim chooses to reestablish a personal relationship with him/her). As Joan Borysenko states in Guilt Is the Teacher, Love Is the Lesson Forgiveness is not a lack of discrimination whereby we let all the criminals out of prison: it is an attitude that permits us to relate to the pain that led to their errors and recognize their need for love. (1991, p. XXX)

Stage Four: Set Clear Boundaries

  • I have set clear boundaries with the perpetrator:
  •  I understand the need for and my right to protect myself.
  • I feel competent in setting and maintaining these boundaries to keep me physically and emotionally safe.

Stage Five: Integrate the Past and Begin Recreating the Future 

  • I have made an internal choice to forgive and a have willingness to recreate a meaningful life for myself.

Linda Curran 101 Trauma Interventions

How to Relieve Anxiety in Children

How to Relieve Anxiety in Children

by Angela Zaffer, MA, NCC, LPCC   August 8, 2016

With children going back to school after the summer break, stress associated with homework, taking a test and or social relationships, maybe something some parents are thinking about.  This article should help guide parents on how to help their child cope with these overwhelming feelings.

What is Anxiety?  Anxiety  is a thought that causes someone to worry or feel nervous or upset. Stressed out is a word people often use to describe anxiety.  Everyone feels anxious from time to time.  It’s a normal emotion. Many people feel nervous when faced with a problem at school or work, before taking a test or going to the doctor.  But for children with anxiety,  worry and fear are constant and can be overwhelming.  For some it can be disabling and lead to feelings of panic. But with simple interventions, children can learn to manage these feelings.

One in eight children has an anxiety disorder. Parents whose children show symptoms of anxiety want to help but don’t always know what to do or where to turn. This guide can help you make sense of the available treatment options and includes some easy tips you can start using right away.

Recommended Treatments for Children With Anxiety

 Recommended forms of Treatment

  • Cognitive Behavioral Therapy (CBT) is the most recommended treatment technique for anxiety in children.
  • Acceptance and commitment therapy, or ACT, uses strategies of acceptance and mindfulness (living in the moment and experiencing things without judgment) as a way to cope with unwanted thoughts, feelings, and sensations.
  • Dialectical behavioral therapy, or DBT, emphasizes taking responsibility for one’s problems and helps children examine how they deal with conflict and intense negative emotions.

Cognitive Behavioral Therapy (CBT)

  • Cognitive therapy examines how negative thoughts, or  Cognitions, contribute to anxiety.
  • Behavior therapy examines how you behave and react in situations that trigger anxiety.

Cognitive Behavioral Therapy (CBT) is a type of therapy that can be used with children to teach interventions to identify and replace  negative thoughts. In cognitive behavioral therapy, children can learn different ways to calm themselves and learn to worry less.  CBT is effective in children as young as 6.  Most children need between 5 and 20 therapy sessions. Depending on the age of the child, a session typically last about 30 to 55 minutes

According to some studies, CBT is as effective as medication in treating anxiety. Unlike medication, CBT has no physical side effects. CBT does require practicing the interventions taught in each session.   Most counselors will teach the parent the interventions as well.  A parent can be quickly oriented in the last five or ten minutes of each session on what the child worked on learning in the session. Also, having the child teach the parent the interventions is also a good way for the child to remember the interventions taught.

Some Typical CBT Interventions include:

  • What is Anxiety
  • How  Anxiety gets started
  • Physical Symptoms
  • Breathing techniques
  • Relaxation techniques
  • Using logic to fight worry thoughts
  • Thought stopping
  • Redirecting thoughts-Distraction

Interventions to Use at Home

  •  Help the child to recognize the physical symptoms of anxiety. A few physical symptoms of anxiety are—upset stomach, racing heart, out of breath, crying, sweaty hands, headache. Sometimes children with anxiety visit the school nurse for these symptoms. Teach your child to  use coping strategies, such as deep breathing when these symptoms occur.
  • Listen and Validate  Let your child know you hear their worries and are empathetic to what that the child is feeling.  Let the child know they can share their worries for one time a day for fifteen minutes.  The late afternoon or early evening is usually in the best time.  After they have shared the worries, the child needs to know you will not discuss their worries again until the next day.  This helps the brain learn to re-wire itself from a worry brain to a non-worry brain.  The brain has to be trained to worry less.
  • Worry Box:  Create a worry container  The child can write down the worries on a piece of paper and put them in a box or other container.  If they are worrying at school, a worry folder made to hold these  worry notes works really well. The child can also write positive notes and coping skills  on the front outside of the worry folder.
  • Breathing Techniques:  Deep breathing can help decrease the stress response in the body.  Take a deep breathe with your child and breath the air out slowly.  Pretend you are breathing out through a straw.  You can also have the child blow the air out slowly on their hand.
  • Excercise:  Go for a walk together.  Your child can use this time to discuss what they are worrying about during the walk.  Also, excercise is a great way to get ride of the stress chemicals that build up in the body.
  • Modeling ways to cope with stress:  A child who sees his parents take some deep breaths to calm down may learn to do the same.
  • Should Medication be Used?
  • The  medications that are commonly used to treat anxiety in children are antidepressants. However, because all medications have side effects, medication is rarely prescribed as a first treatment for anxiety. Medication is most often used when other interventions have not been successful, or as a complement to therapy.Depending on your child’s level of anxiety,  professional counseling may be needed to find the treatment and coping strategies that work best for your child and your family.


Your doctor or counselor may recommend one or a combination of treatments.

Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin Norepinephrine Reuptake Inhibitors (SNRIs):  These are commonly known as second generation antidepressants.

Another antidepressant that is commonly used is bupropion. Bupropion ,or Wellbutrin, is a third type of antidepressant which works differently than either SSRIs or SNRIs. Bupropion affects the dopamine neurotransmitters whereas SSRIs affect serotonin nerotransmitters.

SSRIs, SNRIs, and Bupropion are popular because they do not cause as many side effects as older classes of antidepressants, and seem to help a broader group of depressive and anxiety disorders. These medications are thought to work by targeting chemicals in the brain called neurotransmitters. These chemicals affect mood and emotion. Experts have traditionally thought that they restore a chemical imbalance.   But new research suggests that stress may actually destroy the connections between nerve cells — and even the cells themselves. They believe that antidepressants work by restoring these nerve pathways.  These medications take 4 to 6 weeks to reach their full effectiveness. Anyone taking an antidepressant should be closely monitored, especially children, in the first few weeks.

Medication may allow your child to participate in activities he or she would otherwise avoid. Medication can help get symptoms under control while a child is learning new coping techniques in therapy.  Ask your child’s doctor about the risks and benefits of any suggested medication. Also ask about follow-up appointments and medication monitoring.

Like other medical conditions, anxiety disorders tend to be chronic unless properly treated. Most kids find that they need professional guidance to successfully manage and overcome their anxiety.

Written by Angela Zaffer MA, NCC, LPCC

Angela Zaffer is a nationaly certified (NBCC) and Licensed Professional Clincal Mental Health Counselor in Rio Rancho, New Mexico.  She specializes in treating anxiety disorders in children.  Angela also treats children, teenagers and adults with depression, low self esteem, grief and trauma/PTSD.  She is the CEO and Clinical Director of Counseling Solutions.  Angela can be contacted at:


Counseling Solutions: Counseling and Psychotherapy for Children, Teenagers and Adults

Finding a Counselor or Therapist for Treating Trauma


Why is it Important to Find a Therapist Who Specializes in Treating Trauma?

Treating Trauma is different than treating other diagnosis.  People who have experinced trauma can react differently in theraputic situtaions and react differently to theraputic interventions.

Why Trauma Treatment is Tricky

Unlike the medical model, the trauma model is an empowerment model that recognizes the therapeutic relationship is requisite to healing.  Although the clinician should possess and provide many things-professional training, skill, useful information, empathy, insight, intuition, etc.-it is the client who is the expert on the client and the primary agent of change.

Whether choosing a psychiatrist, psychologist, social worker or counselor, steer clear of authoritative clinicians.

The therapeutic relationship is paramount to successful treatment. If it isn’t collaborative it’s doomed to failure.

Linda Curran, Trauma 101

First steps

  • Make sure the provider has experience treating people who have experienced a trauma.
  • Try to find a provider who specializes in evidence-based treatments or effective psychotherapy for Trauma or PTSD   (e.g., Mindfulnessbaded cognitive behavioral therapy (MCBT); eye movement desensitization and reprocessing (EMDR), prolonged exposure therapy (PE) etc). There is a list of  recommended treatments at the bottom of this page.
  • Find out what type(s) of insurance the provider accepts and what you will have to pay (out-of-pocket costs) for care.
  • Contact your family doctor to ask for a recommendation. You can also ask friends and family if they can recommend someone.
  • If you have health insurance, call to find out which mental health providers your insurance company will pay for. Your insurance company may require that you choose a provider from among a list they maintain.

Make sure the therapist or counselor understands effective trauma treatment

Trauma-Informed Care is not just about the specific therapeutic techniques—it is an overall approach, a philosophy of providing care.

  • A safe therapeutic environment is essential to aid in recovery. 
  • Trauma-related symptoms and behaviors originate from adapting to traumatic experiences.
  • Recovery from trauma is identified as a goal in treatment.
  • Resiliency and trauma-resistant skills training are part of treatment. 
  • Trauma-Informed Care includes a focus on strengths rather than pathology.
  • Trauma recovery is a collaborative effort.

Finding a provider using the internet

These resources can help you locate a therapist, counselor, or mental health provider who is right for you. Note: These resources can be used by anyone.

  • Internet search looking for a therapist or counselor  who treats Trauma or PTSD
  • Psychology Today Website
  • Integrative Trauma Treatment
  • Sidran Institute  Help Desk will help you find therapists who specialize in trauma treatment. Email or call the Help Desk at (410) 825-8888.
  • EMDR International Association has a locator listing professionals who provide EMDR  or to search more locally, Google EMDR
  • Search For EMDR  in your web browser for local listings
  • ISTSS Clinician Directory is a service provided by the International Society for Traumatic Stress Studies (ISTSS) that lets you consider many factors in searching for a clinician, counselor, or mental health professional.

Here is an example as  written by Barbara Markway, Ph.D of a client seeking therapy for trauma.  

Caitlyn had been to several mental health professionals for ongoing depression, but hadn’t gotten better. She felt that none of the therapists understood her. In addition to her mood symptoms, Caitlyn experienced periods of time where she felt very out of control, sometimes cutting her arms with a razor blade. She did not want to die, but some of her past therapists had hospitalized her every time she talked about her cutting.

Caitlyn was about ready to give up all hope of counseling helping her when she had a different experience with a new therapist. Caitlyn hesitated in mentioning her “self-mutilation,” as her other therapists called it, but when she finally did, this therapist responded differently than the others. The previous therapists had asked questions suggesting there was something wrong with her, but this one gently said, “I wonder if something traumatic has happened to you. Would you like to talk about it?”

In that transformative moment, Caitlyn felt safe enough to begin discussing her traumatic childhood experiences. Through her tone and her words, the therapist communicated that there was nothing wrong with her, and that her cutting behavior was a way she had learned to cope with a horrific experience.

What made the difference? Her therapist had been trained in Trauma-Informed Care (TIC).

  • A safe therapeutic environment is essential to aid in recovery. Caitlyn had not felt safe with past therapists. She felt that she was considered a “problem client” who sometimes needed more that the therapist was willing and/or able to give. Therapists guided her away from certain topics because they feared “opening up” her pain. On the other hand, her new therapist recognized that learning to cope with her pain was an essential part of her recovery.
  • Trauma-related symptoms and behaviors originate from adapting to traumatic experiences. Caitlyn sometimes withdrew and “shut down” when she felt overwhelming pain. The therapist accepted that this was a coping skill. Also, the therapist recognized that cutting served to soothe Caitlyn’s emotions. While these behaviors were not ideal coping strategies, they did serve a purpose. Trauma-informed care gives individuals an opportunity to see how resourceful they were in managing a very difficult experience.
  • Recovery from trauma is identified as a goal in treatment. Recall that Caitlyn initially came to therapy because of depression. She hadn’t connected the dots between her past trauma history and her current difficulties.  The therapist expresses hope that Caitlyn can recover, and that dealing with past trauma is part of the recovery process.
  • Resiliency and trauma-resistant skills training are part of treatment. There are many alternative coping strategies that can be learned to cope with past trauma. The therapist works with Caitlyn to develop a repertoire of such skills.
  • Trauma-Informed Care includes a focus on strengths rather than pathology.Caitlyn’s therapist noted that she had survived the trauma and asked questions such as: “What would you say are your strengths? What characteristics have helped you manage your experiences? How have you coped with your feelings? What are some of your accomplishments that make you feel proud?” With a therapist using such positive language, Caitlyn was able to recognize that she had coped quite well with very difficult experiences.
  • Trauma recovery is a collaborative effort. The therapist asked Caitlyn about her personal goals for treatment, about what recovery would look like for her.

All of these factors enabled Caitlyn to see herself as a person deserving of respect, as a strong individual capable of recovery.  As Published in Psychology Today by  Barbara Markway, Ph.D. Dec 29, 2015


Angela Zaffer, MA, NCC, LPCC

Some of the recommended treatment modalities from the Intergrative Trauma Treatment website

Accelerated Experiential Dynamic Psychotherapy

Acceptance and Commitment Therapy





Hypnosis & Hypnotherapy

Mindfulness Based Cognitive Therapy

Somatic Experiencing

Somatic Trauma Therapy

Trauma Focused Cognitive Behavioral Therapy




What is a Highly Sensitive Person?




When I think of this term “highly sensitive person” my mind immediately thinks of a cry baby, someone who is overly dramatic or has a histrionic personality.



This is a term some of us have never heard of, and if you have, it has been a more recently used term.  No, it is not a new mental health diagnosis, but it is a new way of looking at personality type.  In the book written by Elaine Aron, she discusses this conception of the highly sensitive person? She describes the HSP as having a keen imagination,vivid dreams and become are often told they are “too shy” or “too sensitive” according to others.  They have the need to be alone during the day and noise and confusion become very overwhelming.  Aron explains in her book how to  understand yourself and your trait to create a fuller, richer life.

Do some of these things sound like you?

  • Do you get rattled when you have a lot to do in a short amount of time?
  • Do you make it a high priority to arrange your life to avoid upsetting or overwhelming situations?
  • Do you need to withdraw during busy days, into bed or a darkened room or some other place where you can have privacy and relief from the situation?
  • Are you easily overwhelmed by such things as bright lights, strong smells, coarse fabrics, or sirens nearby?

  • When you were a child, did your parents By Admin on June 22, 2013 WTF Picturesor teachers see you as sensitive or shy?
  • Do you make a point of avoiding violent movies and TV shows?
  • Do you notice or enjoy delicate or fine scents, tastes, sounds, or works of art?
  • Do you have a rich and complex inner life?  (Aron, 2016)

If you answered yes to some of these questions and are curious to see if you are an HSP, then you can take a self test at

The Huffington Post wrote a great article 16 Habits of Highly Sensitive People  using a guide written by Ted Zeff.  In his article, he explains the strengths and challenges of the HSP.

1. They feel more deeply.funny dramatic animals (7)

One of the hallmark characteristics of highly sensitive people is the ability to feel more deeply than their less-sensitive peers. “They like to process things on a deep level,” Ted Zeff, Ph.D., author of The Highly Sensitive Person’s Survival Guide and other books on highly sensitive people, tells HuffPost. “They’re very intuitive, and go very deep inside to try to figure things out.”

2. They’re more emotionally reactive.

People who are highly sensitive will react more or feel more in a situation. For instance, they will have more empathy and feel more concern for a friend’s problems.  They may also have more concern about how another person may be reacting in the face of a negative event.

3. They’re probably used to hearing, “Don’t take things so personally” and “Why are you so sensitive?”

Depending on the culture, sensitivity can be perceived as an asset or a negative trait, Zeff explains. In some of his own research, Zeff says that highly sensitive men he interviewed from other countries — such as Thailand and India — were rarely or never teased, while highly sensitive men he interviewed from North America were frequently or always teased. “So a lot of it is very cultural — the same person who is told, ‘Oh, you’re too sensitive,’ in certain cultures, it’s considered an asset,” he says.

4. They prefer to exercise solo.

Exercise is good for healthHighly sensitive people may tend to avoid team sports, where there’s a sense that everyone is watching their every move, Zeff says. In his research, the majority of highly sensitive people he interviewed preferred individual sports, like bicycling, running and hiking, to group sports. However, this is not a blanket rule — there are some highly sensitive people who may have had parents who provided an understanding and supportive environment that would make it easier for them to participate in group sports, Zeff says.

5. It takes longer for them to make decisions.

Highly sensitive people are more aware of subtleties and details that could make decisions harder to make, Aron says. Even if there is no “right” or “wrong” decision — foToo Many Choicesr example, it’s impossible to choose a “wrong” flavor of ice cream — highly sensitive people will still tend to take longer to choose because they are weighing every possible outcome. Aron’s advice for dealing with this: “Take as long to decide as the situation permits, and ask for more time if you need it and can take it,” she writes in a recent issue of her Comfort Zone newsletter. “During this time, try pretending for a minute, hour, day, or even week that you have made up your mind a certain way. How does that feel? Often, on the other side of a decision things look different, and this gives you a chance to imagine more vividly that you are already there.” One exception: Once a highly sensitive person has come to the conclusion of what is the right decision to make and what is the wrong decision to make in a certain situation, he or she will be quick to make that “right” decision again in the future.

6. And on that note, they are more upset if they make a “bad” or “wrong” decision.

You know that uncomfortable feeling you get after you realize you’ve made a bad decision? For highly sensitive people, “that emotion is amplified because the emotional reactioverly dramatic cat | Lolcats | Pinterestvity is higher,” Aron explains.

7. They’re extremely detail-oriented.

Highly sensitive people are the first ones to notice the details in a room, the new shoes that you’re wearing,
or a change in weather.

8. Not all highly sensitive people are introverts.

In fact, about 30 percent of highly sensitive people are extroverts, according to Aron. She explains that many times, highly sensitive people who are also extroverts grew up in a close-knit community — whether it be a cul-de-sac, small town, or with a parent who worked as a minister or rabbi — and thus would interact with a lot of people.

Teamwork :-) | Animal | Pinterest9. They work well in team environments.

Because highly sensitive people are such deep thinkers, they make valuable workers and members of teams, Aron says. However, they may be well-suited for positions in teams where they don’t have to make the final decision. For instance, if a highly sensitive person was part of a medical team, he or she would be valuable in analyzing the pros and cons of a patient having surgery, while someone else would ultimately make the decision about whether that patient would receive the surgery.

10. They’re more prone to anxiety or depression (but only if they’ve had a lot of past negative experiences).

“If you’ve had a fair number of bad experiences, especially early in life, so you don’t feel safe in the world or you don’t feel secure at home or … at school, your nervous system is set to ‘anxious,'” Aron says. But that’s not to say that all highly sensitive people will go on to have anxiety — and in fact, having a supportive environment can go a long way to protecting against this. Parents of highly sensitive children, in particular, need to “realize these are really great kids, but they need to be handled in the right way,” Aron says. “You can’t over-protect them, but you can’t under-protect them, either. You have to titrate that just right when they’re young so they can feel confident and they can do fine.”

11. That annoying sound is probably significantly more annoying to a highly sensitive person.

While it’s hard to say anyone is a fan of annoying noises, highly sensitive people are on a whole more, well, sensitive to chaos and noise. That’s because they tend to be more easily overwhelmed and overstimulated by too much activity, Aron says.

12. Violent movies are the worst.

Because highly sensitive people are so high in empathy and more easily overstimulated, movies with violence or horror themes may not be their cup of tea, Aron says.

Animal abuse and pet cruelty and neglect with a sad crying kitten cat ...13. They cry more easily.

That’s why it’s important for highly sensitive people to put themselves in situations where they won’t be made to feel embarrassed or “wrong” for crying easily, Zeff says. If their friends and family realize that that’s just how they are — that they cry easily — and support that form of expression, then “crying easily” will not be seen as something shameful.


14. They have above-average manners.

Highly sensitive people are also highly conscientious people, Aron says. Because of this, they’re more likely to be considerate and exhibit good manners — and are also more likely to notice when someone else isn’t being conscientious. For instance, highly sensitive people may be more aware of where their cart is at the grocery store — not because they’re afraid someone will steal something out of it, but because they don’t want to be rude and have their cart blocking another person’s way.

15. The effects of criticism are especially amplified in highly sensitive people.

Highly sensitive people have reactions to criticism that are more intense than less sensitive people. As a result, they may employ certain tactics to avoid said criticism, including people-pleasing (so that there is no longer anything to criticize), criticizing themselves first, and avoiding the source of the criticism altogether, according to Aron.

“People can say something negative, [and] a non-HSP [highly sensitive person] can say, ‘Whatever,’ and it doesn’t affect them,” Zeff says. “But a HSP would feel it much more deeply.”

16. Cubicles = good. Open-office plans = bad.

Just like highly sensitive people tend to prefer solo workouts, they may also prefer solo work environments. Zeff says that many highly sensitive people enjoy working from home or being self-employed because they can control the stimuli in their work environments. For those without the luxury of creating their own flexible work schedules (and environments), Zeff notes that highly sensitive people might enjoy working in a cubicle — where they have more privacy and less noise — than in an open-office plan. (Zeff, 2004)

  INFP: I am NOT too sensitive!

Now, lets talk about  other ways to look at personality types. There are different theories on personality types, so this personality type may not be a fit for you at all.  So if you are not an HSP, you may like the personality test below:  The very famous Myer Briggs Typology or MBTI.

Carl Jung’s and Isabel Briggs Myers’ typology, along with the strengths of preferences and the description of your personality type,  You can take the test here to see your MBTI personality type:

Personality Type Explained

According to Carl G. Jung’s theory of psychological types [Jung, 1971], people can be characterized by their preference of general attitude:

  • Extraverted (E) vs. Introverted (I),

their preference of one of the two functions of perception:

  • Sensing (S) vs. Intuition (N),

and their preference of one of the two functions of judging:

  • Thinking (T) vs. Feeling (F)

The three areas of preferences introduced by Jung are dichotomies (i.e. bipolar dimensions where each pole represents a different preference). Jung also proposed that in a person one of the four functions above is dominant – either a function of perception or a function of judging. Isabel Briggs Myers, a researcher and practitioner of Jung’s theory, proposed to see the judging-perceiving relationship as a fourth dichotomy influencing personality type [Briggs Myers, 1980]:

  • Judging (J) vs. Perceiving (P)

The first criterion, Extraversion – Introversion, signifies the source and direction of a person’s energy expression. An extravert’s source and direction of energy expression is mainly in the external world, while an introvert has a source of energy mainly in their own internal world.

The second criterion, Sensing – Intuition, represents the method by which someone perceives information. Sensing means that a person mainly believes information he or she receives directly from the external world. Intuition means that a person believes mainly information he or she receives from the internal or imaginative world.

The third criterion, Thinking – Feeling, represents how a person processes information. Thinking means that a person makes a decision mainly through logic. Feeling means that, as a rule, he or she makes a decision based on emotion, i.e. based on what they feel they should do.

The fourth criterion, Judging – Perceiving, reflects how a person implements the information he or she has processed. Judging means that a person organizes all of his life events and, as a rule, sticks to his plans. Perceiving means that he or she is inclined to improvise and explore alternative options.

All possible permutations of preferences in the 4 dichotomies above yield 16 different combinations, orpersonality types, representing which of the two poles in each of the four dichotomies dominates in a person, thus defining 16 different personality types. Each personality type can be assigned a 4 letter acronym of corresponding combination of preferences:

The 16 personality types

The first letter in the personality type acronym corresponds to the first letter of the preference of general attitude – “E” for extraversion and “I” for introversion.

The second letter in the personality type acronym corresponds to the preference within the sensing-intuition dimension: “S” stands for sensing and “N” stands for intuition.

The third letter in the personality type acronym corresponds to preference within the thinking-feeling pair: “T” stands for thinking and “F” stands for feeling.

The forth letter in the personality type acronym corresponds a person’s preference within the judging-perceiving pair: “J” for judging and “P” for perception.

For example:

  • ISTJ stands for Introverted, Sensing, Thinking, Judging
  • ENFP stands for Extraverted, Intuitive, Feeling, Perceiving

Take the two tests and then explore what you feel is a more correct way of defining how you see yourself living in the world.  Let me know what you think?  Later we will discuss HSP and Sensory Integration Disorder.

Angela Zaffer, MA, NCC, LPCC


Aron, Elaine N.Ph.D. 2016.

Aron,Elaine N. Ph.D. June 2 1997. The Highly Sensitive Person. Paperback, Amazon

Zeff,Tedd. Ph.D. 2004. The Highly Sensitive Person’s Survival Guide : Essential Skills for Living Well in an Overstimulating World.

A Deathbed Exercise: A tool for evaluating your life


Imagine you’re on your deathbed.

1. You’re reviewing your life.

What are you glad and sad about your worklife?

Your relationships?

Your charitable efforts?

Your hobbies?

Does any of that make you want to make any changes now?

2. Imagine that the person who knows you best is by your bedside.

What might that person say to you if s/he were honest?

What would you say to that person?

What would you ask that person?

Does that make you want to change anything about how you’re living your life?

3. What would you last wish be? Could you get that now or soon?

So now, having completed this exercise, is there anything you want to do differently?

Don’t: Panic, Forget to Breathe, or Worry


Don’t Panic:  Written on the back of the Hitch Hiker’s Guide to the Galaxy

Don’t Forget to Breathe:  A cool song by Bitter:Sweet.

Don’t Worry, Be Happy:  A cool song by Bobby McFerrin.

I like these titles. While we may not always like things worded in a negative manner, these pieces of advice really do stand out well.

There are things that happen in our life that lead us to panic (I see this in my practice all of the time)  – where we think that there is no way that we will ever get out of (insert feared thing here). When this happens, we feel so helpless and stuck – as if there is a crushing blow that we have received that takes our breath away (difficulty breathing is a common panic experience). But, we all have to adjust. We may end up with things that we do not like or do not feel great about, but we have to decide to be happy. We have to make the best of the situation that we find ourselves in (you can hate having panic, or you can learn to live with it). Maybe our life will grow into something so awesome that it will just surprise us one day how great it is, or maybe someday, through a lot of work and dedication and patience, we will gather up all of the things that we want and need in our lives and we will finally feel complete. Either way, it is not going to be perfect – there are going to be bumps in the road. But, we can all learn to adjust to those. Successful people learn how to adjust – people who do not adjust do not succeed.

Either way, we have to have hope that all will turn out well. In “The Shawshank Redemption” the underlying message in that movie was hope – never lose hope. My favorite line in the movie was said by Red, “Get busy living, or get busy dying.” I hope that we all take a moment to work on getting ready to really live.

If you have anxiety or depression, use the ACT workbook “Get out of your mind and into your life” by Steven Hayes. If you have severe anxiety and are ready to start living, see a counselor, therapist, or life coach today!

Panic Is Mental and Physical: A panic attack can have both psychological and physical symptom


If you’ve never experienced high levels of anxiety, you may not know that  anxiety can feel physically draining on your body.
Here are some symptoms you might experience when having a panic attack:

  • Dizziness
  • Racing heart 
  • Difficulty breathing
  • Numbness and tingling
  • Muscle spams and/or pain
  • Headaches
  • Body aches

Reading that list makes one think that panic is more than just being nervous about something. Anxiety has physiological symptoms that are draining to the mind and the body.

I remember being in the midst of an episode of panic in 2011. My heart had been been racing for quite some time and my breath was heavy. I had to lay down. My body was exhausted from fighting. 

I’ve learned through dealing with panic to listen to my body. In the midst of feeling anxious, my body responds differently than it would on a regular day. For example, when anxious, most people will crave comfort foods. 

Being mindful of your body when you are dealing with anxiety is one of the best things you can do. Be in the moment and listen to what your body is telling you. You may need more rest than usual. You might need to go outside and breathe some fresh air. Your body is sending you a message as to how to cope with your feelings. Listen to it. 

It is when we ignore the messages from our mind/body that we can get into trouble. Be respectful of the fact that your body needs more rest during an episode of anxiety, because the last thing you want is to become overly exhausted. 

Our bodies are powerful communicators. If we listen to them, we will be able to be the best possible version of ourselves.

Great ways to combat anxiety and panic attacks: 

Practice Mindfulness throughout the day–not just when you are in the mist of a panic attack.

Use techniques from ACT:  Acceptance and Commitment Therapy    

EFT:  Emotional Freedom Technique