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What is stigma generally in our society? What is the stigma of mental health conditions and substance use? How does this stigma affect people and keep them from receiving the treatment they need to live full, productive lives? These are just a few of the many questions surrounding stigma. We wanted to publish this page as a resource and a recognition that the ongoing roles we all play in breaking down stigma are important and meaningful.

Taking a dictionary definition approach, stigma is "a mark of disgrace associated with a particular circumstance, quality, or person." For purposes of behavioral health, people often assign negative qualities to a person based on their circumstances.

3 Types of Stigma

Stigma usually appears in three forms. Here's how it can influence people consciously and unconsciously

Public - Discrimination and devaluation by others. Stigma in the public sphere can refer to stereotypes of people with behavioral health conditions. Belief in those stereotypes and actions taken in response can affect job prospects, housing decisions, even the quality of healthcare that they receive.

Systemic - Reduced access to care and resources due to policies. Systemic stigma exists when those public stigma stereotypes are embodied in laws, institutions, and organizations that regulate or influence society. While public stigma affects individuals or smaller groups, systemic stigma affects large groups of people.

Self - Internalization of negative stereotypes. Internalized stigma affects a person's self-esteem and self-efficacy leading to persistent doubt and hopelessness.

Why Breaking Stigma Matters

Addressing the influence of stigma and working to reduce it is vitally important in addressing the behavioral health needs of our state. Stigma serves as a barrier to treatment keeping a person in a potentially life-threatening situation. Listen to the perspective in this video.

Easy Ways You Can Reduce Stigma

The National Alliance on Mental Illness (NAMI) has some great ideas on ways we all can break stigma around behavioral health challenges.

Talk openly about mental health. Social media has become a great space for positivity.

Educate yourself and others - respond to misperceptions or negative comments by sharing facts and experiences.

Be conscious of language - remind people that words matter.

Encourage equality between physical and mental illness - draw comparisons to how they would treat someone with cancer or diabetes.

Be honest about treatment - normalize mental health treatment, just like other health care treatment.

Show compassion for those with mental illness.

Choose empowerment over shame

Social media, especially Instagram, is a great source for stigma-busting support. The image above is linked to a popular account.

Words to Watch

This section on stigmatizing language was adapted from longer documents linked below.

The Mentally Ill

People with Mental Illness, People with Lived Experience of Mental Illness

The less stigmatizing choices all use person-first language which emphasizes the person's humanity rather than the issue or diagnosis. The preferred terms emphasize that the person *has* a problem rather than *is* the problem. Terms that are less stigmatizing avoid negative thoughts or associations.

He's schizophrenic

He has a mental illness, He has schizophrenia

Addict, User, Junkie, Drug or Substance Abuser

Person with Substance Use Disorder, Patient

Alcoholic, Drunk

Person with Alcohol Disorder, Person who Misuses Alcohol

Former Addict, Reformed Addict

Person in Recovery, Person who Formerly Used Drugs

Habit

Substance Use Disorder or Drug Addiction

"Habit" undermines the seriousness of the disease and inaccurately implies that a person with a substance use disorder is choosing to use or can choose to stop.

Clean or Dirty

Testing Positive or Testing Negative

It's important to use clinically accurate, non-stigmatizing terminology the same way it would be used for other medical conditions. Also, use of such terms may evoke negative thoughts or feelings.

Commit/Committed Suicide

died by suicide, lost his/her life to suicide

"Commit" implies suicide is a sin or crime, reinforcing the stigma that it's a selfish act and personal choice.

He's low-functioning

He has a tough time taking care of himself, He is still early in his recovery journey, He has a tough time learning new things

Less stigmatizing language speaks directly to a person's individual experience.

Resources to Share

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What is stigma generally in our society? What is the stigma of mental health conditions and substance use? How does this stigma affect people and keep them from receiving the treatment they need to live full, productive lives? These are just a few of the many questions surrounding stigma.

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Benefits of Workplace Counseling | Mazzitti & Sullivan EAP

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Workplace counseling offers many benefits to both employees and employers. Learn more about how a workplace counseling program can help your organization.

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It's professional.

All therapists are licensed, accredited professionals. BetterHelp allows you to connect with them in a safe and convenient online environment.

It's affordable.

Pay a low flat fee for both live sessions as well as messaging with your therapist. Therapy doesn't have to be expensive.

It's convenient.

Do it at your own time and at your own pace. Communicate with your therapist as often as you want and whenever you feel it's needed.

It's effective.

Thousands of people have benefited from therapy (just check out their reviews!) With BetterHelp, you can switch therapists at any point if you don't feel you are getting enough benefit.

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BetterHelp - Get Started & Sign-Up Today

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Online therapy is the best mental health counseling service. Receive support from over 20,000 licensed therapists at BetterHelp via the internet using video & messaging programs.

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Finding affordable therapy when you need it is essential. Services like Talkspace, BetterHelp, Mental Health America, and Amwell can be great options. Here's how to find what's best for you.

Illustration by Brittany England

Finding a therapist is a huge step in taking charge of your mental health. But, unlike a cold or the flu, mental health conditions - like anxiety and depression - can take time to heal.

The American Psychological Association (APA) says there's a big range of sessions needed. Some people find improvement after eight sessions, and others after 6 months. Sometimes, for more severe cases, a year or two may be needed.

What this means: Therapy is a commitment, and, depending on your health insurance coverage, it can be costly.

Unfortunately, having health insurance doesn't guarantee you won't need to pay upfront for therapy. Plans with high deductibles won't cover any medical costs until the deductible has been met. Until that time, you'll need to pay out of pocket for your appointments.

Unlike a $10 to $30 insurance copay, many therapists may charge between $65 and $150 per session. In most areas, the cost of therapy is about $100 to $200.

In cities such as San Francisco, Los Angeles, and New York, however, therapy can cost as much as $200 per session or more.

Luckily, for people who want to book with a therapist - but don't have the means to shell out a significant amount of cash - cost-effective services are available.

To help you get started, we've provided a list of affordable mental health care options.

To narrow down our list of the best affordable therapy options, we took a few factors into account:

Accessibility: Some affordable therapy platforms are available online, allowing users to talk to their counselor from the comfort of their home. However, this isn't the most accessible option for everyone, so we made sure to include an array of directories, apps, support groups, and more.

Mental health expertise: Each platform, site, and app on our list is guided by folks who are well-versed and trained to offer mental health assistance.

Medical review: Our team of medical experts carefully vetted each option in our roundup, and a mental health professional from Healthline's Medical Network reviewed this article to provide insights, offer advice, and verify that all information is correct.

Best therapy apps

Best online therapy platforms

Best directories

Best support group resource

What else to know about mental health support groups

People experiencing eating disorders, postpartum depression, alcohol and substance use disorder, and grief or loss may benefit from attending a support group.

There are both local and online options depending on your needs. Because of the COVID-19 pandemic, online support groups have risen in popularity to keep patients safe.

You can find groups for various conditions, including:

Different from individual therapy, support groups connect people with others who are going through a similar experience. While individual therapists often avoid giving direct advice, support groups allow people to ask for others' opinions.

It can also be healing to hear other people share their stories because it reminds you that you're not alone. This can be especially helpful if you're coping with a disease, like cancer, or supporting a loved one with a chronic health condition or mental illness.

Similar to individual therapy, it's important to find a group that meets your needs. Before joining a group, it can be helpful to ask the group leader about the group dynamic (i.e., how their participants engage with one another) and to find out about the structure of the group.

Open-ended groups, like new mom support circles, allow participants to share at any time during the session. Structured groups, especially those that teach participants a set of life skills like mindfulness, may follow a set curriculum each week.

Best for crisis help

You can find free or low cost therapy in a number of different places. The following list includes resources for one-on-one appointments, group therapy, online offerings, and more.

Sliding-scale therapists

Sliding-scale therapists are psychotherapists, psychologists, and social workers who adjust their hourly fee to make therapy more affordable for the client.

Finding this type of therapist may be a good option if you need to pay out of pocket for counseling or if your insurance provider doesn't offer referrals to specialists.

All mental health professionals are trained to treat general conditions - like anxiety, depression, and adjustment disorders - but not all specialize in treating other conditions, like postpartum depression, complicated grief, or post-traumatic stress disorder (PTSD).

People seeking help for these types of conditions may benefit from finding a specialist who will slide their scale.

Free or low-income mental health services

If you don't have health insurance, and you can't pay out of pocket for mental health care, low-fee or free community mental health clinics can provide the care you need.

These clinics are staffed by psychotherapists and psychologists but often use student psychologists, student mental health counselors, and student social workers who are supervised by licensed, experienced professionals. Services are often provided at no cost or at a remarkably reduced rate.

At the clinics, mental health professionals offer a variety of services, including individual and family counseling, medication management, and substance use disorder counseling. They're also trained to treat a wide range of psychological conditions, like depression, anxiety, bipolar disorder, and schizophrenia.

To find a clinic in your local area, contact the National Alliance on Mental Illness (NAMI) HelpLine or go to MentalHealth.gov. Your primary care physician can provide recommendations in your community, or you can visit your local library to see if there are support groups there, too.

Local colleges and universities

Many colleges and universities with mental health practitioner programs may have clinicians-in-training that offer reduced rates. These clinics are usually open to the public, and they offer sliding scales fees that can be as low as $1.

These graduate students are working under the supervision of experienced professionals, so there's nothing to be wary of. Plus, because they have a limited caseload, they're likely to spend more time thinking about how to help you.

Some colleges may even have licensed professionals with a master's or doctoral degree who offer free, time-limited, short-term counseling.

Find an in-network professional

If you have health insurance, call your insurance provider to find out whether they cover mental health services. If they do, ask for the contact information of local service providers who accept your insurance plan.

Many online therapy services take insurance, but it's important to double-check and ask if everything is covered or if there are copay and deductible amounts.

If you need support for a specific condition, ask for professionals who treat that condition. Your insurance plan may allow you to work with a mental health expert who's out of network, but at a higher cost.

Employee Assistance Programs (EAP)

Your employer may offer therapy services for free through an Employee Assistance Program (EAP). This voluntary program is set up by workplaces to provide a number of confidential services, like assessments, short-term counseling, referrals, and even follow-up help, for free or a reduced cost.

These services are intended to help with any issue that affects your mental or emotional health and, therefore, your work performance. This may include things like:

alcohol or substance use

psychological disorders, like anxiety and depression

stress

grief

trauma

other family issues

Services may be internal (offered onsite at your company) or external (referrals to help in the local community). To find out what services are available where you work, contact your human resources department.

Community resources

Free therapy may also be available in your local community. Finding it may take a little digging. Places like community centers, hospitals, and schools may run free programs, like support groups. Local places of worship - churches, synagogues, temples, etc. - are resources where you might find these types of programs as well.

Contact these organizations directly for more information or look for flyers or online advertisements. You may even hear of these programs by word of mouth or through a healthcare professional.

Publicly funded state-run services may be another option for free or low cost therapy. If you qualify, you will have access to certain professionals that participate in your state's program. Contact your state's department of mental health for more information.

Mental health emergencies - like suicidal thoughts, sexual assault, and domestic violence - require immediate care and attention.

If these crises arise, hotlines can be called at any hour of the day. These hotlines are staffed by trained volunteers and professionals who provide emotional support and can connect you with assistance.

If you have health insurance, there's a chance your plan may cover some or all therapy costs.

To find out if your insurance covers therapy or mental health care, log into your plan's website, which should contain information about your coverage. You can also call your insurance company or even chat with your company's HR department.

If you find a therapist you want to talk with, you can also ask if they accept your insurance.

Even if you find a platform or mental health professional in your budget, they might not be the best fit for you.

It's important to know this is completely OK and actually quite normal. It can take some time to find someone who is a great match for you, whether that means they:

are familiar with LGBTQIA+ issues

are a Person of Color

speak multiple languages

have different specialties, such as couples therapy and counseling, trauma processing, or grief counseling

You'll know your therapist is a good match when they consistently make you feel comfortable and welcomed.

If you don't think they're a good match, communicate that to them by asking them not to schedule another appointment. This can be done face-to-face or over a text, call, or email.
Find more tips on how to pick a therapist here.
How can I afford to see a therapist?

If you want or need to talk with a mental health professional but are worried about being able to afford it, you do have options.

Low cost therapy may be available through social services, nonprofits, and universities, while some platforms offer financial aid or sliding scales.

If you've found a therapist you'd like to start seeing, you can contact them to see whether they accept your health insurance. Some of these costs may be covered through your insurance.

How much is therapy in the United States without insurance?

The average cost of therapy largely depends on the counselor, how often and long your sessions are, and where you're located.

Generally speaking, an hour-long therapy session can cost anywhere from $65 to $250.

How often should you see a therapist?

The frequency of your therapy appointments depends on your goals, why you're in counseling, and what your therapist thinks.

You may see your therapist once a week, biweekly, or even once a month, but you can always talk with them about increasing or decreasing the frequency of your appointments.

Finding low cost mental health professionals can be a challenge at first, but there are plenty of resources available. Remember that your mental health is just as important as your physical health, and it shouldn't have to take a toll on your finances.

If you need help right away, consider looking for a support group or calling your local university. If you have a digital device and an internet connection, telehealth services may also be available to you.

Choosing the right mental health professional doesn't have to be expensive, and the benefits of having support will be well worth it in the long run.

Read this article in Spanish.
Juli Fraga is a licensed psychologist based in San Francisco, California. She graduated with a PsyD from the University of Northern Colorado and attended a postdoctoral fellowship at UC Berkeley. Passionate about women's health, she approaches all her sessions with warmth, honesty, and compassion. See what she's up to on Twitter.

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Finding affordable therapy when you need it is essential. Services like Talkspace, BetterHelp, Mental Health America, and Amwell can be great options. Here's how to find what's best for you. Finding a therapist is a huge step in taking charge of your mental health.

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"...Talking with a therapist about personal issues can be tough, but it can help you come to grips with problems in your life."

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From Client to Wellness Center Owner: On a Mission to Destigmatize Therapy with Juliet Kuehnle

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Listen to this episode from Wellness Center Creators on Spotify. This episode of the Wellness Center Creators podcast features Juliet Kuehnle, a National Board-certified counselor and mental health therapist who owns Sun Counseling and Wellness, a private practice with multiple locations and telehealth services.

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Thank you to Anne Floyd and Rob Winkler and for authoring this article! It speaks to the value of Mental Fitness and how to Nurture your Mental Health.

In a society that is often focused on material things, it's easy to justify spending that improves our attractiveness. We have a natural incentive to care about what we look like: physical appearance is emphasized as the end-all be-all virtually everywhere we get our media. We buy gym memberships to look a certain way, as though mirroring the physical perfection we see in the media will magically make us happy. Going to the gym is also seen as the main route to "getting healthy" - and improving psychological health is not emphasized in the same way. Why?

Likely, the reason why psychological health is deemphasized is because improving it isn't seen to have the same effect on our appearance as the gym. However, even the claim that therapy doesn't impact our appearance can be contested: research has shown that our mental health affects how others perceive our physical appearance - and whether they want to befriend us (Rosenblatt & Greenberg, 1988; Chancellor, Layous, Margolis, & Lyubomirsky, 2017). Another (perhaps less superficial) argument for the importance of therapy is the buoyancy effect. Therapy helps us through difficult times, which are inevitable given that life is unpredictable, often strange, and frequently painful. As a protective factor, therapy can help smooth the bumps in the road - as well as make a good thing even better. Intrigued but not yet convinced? Read 5 reasons how therapy positively impacts long-term psychological health.

1. Therapy can help you learn life-long coping skills.

Great, you're thinking, but what exactly are coping skills? Coping skills are anything that helps you through difficult times, whether it's not getting the promotion you deserve, anxiety about driving, or the death of a loved one. Therapists are educated and trained to help foster the natural coping skills everyone has. Coping skills will look a little different from person to person because everyone is unique. For example, I'm a writer, so I like to journal my thoughts as a way of coping - but someone else might find aromatherapy and bubble baths to be more relaxing. We're all different, and that's okay - but it also means that there is no "one size fits all" coping skill.

Therapists can also teach coping skills that might not be as innate. For example, cognitive behavioral therapists will often teach their clients that what they say to themselves has enormous influence on how they feel & how others respond to them. Attachment-focused therapists might ask their clients to think differently about how they interact with people in their lives. Person-centered therapists encourage their clients to treat themselves with unconditional positive regard and practice radical self-acceptance. Regardless of the modality of therapy, the idea is to bolster your personal strengths - often using evidence-based practices the therapist has taught you. Psychologist Rob Winkler agrees, asserting that "better coping leads to better responses and better responses lead to better experiences, which create more opportunity and prosperity in all aspects of our lives." So while it may not seem as exciting as getting six-pack abs, learning coping skills improves your life exponentially in the long-run.

2. Therapy can change how you interact with people in your life - in a good way.

Sometimes we're not aware of just how many ways we're negatively impacting our relationships. We might snap and call our partner names when we're mad and then forget about it after the fight, not realizing the effect that it has on our partner. On the other side of things, maybe we're so used to keeping our feelings bottled inside that we have a hard time being assertive with the people we love. A therapist can help balance the way we communicate with our loved ones to improve our relationships. For example, for a client who has a hard time being assertive, a DBT therapist might teach the "Dear Man" skill. In a nutshell, "Dear Man" is a skill that helps a client describe what they want and advocate for themselves in a non-judgmental way.

It can also be useful to hear another person's input on the important relationships in your life. Are you getting what you want out of your partner - do they make you feel fulfilled? Are your expectations reasonable, or do you think that your partner should be your everything? Or maybe you're doing everything "right" but there are still ways you could make your connection stronger. A therapist, especially a therapist specialized in family and relationship counseling, can give you the tools and support you need to make changes that will positively impact your relationships. Increasing the positivity of your relationships builds to a more fruitful long-term future - because when it comes down to it, life is about having fulfilling relationships with the people you love and being able to successfully navigate relationships with people you don't.

3. Therapy can make you feel happier.

True happiness is an elusive thing, and many times people chase the external - money, success, a fancy car - to try to achieve it. Even though it's an old cliché, there's truth to the statement that money can't buy you happiness. Having too little money can cause unhappiness, but money doesn't have an inherent value that makes our lives more fulfilled. Buying fancy things might give us a temporary thrill or a sense of satisfaction; however, these feelings don't last and tend to scratch at the surface of true happiness. No one has ever claimed, for example, that the meaning of life is a car; the meaning of life is thought to have more breadth and importance than that.

So how does therapy help you feel happier on a deeper level? Talking over your past, present, and future with a therapist can lead to greater self-understanding. While self-understanding doesn't always imply self-acceptance, it is the first step towards truly embracing who you are at the core. A related concept is self-compassion. Greater self-compassion helps you handle the bumps in the road that inevitably happen in life without getting stuck in a mire of negativity. Therapists, especially person-centered therapists, often emphasize self-acceptance and self-compassion - and talk us through techniques for increasing both. Learning self-compassion in therapy has tangible benefits: High self-compassion has been found to lead to more health-promoting behaviors (Sirois, Hirsch, & Kitner, 2015), nurture well-being (Neely, Schallert, Mohammed, Roberts, & Chen, 2009), increase empathy and altruism (Neff & Pommier, 2012), and provide a buffer against anxiety (Neff, Kirkpatrick, & Rude, 2007).

4. Through its link to happiness, therapy leads to more productivity.

In The Happiness Advantage, Shawn Achor explains how positive emotions lead to greater productivity: "Happiness gives us a real chemical edge...How? Positive emotions flood our brains with dopamine and serotonin, chemicals that not only make us feel good, but dial up the learning centers of our brains to higher levels" (44). In other words, feeling positive emotions allows you to work harder and learn more because of the "feel good" chemicals in your brain. While productivity isn't everything, most of us have too much to do and not enough time to do it, especially those of us with demanding jobs or those of us with kids. Increasing your levels of happiness-and with it, your productivity-not only helps you in your career but also helps you cope with the messiness and hectic pace of life.

Therapy can also help you discover obstacles blocking you from performing at your best. These types of road blocks (e.g., perfectionism or overthinking) are challenges a therapist can help you work through to find an effective solution. You and your therapist can also discuss time-management skills and whether changing negative long-term habits-such as poor prioritization or inaccurate assessments-could help with your focus and productivity. These types of changes can lead to long-term benefits such as increased work performance, greater feelings of self-efficacy, and improved relationships. For more information, check out Shawn Achor's TED Talk "The happy secret to better work."

5. Therapy can help improve chronic stress.

The ways that therapy can improve long-term stress are numerous. A therapist can teach you methods of calming your body and mind, which might include techniques such as guided visualization, progressive muscle relaxation, and deep breathing. Therapists can also help problem-solve the sources of your stress and teach you stress-reduction techniques. They can introduce you to new concepts such as radical acceptance - that many things in your life are beyond your control and acceptance is the key to reducing your suffering. Best of all, once you learn these techniques, you carry them with you into the rest of your life. In other words, stress relief in the short-term can build into long-term patterns of stress management.

Crucially, a therapist can also be a sounding board who listens to you talk about your life and validates your feelings. This isn't the same thing as agreeing with you and supporting your every decision, but it can be more valuable - because it nurtures the idea that you're important, your feelings are worth listening to, and you're understood. Social support has been shown to be essential for mental health, and, perhaps as importantly, lacking in situations where mental health issues are present. In both the short- and long-term, social support soothes the mind and improves health- as evidenced by numerous studies (Berkman, 1995; Cohen and Janicki-Deverts, 2009; Umberson and Montez, 2010). In short, therapists are effective social support, and feeling supported leads to greater psychological health.

I hope that this blog is an invitation to reexamine how we consider therapy in a wider context. Our culture is ready to accept going to the gym as a way to improve physical health; why not embrace therapy as a way of improving psychological health? Think of therapy as a method of self-improvement, a life-affirming way to make positive changes instead of stagnating. Therapy is not about fixing something that is broken: instead, it is about embracing what we have in order to reach our full, prosperous potential as human beings.

References:

Achor, S. (2010). The Happiness Advantage. New York City, New York: Penguin Random House.

Berkman, L.F. (1995). "The Role of Social Relations in Health Promotion." Psychosomatic Medicine 57, 245-54.

Chancellor, J., Layous, K., Margolis, S., & Lyubormirsky, S. (2017). "Clustering by Well-Being in Workplace Social Networks: Homophily and Social Contagion." Emotion 17(8), 1166-1180.

Cohen, S., & Janicki-Deverts, D. (2009). "Can We Improve Our Physical Health by Altering our Social Networks?" Perspectives on Psychological Science 4, 375-78.

Neely, M.E., Schallert, D.L., Mohammed, S.S., Roberts, R.M., & Chen, Y. (2009). "Self-Kindness when Facing Stress: The Role of Self-Compassion, Goal Regulation, and Support in College Students' Well-Being." Motiv Emot 33, 88-97.

Neff, K.D., Kirkpatrick, K.L., Rude, S.S. (2007). "Self-Compassion and Adaptive Psychological Functioning." Jounral of Research in Personality 41, 139-154.

Neff, K.D., & Pommier, E. (2012). "The Relationship between Self-Compassion and Other-Focused Concern among College Undergraduates, Community Adults, and Practicing Meditators." Self and Identity, 1-17.

Rosenblatt, A., & Greenberg, J. (1988). "Depression and Interpersonal Attraction: The Role of Perceived Similarity." Journal of Personality and Social Psychology 55, 112-119.

Sirois, F.M., Hirsch, J.K., & Kitner, R. (2015). "Self-Compassion, Affect, and Health-Promoting Behaviors." Health Psychology 34(6), 661-669.

Umberson, D., & Montez, J.K. (2010). "Social Relationships and Health: A Flashpoint for Health Policy." Journal of Health and Social Behavior 51, S54-66.

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Thank you to Anne Floyd and Rob Winkler and for authoring this article! It speaks to the value of Mental Fitness and how to Nurture your Mental Health. In a society that is often focused on material things, it's easy to justify spending that improves our attractiveness.

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Wondering if therapy is right for you? You're not alone.

Seeking help from a mental health expert is something many people consider, especially when:

facing a significant crisis

dealing with an extended period of anxiety or depression

coping with a major life transition

dealing with complicated family dynamics

grappling with problems in a relationship

trying to manage addiction or substance abuse

wanting to make changes for better mental and emotional health

Regardless of your reason, therapy offers a broad array of benefits for all of us. We've partnered with Florida Blue to bring you this article on six types of therapy and the benefits of each.

Talk therapy (aka psychotherapy) is a tool used by:

Talk therapy encourages open and honest dialogue about issues that cause you distress. Through your relationship with your therapist, you'll work to identify and understand how these stressors are impacting your life, plus develop strategies to manage the symptoms.

If you're still on the fence about the benefits of talk therapy, consider this: About 75 percent of people who participate in talk therapy experience some benefit, according to the American Psychological Association.

In the case of individual therapy, the relationship between you and your therapist - which is fostered through talk therapy - is key to your success.

Individual therapy gives you a safe space to explore your thoughts, feelings, and concerns.

Unlike couples, family, or group therapy, individual therapy focuses solely on you. This allows for a deeper understanding of the issues and more time for developing coping strategies to help you handle difficult situations.

The goal of individual therapy is to inspire change and improve the quality of life through self-awareness and self-exploration.

Being in therapy can also:

help improve communication skills

help you feel empowered

empower you to develop fresh insights about your life

learn how to make healthier choices

develop coping strategies to manage distress

When families face hurdles that seem a bit too high to conquer on their own, they may seek help from a family therapist. According to the American Association for Marriage and Family Therapy, a therapist can:

evaluate and treat mental and emotional disorders

evaluate and treat behavioral problems

address relationship issues within the context of the family system

Unlike individual therapy, treatment isn't just for one person - even if that's the only member of the family working with the therapist. Instead, the focus is on the set of relationships that make up the family unit.

Some of the most notable benefits of family therapy include:

improving communication skills

providing help treating mental health concerns that impact the family unit (such as substance abuse, depression, or trauma)

offering collaboration among family members

developing individual coping strategies

identifying ways to find healthy support

Think couples therapy is only for people having problems? Think again!

Marriage and family therapists are the first to say that couples therapy is an effective way to keep a relationship on track before it goes off the rails. But if the strains are real and communicating is almost impossible, going to therapy allows couples to meet with a neutral party.

One of the foundational goals of couples therapy is learning how to improve interpersonal dynamics. A 2016 research review suggest that couples therapy is an effective treatment when a couple is experiencing individual and relational distress.

Couples seek therapy for a variety of reasons. Some of the more common benefits cited by couples include:

improving communication skills

resolving conflict

restoring lost trust

increasing shared support

restoring intimacy

learning how to support each other through difficult times

forming a stronger bond

Cognitive-behavioral therapy (CBT) is a blend of two other therapies: behavioral and cognitive.

Therapists use this technique to treat many conditions, including:

anxiety disorders

bipolar disorder

depression

eating disorders

substance abuse and addiction

obsessive-compulsive disorder

phobias

post-traumatic stress disorder

In CBT, your therapist will guide the sessions with an emphasis on the important role of thinking in how you feel and what you do.

In terms of effectiveness, CBT has proven successful as a treatment option on its own or as a supplemental therapy to medication for several mental health conditions, including:

anxiety disorders

bipolar disorder

depression

A 2017 research review found that CBT has a positive impact for people living with bipolar disorder by:

reducing depression levels

reducing the severity of mania

decreasing the relapse rate or how often people experience mania and depression

increasing psychosocial functioning, which means improving abilities and experiences in day-to-day activities and relationships

A 2015 review reports that CBT is the most consistently supported psychotherapeutic option for treating anxiety disorders.

The way we seek help is changing as more providers move to online platforms. Just the idea of having options is one of the benefits of online therapy, or teletherapy.

Not only does this allow you to meet with a therapist from wherever you might be, it also gives you the freedom to choose the delivery method of that therapy. In other words, you can reach a therapist from your phone, an app, or online.

This may make it easier for you to find a counselor you connect and communicate well with.

The ability to get help for mental health this way means more people have access to therapy than ever before. It also helps minimize the stigma attached to mental health, and it gives you options.

If you're worried about online therapy not being as effective as the in-person kind, consider the results from this small 2014 study. Researchers found that internet-based treatment for depression was equally beneficial as face-to-face therapy.

While over-the-phone and online therapy may not work for everyone in all situations, it's an option to try.

Just as there are options to speak with a therapist over the phone, voice chat, and online, there are:

If you're looking into therapy, another place to start is by talking with a general physician about getting a referral.

Working with a psychologist, therapist, or counselor in a therapeutic relationship gives you an opportunity to explore your thoughts, feelings, and patterns of behavior.

It can also help you learn new coping skills and techniques to better manage daily stressors and symptoms associated with your diagnosis.

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Benefits of Therapy for Yourself, Family, and Relationships

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Therapy offers a broad array of benefits for all of us. Here are six types of therapy and the benefits of each.

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The stigma of mental health care is finally starting to fade away, and we say, "good riddance." This stigma has impacted how people view others struggling with mental health. It has also caused many people to feel ashamed for needing support with their mental health, resulting in them avoiding getting the help they need altogether. Now, with the stigma changing, we want to go even further. We don't think mental health care is just for people who are struggling, but for everyone. Keep reading to learn more about the stigma of mental health care and why mental health is for everyone.

The stigma of mental health care

The public stigma of mental health care involves discriminatory or negative attitudes toward people with mental health conditions. This stigma can also be internalized, causing a person to feel shame about their own condition. Shame can cause a person to not discuss their condition or what they are struggling with and prevent them from reaching out and getting the support they deserve.

This stigma exists because of a lack of understanding and/or fear of mental health conditions. Unfortunately, mass media tends to amplify the stigma by portraying extreme and often inaccurate conditions and treatments. According to our Houston psychiatrist Dr. Bobbie Porche, these portrayals "are dangerous because they cause people with mental health disorders to feel isolated and struggle alone or in silence, causing them not to seek treatment."

Thankfully, the stigma is changing

There are two big reasons why the stigma around mental health is changing, and those reasons are:

1. Generation Z

2. The COVID-19 pandemic

Unlike generations that came before, Gen Z grew up with smart technology and social media. On media platforms such as TikTok, many young people share more aspects of their lives than previous generations, including their struggles with mental health and the care they receive. Sharing content on these topics helps to spark conversations and normalizes the topic altogether.

During the COVID-19 pandemic, pretty much everyone experienced some isolation and depression. During lockdowns, there was nothing to distract you from your mental health issues. This time was very hard for many of us, but the silver lining is that it also helped people confront mental health in a way they haven't before.

With both Gen Z and the pandemic, we find that mental health is being talked about more and becoming normalized. And as it becomes normalized, the lack of understanding and fear that is the foundation of the stigma begins to break down. As a result, the stigma of mental illness is changing.
Did you know that we offer telepsychiatry? Learn more here.
You don't have to hit rock bottom

As the stigma is thankfully changing, we want to go even further. We don't think mental health care is just for people who are struggling, but for everyone. And that's because our mental health is our emotional, psychological, and social well-being. It affects how we all think, act, and feel. So, getting care and support for something that impacts each and every one of us makes total sense, right?

Dr. Porche is a big believer in everyone receiving mental health care. She says, "Even if you're feeling okay, I encourage every single person on this planet to do therapy because there's no other place you can really focus on yourself and your issues." Unlike talking through issues with family or friends, where there can be bias or back-and-forth, or sometimes even conflict, therapy sessions are confidential and involve talking through your issues with a neutral third party who is a licensed professional.

Whether you're at a particularly low point or you're feeling fine, therapy or other mental health care options can help you improve your internal processing, develop coping skills, and overall enhance your emotional, psychological, and social well-being.
Check out our psychotherapy program.
Tips for getting started

It's important to understand that mental health care is not a one-size-fits-all solution. Everyone's brain is unique, which means that what works for one person may not work for you. Find a provider who you trust, feel safe with, and can relate to. Keep an open mind and don't be afraid to try new things if something isn't working for you. Not vibing with your therapist? Ask for a referral to try a different one. Not finding any success with your sessions? See if there is something else you can try. Were you given medication that is giving you negative side effects? Switch to another one.

Sometimes it can take a while to find what works. And even then, what works for you at one point may not work for you later as you continue to grow. Have hope. Trust the process. We promise it is worth it.

If you're interested in beginning your mental health care journey, we want to help! We have a wide range of mental health services available. Connect with us today and we'll put you on a path that is just right for you. Let's work together to continue changing the stigma of mental health care.

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No More Mental Health Stigma: Why Therapy Is for Everyone | Mindful Health Solutions

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With the mental health stigma changing, we want to go even further. We don't think mental health care is just for people who are struggling...

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Seeking therapy, unfortunately, can come with its fair share of embarrassment or shame. Pursuing professional counsel for mental health concerns has been stigmatized and labeled as something that "only those with mental disorders need." The reality is that many people would benefit from therapy, whether or not they have a diagnosed mental illness. Seeing a therapist can be part of a person's overall mental and emotional well-being.

While effective therapy can be extremely worthwhile for many, it is critically necessary for some, especially those with mental illnesses, such as anxiety, depression, addiction or other disorders. The brain, after all, is an organ and, like other organs, requires some qualified medical attention. Therapy can help you manage life's varied challenges and live a more fulfilled life. It can help you understand what you're feeling, why and how to cope. Just like visiting your doctor for regular wellness exams, or your dentist for checkups, meeting with a therapist can help keep your mental health in order. Indeed, therapy can be beneficial "just because."

What Is a Therapist?

People who seek mental health therapy are often experiencing distressing emotions, thoughts or actions. Therapists can evaluate and provide guidance on these types of symptoms to assess the best method of treatment and serve as an outlet for someone who needs a listening ear.

Using evidence-based practices, mental health therapists can offer different types of therapy, usually based on their educational background. This may include one or more of the following:

Cognitive therapy

Humanistic therapy

Psychotherapy

Dialectical behavior therapy

Holistic therapy

Often, therapists work alongside medical providers who can prescribe medication when necessary. A therapist may recommend that a patient begin a medication regimen to a doctor who can then write the prescription and assist in monitoring for side effects and effectiveness.

Production note: good place for a callout feature: Wondering how to start seeing a therapist or how often you should see a therapist? Your best bet is to contact Davis Behavioral Health for a consultation with one of our providers. With their help, you'll be able to determine the best schedule for therapy based on your specific needs.

What Are the Benefits of Therapy?

Therapy can provide you with the needed tools to manage your emotions. Learning the art of mindfulness-based meditation can even help you take care of your own mental health and well-being. And couples counseling can help people work through relationship troubles and live a happier life together.

In other words, one of the benefits of seeing a therapist is the ability to improve your overall wellness. There is, however, one caveat: therapy may not be the best option for those in crisis. For anyone having suicidal thoughts, it's best to forego therapy in lieu of immediate crisis support to help curb any suicide ideation. The National Suicide Prevention Lifeline provides 24/7, free and confidential support for those in a crisis. And for those who may not feel comfortable talking to someone, messaging the Crisis Text Line can immediately connect them to trained Crisis Counselors.

The same can be said for couples counseling: therapy can help, but it may not be the best choice for those living in abusive relationships. Those in abusive relationships should strongly consider contacting the National Domestic Violence Hotline immediately. Therapy can then help those involved fully recover and live a happy, post-crisis life, free of unhealthy relationships.

Why See a Therapist?

If you're feeling afraid to see a therapist, rest assured that this is normal. Some people feel uncomfortable talking with a mental health therapist about their personal lives. However, there are plenty of reasons to see a therapist that outweigh the trepidation you may be feeling. One or more of these reasons may help you decide when to see a therapist:

1. You're Experiencing Intense Feelings of Sadness or Helplessness

It's normal to feel down every once in a while, but sometimes it's difficult to get out of a low point in your life. These feelings can actually be a sign of major depression, which is a reason to find a therapist who can help you talk through those feelings and begin healing.

2. You've Run Out of Advice From Friends and Family

However well intentioned, advice from friends and family on coping with life's challenges may not be enough. The assistance of a professionally trained and experienced therapist can be much more helpful. You'll find tools that your friends and family cannot provide.

3. You're Using Alcohol, Drugs, Porn or Other Unhealthy Coping Mechanisms

Managing painful or difficult emotions with alcohol, drugs, porn or other addictive means commonly leads to larger problems. At Davis Behavioral Health, we have therapists who specialize in addiction treatment. Let us help you find a better way to cope with mental distress.

4. You or a Loved One Are Living With a Chronic Health Condition

The uncertainty of serious illnesses can bring on stress, anxiety and depression. It's easy to slip into negative thought patterns when you are facing a long-term illness. Therapists can help you see through the troubled waters to a bright horizon so that you can focus on the positives in life.

5. You're Undergoing a Big Change

From a major career shift to a change in marital status or relocating to a new state, big changes can lead to emotional distress. Talking through these changes is almost always better than trying to power through them on your own. A mental health therapist can provide a listening ear so that you can express your true feelings and emotions regarding big changes.

6. You've Recently Lost a Loved One or Close Friend

Grieving is normal and healthy, but if time passes and you're still feeling a heavy burden from the loss of a family member, trusted friend or pet, therapy can help. Having someone to talk to with experience with the grieving process can ease the pain that you are feeling.

7. You Suspect You Have a Serious Mental Health Condition

Some of the most common mental health disorders are effectively treated with a combination of medication and therapy. Our providers are trained in a range of evidence-based therapies that can be utilized to help you on your journey toward better mental health. In nearly every case, leaving a mental illness untreated can lead to worsening symptoms down the road.

8. You Feel Like You've Lost Control

Therapy can help calm the waters of rampant substance abuse, rage, anger or other runaway emotions. Even if you don't have a diagnosed mental illness, there are times when your life may feel out of your control. Talking it through with a therapist is a good way to be reminded of what you do have control over in your life.

9. You're Having Family Issues

Couples and family therapy can help improve communication, work through challenges and resolve conflicts. However, as mentioned earlier, couples therapy is not recommended for those in abusive relationships. Family therapy is great for practically any family unit. There are so many different relationship dynamics at play, and therapists can help each member find understanding and compassion for the others.

10. You Feel Like You Need To Talk to Someone

It's as simple as it sounds-trust yourself. If you feel like you need help, seek it. Don't be ashamed or embarrassed for taking action to improve your mental health, no matter the reason. You know yourself best, and if you think it's time to find a therapist, it is time.

Speak With a Mental Health Therapist Today

Davis Behavioral Health is here to help with life's challenges. Need to find a mental health therapist? We have compassionate, caring and experienced mental health professionals that help our clients understand and manage their mental well-being. Whether it's because you've recently lost a loved one, you're feeling overwhelmed with life or just need to talk to someone, we're here to help you improve your mental health. Please contact us today with questions, or to set up an appointment.

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10 Reasons to See a Therapist | Davis Behavioral Health

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Seeking therapy, unfortunately, can come with its fair share of embarrassment or shame. Pursuing professional counsel for mental health concerns has been stigmatized and labeled as something that "only those with mental disorders need." The

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Psychotherapy is a professional relationship between you and your therapist, devoted to your well being and psychological healing. Relieving your emotional pain, reducing your symptoms, improving relationships, or changing your behavior or lifestyle may be parts of that goal.

The main way we achieve the goals of psychotherapy is by talking together. Clients are most likely to improve if they trust their therapist, feel understood by their therapist and experience a genuine concern and support from their therapist. Clients can facilitate this by disclosing any concerns they have about psychotherapy or about the therapist's perceptions or comments.

Sometimes other kinds of "expression" can be used, such as art, play (most often used with children) or writing in a journal. Other methods (such as relaxation training, meditation, and so on) may be suggested, but your therapist will use only approaches with which you agree. You have a right to be informed and to understand the purposes of these activities, as well as any risks, and reasonable chances of success of any approach.

Some therapists recommend "homework" for the client to do between sessions. Homework may include reading, writing in a journal, practicing assertive communication, exploring job options, spending quality time with a partner, or any other activity designed to help the client learn something new, practice new skills or overcome anxiety. You should always let your therapist know if you are uncomfortable with, or confused by, any homework they suggest.

Regardless of how they approach psychotherapy, all Maps therapists begin by identifying what brings you to therapy and what goals you wish to achieve. They will ask you for specific symptoms in order to make a clinical diagnosis (required by insurance companies), and they will ask you about your history, including any previous counseling or mental health treatment you may have had.

At Maps, we believe that a spiritual assessment is also important, and your therapist will likely ask about your understanding of spirituality, your spiritual or religious heritage, your religious or spiritual practices, and the importance or spirituality or religion in your life. Maps therapists understand that there may be things that you are reluctant or unwilling to disclose or discuss at the beginning of psychotherapy, but may be shared later as you learn to trust your therapist or gain confidence in the process of therapy.

Maps therapists also are sensitive to the importance of cultural factors in how people perceive their world, their problems and possible solutions. Sharing information about your specific cultural background or values is one way to improve the benefits of psychotherapy.

The therapeutic relationship is not a social relationship, and therapists are discouraged from providing psychotherapy to individuals with whom they have personal or social connections. Psychotherapy rarely, if ever, involves physical contact other than a handshake or a pat on the shoulder. Personal relationships, especially intimate relationships, are inappropriate and possibly illegal both during and after therapy has ended. Although you may feel very close to your therapist, please understand that the boundaries they place on the relationship are a necessary part of psychotherapy.

Therapy is often challenging work. You may learn to pay attention to your thoughts, your feelings, and your relationships; to honestly acknowledge them (including feelings you may wish you never had); to work with unwanted aspects of yourself, to learn to feel painful things and to face painful realities; to talk candidly and respectfully with people you'd rather avoid; to accept difficult but inevitable situations; to confront frightening but important realities. The therapist may guide and support you during this process, but ultimately the work is done by you.

The therapist's job is to listen carefully, to point out strengths that have been unnoticed and weaknesses that have been ignored, to look for hope when you are hopeless and danger when you are naive, to allow you to be dependent when you fear depending and to challenge you to be self-reliant when you would love to have someone solve your problems. In short, the therapist's job is to assist you to learn to meet your needs, satisfy your desires, and live more freely in this world.

Known Benefits of Psychotherapy

Research has shown that most of the common approaches to therapy are about equally successful. In general, psychotherapy clients are better off after therapy than they were before it, and they are better off after therapy than 80% of untreated persons.

Therapy is very helpful when the client is depressed, anxious, unhappy, a survivor of trauma, or suffering from a life-problem which requires lots of emotional energy. People who can talk and listen reasonably well, who are comfortable being alone with another person, and who are willing to pay attention to their own feelings, thoughts, and motivations probably will do well in psychotherapy. Sometimes, the benefits of psychotherapy can be enhanced by medications designed to decrease depression or anxiety symptoms.

Common Risks Associated with Psychotherapy

There are potential risks to psychotherapy. People may initially feel worse as the therapy progresses. In rare cases, psychotherapy may even trigger some people to have thoughts about wanting to hurt themselves or end their lives. When this happens, your therapist will be able to help you understand and cope with these feelings safely, and can direct therapy to be more supportive until you are feeling stronger. It is always important that you tell your therapist if you are having any frightening or dangerous thoughts or feelings, or if you are considering harming yourself or someone else.

Some clients develop strong feelings about their therapists. This is especially true in longer therapies. Such feelings are normal, even if sometimes uncomfortable or confusing. Any feelings are possible, and the rule for them all is to talk them over with the therapist. They are experienced with this and will help you understand how this is part of your progress.

Therapy can complicate your life.Therapy is often about making changes or about looking at yourself differently. Therapy can change how you live, and it can change how you feel about your relationships. Your therapist will help you to anticipate these changes and will let you decide what changes are best for you, and when.

Psychotherapy is not free and for many there is a personal financial cost. Usually, if you have health insurance, it will pay some portion of the fee. Prior to beginning therapy we recommend you speak to your insurance representative and find out how much you are expected to pay and if there are limits to the number of sessions your insurance will provide.

Insurance companies have the right to ask about your counseling to determine if treatment is necessary and appropriate. Your therapist will be required to provide a diagnosis and may need to submit a report outlining what you are working on and how long it is likely to take to achieve your goals. If there is anything you wish to discuss in therapy that you do not want shared with anyone, including your insurance company, please discuss this with your therapist.

Insurance also requires that we provide a diagnosis, using the nationally approved DSM 5 or ICD 10 criteria. Your diagnosis, like all of your medical information, is protected by privacy and confidentiality rules and practices. However, some clients fear being labeled or "stigmatized" by their diagnosis, or fear that it could limit their career options or insurance rates. If you have any such fears, please speak about them to your therapist.

Some research suggests that when one spouse or partner meets alone with a therapist to discuss problems involving the other partner, there is a chance that this could increase tension for a couple. For this reason, many marital or relationship problems are best addressed with both individuals coming to therapy together.

While your therapist could offer suggestions and advice when asked, research shows that a therapist's advice about life problems is often no more helpful than anyone else's. Helping you find your own solutions to your life's problems is a far more effective approach.

Finally, not all therapy is effective. If you have been in therapy for several weeks or months, and it does not feel like you are making progress, you should speak to your therapist. It may be that you would do better with a different approach to therapy, or even with a different therapist. As therapists, we know that we cannot be everything to everybody, and we are comfortable helping you make a change if needed.

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What is Therapy and What Are the Potential Risks and Benefits - MAPS

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Psychotherapy is a professional relationship between you and your therapist, devoted to your well being and psychological healing. Relieving your emotional pain, reducing your symptoms, improving relationships, or changing your behavior or [...]

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Why Is There a Negative Stigma Around Therapy?

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Why Is There a Negative Stigma Around Therapy?

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January 20, 2021

Why is There a Negative Stigma Around Therapy?

The pandemic has elevated the need for mental health therapy for millions of people. People feel isolated as they're thrown from their normal routine into isolation, yet many aren't seeking treatment. The problem is that there is often a negative stigma on mental health therapy.

Almost half of the people in America surveyed last year stated they are fighting their own battles with mental health issues. Millions aren't seeking therapy because there are certain negative stigma labels put on therapy by society that leave many unable to seek help move forward in their lives.

Mental Health Stigmas

Many people refuse to normalize therapy because of the negative societal stigmas. They may feel that their loved ones just don't understand them, yet they feel they have nowhere to turn. It's often this lack of understanding regarding mental health issues that leads to stigmas on therapy. People are fearful of therapy because of misleading media representations. Many people understand there are medical issues that involve mental health, but they still hold a negative view.

Types of Stigma

Public Stigma - This is the stigma that the public has about mental illness. This also includes negative attitudes towards it.

Self-Stigma - This is the feeling an individual has about their mental illness. They are shameful and negative towards their mental health.

Institutional Stigma - This is more about the government and other organizations limiting the opportunities for people that have a mental illness. This might mean limiting research or funding for mental health services.

The Media's Role in A Negative Stigma

Although we may not even be aware of it, many of us have preconceived notions about mental health due to media influences. When there is an act of violence, the media often quickly jumps to label the perpetrator as "crazy." This person may actually have a mental illness, but they are often slapped with a derogatory term before anyone knows anything about them. Someone watching the news as this event unfolds only hears the negative terms or connotations. In turn, they may think if they seek mental health help, they will be labeled as "crazy." They feel as if the media has roped them into the same realm as criminals.

Television and Movie Portrayals of Mental Health Issues

There are many television and movies that don't portray mental health in a positive light either. Movies like "One Flew Over the Cuckoo's Nest," "Girl, Interrupted," and "Joker" scares many people into thinking they are just like the characters. It's crucial that media like this destigmatize therapy. In reality, most people with mental illness are nothing like the intense characters in these movies. Many people just need a little boost and a little help; someone to talk to. They aren't going to go off the rails like the Joker.

Effects of Negative Stigma on Mental Health

One of the biggest problems with the stigma of mental health therapy is lack of opportunity. Many people that are suffering from mental health issues are held back in their professional and personal lives. Sometimes health insurance companies refuse to cover the costs of mental health help, making it virtually impossible for some to seek help. These things lead to the person suffering on their own. They cannot get the treatment they need to live a normal life. They often feel left out or unsuccessful because they cannot treat themselves.

Cultural Issues

Many times, cultural beliefs steer people away from seeking mental health help. For some in certain cultures, they will go to other family members or their primary doctor for their symptoms regarding mental health. Instead of speaking with mental health professionals, they believe others can help them. They often fear their own cultures will not accept them.

Some members of black families steer away from mental health professionals because many in their community have experienced mistreatment and racism from health providers throughout the years. They try to handle these issues independently.

Many Middle Easterners and Asian Americans believe, in their culture, that if they seek mental health help, it will bring shame to their families. They believe this will dishonor the heads of the family. Many Asian Americans are pressured by their families to have a public persona of success. Mental health help doesn't fit into this public persona. All of these beliefs are valid for these cultures, but the negative views must be changed for the benefit of the person. If they need a higher level of help, it's important they reach out beyond their own circle.

How to Cope with Mental Health Issues

Understand You Aren't Crazy

Millions of people go to therapy every day. It doesn't matter if you need help with a mental illness or you need to talk through issues, you aren't "crazy" if you go to a therapist. You might joke around that you're losing your mind or you are on your way to the loony bin. It's no joking matter. You are like millions of other people that need a little help. You should normalize therapy by setting aside the negative stereotypes. The things you see in movies aren't usually real life. A therapist understands you aren't losing your mind and they will never treat you like you are.

Put Yourself First

You must first confront your own stigmas around counseling before you can change the rest of the world. You must see yourself in a positive light as you get ready to open up to other people. You don't need to shout it from the mountaintops, but you can share your goals of therapy with your loved ones. If you hide it, you're letting the stigma lead the way. Be open about the reasons you need to go to therapy. You'll be surprised at the level of support around you. If you seem ashamed, your loved ones might start to believe in the stigmas as well. Stay on top of these thoughts. Help others see the light you've seen, and help them understand how therapy is helping you.

Don't Set A Timeline

It's important to go at your own pace when seeking mental health help. It's tempting to wonder when you will ever be done with the process. In reality, there is no specific time it takes to heal yourself. Therapy is about working towards your goals and changing your life one step at a time. It isn't about "fixing" anything. Don't let the stigma of a certain timeline stop you from getting the help you need.

Be Honest

You wouldn't lie to people when you are going to a primary care doctors' appointment, so it's important to be honest in mental health appointments. It's important not to hide these appointments just because you feel there is a negative stigma. You can work to change that stigma by being open and honest about your appointments. You don't have to share with the world everything you talked about in the appointment, but you can be open about the fact you are seeking mental healthcare. This helps change the negative stigma as people realize that not everyone is perfect.

Know Everyone Is Not the Same

Everyone you meet is fighting a battle. Mental health help is all about reflection and exploring your own thoughts. Everyone's battle and their experience is different, so don't ever compare yourself with someone else's mental health journey. Your approach to therapy may be totally different than someone else's approach to their own therapy. Each counseling journey is personalized for that specific person's needs.

Mental Illness Is Not Your Definition

Don't ever let your mental health issues define who you are as a person. Rather than say you are bipolar, for example, simply say you suffer from a bipolar disorder. You choose what defines you in life. Mental health issues may be a part of the person you are, but you are so much more than just the mental health diagnosis. Don't let it rule your life. Don't let it be your title in life. You might not be able to choose the issues, but you can choose which issues define you.

Find the Light

As you search for meaning in your mental health issues, find the light around you. Realize that you are blessed to have the ability to fight these issues. The positive outlook should outweigh the negative fears you have about mental health help. Know you are going to feel better after you get treatment. Know you are going to find the light in all things as you go through this journey. This lowers the stigma and doesn't give it any power.

Lean On Your Own Opinions

Listening to other people's opinions is often an obstacle for people that need mental health help. It's crucial that you don't let other people keep you from seeking therapy. Do your own research. Make your own opinions. Reach out to people you trust that want the best for your mental health. You can join a support group that helps you share your issues with other people. Don't let anyone define you by your mental health issues. If you only listen to the negative opinions of others, you will find yourself in isolation and fear.

Know You Aren't Alone

One of the most important ways to get rid of the negative stigma of seeking mental health help is to understand that you are not alone. Many people are scared to discuss their issues. They fear everyone else is leading a "perfect" life. They isolate themselves because they believe they're the only one experiencing these issues. This is not true at all. There are millions of people that need mental health help in the world. It's common and totally normal to seek help. You are not alone in your struggles. Once you start talking about it, you'll see other people raise their hands to say they need help as well. The American Counseling Association stated that over 40 million Americans suffer from anxiety. They state that over 20 percent of the population fights different mental disorders. This means you are not alone at all.

Challenge the Media

Don't let the media get away with stigmatizing mental health. They are a public outlet so it's important they work with the audience to destigmatize therapy. If you watch a television show that depicts mental illness in a negative way, reach out to them. If someone on your social media writes derogatory comments about it, make a statement yourself. You can make a difference by reaching out to explain to them their impact on people reading and watching these stories.

Mental Health Is Just as Important as Physical Help

Your mental health is just as important as your physical health. Many people are scared to address their mental health concerns because they cannot be seen. If you are feeling physically ill, you go to a physician to find the cause. You seek medication to feel better. If you are dealing with a mental health challenge, it's important to reach out to a mental health professional. Many people put mental health on the back-burner because they don't understand how to heal it. Just like your physical health, mental health needs to be addressed and treated.

In Conclusion

It's time to get rid of the negative stigmas that partner with mental health help. It's totally normal to get help when you need it most. You need to take care of your mind and body by all means possible. Believing in mental health stigmas will only hold you back from your own true happiness.

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Why is There a Negative Stigma Around Therapy?

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People often associate a negative mental stigma with getting the mental health help they need from professionals. The good news is that you can get over the negative perception and feel better.

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Choose a unique, qualified therapist who accepts your insurance and specializes in the areas of your life that you'd like to focus on.

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Psychology Today: Health, Help, Happiness + Find a Therapist

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View the latest from the world of psychology: from behavioral research to practical guidance on relationships, mental health and addiction. Find help from our directory of therapists, psychologists and counselors.

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J Clin Child Adolesc Psychol. Author manuscript; available in PMC 2020 Jan 18.

Published in final edited form as:

Abstract

Objective:

Family therapy has the strongest evidence base for treating adolescent conduct and substance use problems, yet there remain substantial barriers to widespread delivery of this approach in community settings. This study aimed to promote the feasibility of implementing family-based interventions in usual care by empirically distilling the core practice elements of three manualized treatments.

Method:

The study sampled 302 high-fidelity treatment sessions from 196 cases enrolled in one of three manualized family therapy models: Multidimensional Family Therapy (102 sessions/56 cases), Brief Strategic Family Therapy (100 sessions/94 cases), and Functional Family Therapy (100 sessions/46 cases). Adolescents were 57% male; 41% were African American, 31% White Non-Hispanic, 9% Hispanic American, 6% another race/ethnicity, and 13% unknown. The observational fidelity measures of all three models were used to code all 302 sessions. Fidelity ratings were analyzed to derive model-shared treatment techniques via exploratory factor analyses on half the sample; the derived factors were then validated via confirmatory factor analyses supplemented by Bayesian Structural Equation Modeling on the remaining half.

Results:

Factor analyses distilled four clinically coherent practice elements with strong internal consistency: Interactional Change (6 treatment techniques; Cronbach's α = .93), Relational Reframe (7 techniques; α = .79), Adolescent Engagement (4 techniques; α = .68), and Relational Emphasis (4 techniques; α = .67).

Conclusions:

The four empirically derived factors represent the core elements of three manualized family therapy models for adolescent behavior problems, setting the foundation of a more sustainable option for delivering evidence-based family interventions in routine practice settings.

Keywords: family therapy, core elements, adolescent conduct problems, adolescent substance use, empirical distillation

This study advances efforts to disseminate family-based treatment in routine care for adolescent conduct and substance use problems by identifying core practice elements of the family therapy approach. Core elements are discrete treatment practices common to multiple treatment manuals for a given behavioral disorder that can be more readily adopted and flexibly implemented than full manuals ( Chorpita, Daleiden, & Weisz, 2005). This study distilled the core practices of three well-validated family therapy models via observational coding of high-fidelity treatment sessions.

Formidable Barriers to Implementing Manualized Family Therapy in Routine Care

Family therapy is an evidence-based approach to treating adolescent behavior problems that focuses on intervening directly with family members to repair relationships and addressing challenges encountered by adolescents and caregivers in key extrafamilial systems ( Baldwin, Christian, Berkeljon, & Shadish, 2012). There are a handful of "brand name" family therapy models designed to treat adolescent behavior problems (ABPs), with three establishing themselves as efficacious for disruptive behavior, substance use, or both: functional family therapy (FFT), multidimensional family therapy (MDFT), and brief strategic family therapy (BSFT) ( Hogue, Henderson, Becker, & Knight, 2018; McCart & Sheidow, 2016). Manualized family therapy models for ABPs have posted an exemplary record of success in comparison to individual and group treatments and, in meta-analyses, produced the largest effect sizes by a healthy margin ( Baldwin et al., 2012; Riedinger, Pinquart, & Teubert, 2017; Tanner-Smith, Wilson, & Lipsey, 2013).

Despite their exceptional research portfolio, manualized FT models have not been widely adopted in behavioral treatment systems ( Riedinger et al., 2017). Developers of manualized FTs typically disseminate their respective models by establishing corporate entities that contract directly with host agencies to govern adoption and training activities. To promote high-fidelity delivery, each brand-name model contains an extensive set of quality assurance procedures anchored by a standardized training toolkit, guidelines for ongoing training and observational consultation from model experts, and implementation support and fidelity tracking methods that feed therapy session data back to providers (see Hogue, Ozechowski, Robbins, & Waldron, 2013). Such procedures incur substantial costs numbering tens of thousands of dollars annually for initial training plus certification maintenance ( Substance Abuse and Mental Health Services Administration, 2012). In addition, manualized FTs prescribe numerous complex treatment procedures, often with a fixed intervention sequence-features that inhibit treatment selection and tailoring practices for clients favored by community clinicians ( Chorpita et al., 2005).

Core Elements: Innovative Approach to Implementing Evidence-Based Interventions

Implementation barriers such as those listed above are common to manualized treatments of many kinds, not just FT models. In response, experts in mental health (e.g., Chorpita, Becker, & Daleiden, 2007; Garland, Hawley, Brookman-Frazee, & Hurlburt, 2008) and substance use advocate an alternative strategy to complement manual-driven methods: Focus on core elements of evidence-based interventions (EBIs) that represent a reduced set of intervention techniques common to multiple treatments for a given disorder. This is achieved by (a) specifying the discrete techniques prescribed by similar treatment manuals and (b) distilling these techniques into a smaller number of overlapping practice elements that are core features of each manual ( Chorpita & Daleiden, 2009). Thus whereas manuals are predominantly complex, uniform, and disorder-specific, distilled core elements are instead granular, flexible, and transdiagnostic-three user-centered features ( Lyon & Koerner, 2016) that may help solve vexing barriers associated with implementing manuals in routine care ( Weisz et al., 2017). For example, core practices can be more readily learned by clinicians and flexibly applied to a larger set of problems, making them well-suited for client-tailored treatment planning ( Garland, Bickman, & Chorpita, 2010). The transdiagnostic feature of core practices is highly germane to ABPs, insofar as conduct problems and substance use problems share a large set of common risk and protective factors during adolescence, for which a core set of FT techniques appears applicable and effective (see Baldwin et al., 2012; Henggeler & Schaeffer, 2016; Hogue, Dauber, Henderson, et al., 2015).

In the most ambitious distillation project yet undertaken, Chorpita and Daleiden (2009) reviewed 322 randomized trials of EBIs for youth populations across the behavioral spectrum. They reliably isolated 41 core elements variously used to treat anxiety and depression, conduct problems, attention and impulsivity, sleep and eating problems, autism-spectrum problems, substance use, and so forth. Notably, from among the numerous trials containing a FT condition, the authors identified only one undifferentiated code broadly termed "family therapy". This underscores the absence of progress to date in distilling core elements for the FT approach.

Family Therapy for Adolescent Behavior Problems: Primed for Core Elements Distillation

The FT approach for ABPs is well positioned to support a distillation process with far more differentiated results than the solitary "family therapy" element isolated in the Chorpita and Daleiden (2009) taxonomy. There is ample evidence from existing research that three brand-name FT models for ABPs-FFT, MDFT, BSFT-share a set of common treatment techniques that are operationalized in their respective model fidelity metrics, are empirically linked to client outcomes, and can be readily synthesized into core elements. FFT contains family interventions such as minimizing blame ( Alexander et al., 1989), reframing negative behaviors ( Robbins et al., 1996), and interrupting defensive interactions among family members ( Robbins, Alexander, & Turner, 2000) that have been correlated with in-session and post-treatment outcomes. MDFT contains several techniques ubiquitous within the FT approach (e.g., coach in-session family interactions; target caregivers for change) that predict long-term improvement in family functioning as well as adolescent symptoms ( Hogue, Dauber, Samuolis, & Liddle, 2006; Hogue et al., 2008). BSFT is anchored by signature techniques of the FT approach-joining, diagnostic enactment, reframing, and restructuring interventions-that variously predict improvements in treatment engagement, family functioning, and adolescent symptoms ( Robbins et al., 2011).

Buoyed by this cohesive portfolio of process-outcome research, the authors completed a conceptually-driven distillation process to isolate the core elements of these manualized FT models ( Hogue et al., 2017). Our conceptual distillation process focused on the observational fidelity scales corresponding to each model: FFT ( Ozechowski & Waldron, 2016), MDFT ( Hogue et al., 1998), and BSFT ( Hervis & Robbins, 2015); see Study Measures. This process thereby leveraged the available fidelity blueprints laid bare by the respective model developers to operationalize discrete techniques considered essential to model adherence. In accord with standard distillation procedures ( Chorpita & Daleiden, 2009), the various treatment techniques contained in the three fidelity scales were examined to identify thematic clinical strategies that appeared to be (1) common across the models, (2) theoretically salient to the FT approach, and (3) embodied by multiple techniques from all three scales. This process yielded four core practice elements: (a) Family Engagement: enhance family member involvement in treatment and build the relationship between therapist and all members; (b) Relational Reframing: de-emphasize individual and intrapsychic ways of defining problems in favor of a systemic conceptualization focused on relational processes; (c) Family Behavior Change: teach new skills and encourage individual behavior changes that promote improved family relations; (d) Family Restructuring: prompt changes in family emotional processes and encourage insight into predominant cycles of relational interactions.

Study Aim: Identify EBI Core Elements via Novel Empirical Distillation Methods

The aim of the current study was to empirically distill core elements of FT for ABPs via observational ratings of therapy sessions using model-specific fidelity scales. To our knowledge this study is the first to utilize empirical distillation methods to identify EBI core elements. Prior distillation efforts have used exclusively conceptual methods, which rely on expert review of the content of treatment manuals and/or protocol descriptions, usually fortified by team-based coding and consensus procedures among multiple reviewers (e.g., Chorpita & Daleiden, 2009), and sometimes further confirmed by expert survey (e.g., Garland et al., 2008). Conceptual methods possess the considerable virtues of strong face validity, modest technical demands, and flexibility in review procedures. By the same token, they are subject to legitimate questions regarding the reliability and generalizability of distillation results: How credibly do the distilled elements represent the original EBI content? Would different groups of experts reach meaningfully different results, and if so, what are the implications for the clinical validity of the elements themselves? These questions loom largest for complex EBIs that resist disaggregation or easy reduction to simpler constructs, such as manualized FT ( Chorpita & Daleiden, 2009).

To meet our study aim we developed a novel, two-part empirical distillation method. First, we collected observational fidelity data on 302 treatment sessions of FFT, MDFT, and BSFT. As described below in Method, all sessions were verified to be high-fidelity exemplars of the respective models, thereby constituting a "gold standard" sample pool that incontrovertibly represented the models and their constituent treatment techniques. We employed a fully-crossed design in which observers rated each of the 302 sessions for the occurrence of all techniques from all three fidelity scales. Though time-intensive and technically demanding, nonparticipant ratings remain the most rigorous method for assessing treatment fidelity in both research trials ( Hogue, Liddle, & Rowe, 1996) and standard practice settings ( Garland et al., 2010). Second, we conducted factor analyses of the fully crossed observational data set to distill its latent, core FT elements. We randomly split the sample in half, deriving core factors via exploratory factor analyses and then validating the derived factors via confirmatory factor analyses supplemented by Bayesian analysis. We conservatively hypothesized that these empirical methods would generate core FT elements mirroring those obtained from our conceptual distillation: Family Engagement, Relational Reframing, Family Behavior Change, and Family Restructuring.

Method

Study Sample: Three High-Fidelity Sample Pools

This study sampled 302 videotaped sessions from 196 cases enrolled in three manualized FT models for ABPs: MDFT (101 sessions/56 cases), BSFT (100 sessions/94 cases), and FFT (100 sessions/46 cases). Adolescents who attended sessions were 57% male; 41% were African American, 31% White Non-Hispanic, 9% Hispanic American, 6% another race/ethnicity, and 13% unknown. MDFT sessions were selected from a controlled prevention trial involving high-risk young adolescents (11-14 years) ( Hogue, Liddle, Becker, & Johnson-Leckrone, 2002). Trial therapists demonstrated strong adherence to the MDFT model via observational ratings ( Hogue, Liddle, Singer, & Leckrone, 2005). There were five male therapists: two African American, two White Non-Hispanic, one Asian American. BSFT sessions were selected from an archive of expert-supervised training sessions in which community therapists treated adolescents (13-18 years) in outpatient care for ABPs. All BSFT sessions were observationally rated by model experts as demonstrating above-average model fidelity; sessions included 53 therapists from diverse backgrounds (specific race/ethnicity data were not available). FFT sessions were selected from an archive of controlled trials involving adolescents (14-19 years) with conduct and substance use disorders (e.g., Rohde et al., 2014; Waldron et al., 2001). Sessions were chosen from among those having been observationally rated as exemplary in model fidelity. There were 11 FFT therapists (nine female); race/ethnicity data were not available. Establishing the strong fidelity of sampled sessions is essential in order to ensure that distilled techniques validly represent the three manualized models; however, source fidelity data from the three sample pools were not used in study analyses.

Sample Selection Procedures

Across all three sample pools, sessions were randomly chosen to maximize representation across treatment duration: one apiece from Sessions 1 - 3 (Early), 4 - 9 (Middle), and 10+ (Later), depending on availability (as described below). Only sessions lasting at least 30 minutes were retained. Adolescents and caregivers appeared together in 88% of sessions, with 7% of sessions containing only adolescents and 5% only caregivers. The MDFT pool (102 sessions/56 cases) was randomly selected from 574 recorded sessions of the 56 cases: 28% Early, 34% Middle, and 38% Later. The BSFT pool (100 sessions/94 cases) was chosen by model experts with personal knowledge of each case. Because this was a training sample, almost every available BSFT case had only one recorded high-fidelity session, and the bulk of recorded sessions represented early treatment: 52% Early, 36% Middle, 12% Later. The FFT pool (100 sessions/46 cases) was randomly selected to maintain a balance of cases deemed by model experts to be "easy" versus "difficult": 27% Early, 51% Middle, 22% Later.

Study Measures

Multidimensional Family Therapy Therapist Behavior Rating Scale (MDFT-TBRS).

The 13-item MDFT-TBRS ( Hogue et al., 1998) describes treatment techniques for engaging family members in therapy, improving parenting and family skills, intervening in family interaction patterns, and addressing key developmental issues involving extrafamilial systems. The scale measures MDFT extensiveness, that is, the thoroughness/frequency with which each technique was utilized in the observed session, based on a 5-point Likert-type scale: 1 = Not at all, 2 = A little bit, 3 = Moderately, 4 = Considerably, 5 = Extensively. The scale has shown strong factor properties, interrater reliability (ICCs = .60-.89), internal consistency (α = .67-.81), and links to client outcomes in studies of high-risk youth ( Hogue et al., 2005) and youth with conduct and substance use disorders ( Hogue et al., 2006; Hogue et al., 2008).

Brief Strategic Family Therapy Fidelity Rating Scale (BSFT-FRS).

The 24-item BSFT-FRS ( Hervis & Robbins, 2015) specifies clinical techniques associated with four domains of structural-strategic FT: Joining (alliance building with all family members), Tracking (assessing family relations in session), Reframing (endorsing positive meaning to attributions/behaviors), Restructuring (realigning family boundaries and strengthening relationships). Analyses from a multisite effectiveness study ( Robbins et al., 2011) revealed strong interrater reliability across model domains (ICCs = .81-.85), excellent construct validity (measurement model yielded CFI = .94 and RMSEA = .08 on cross-validation sample; CFI = .94 and RMSEA = .08 on full sample), and robust item-factor loadings and composite reliability: .32-.77 (ICC = .85) for Joining, .48-.86 (ICC = .78) for Tracking, .99-1.00 (ICC = .99) for Reframing, and .32-.82 (ICC = .83) for Restructuring, with factor intercorrelations ranging from .43-.80. BSFT-FRS fidelity ratings predicted client retention and symptom improvement. For consistency, in the current study the BSFT-FRS used the same 5-point extensiveness anchors described for MDFT-TBRS.

Functional Family Therapy Therapist Adherence Rating Scale (FFT-TARS).

The 14-item FFT-TARS ( Ozechowski & Waldron, 2016) describes treatment techniques that capture five basic phases of the FFT model: Engagement, Motivation, Relational Assessment, Behavior Change, Generalization. FFT focuses on establishing balanced alliances with family members, assessing the relational functions of individual behaviors, utilizing reframing and relabeling techniques as meaning-changing interventions, and teaching new family skills that generalize to multiple contexts ( Alexander, Waldron, Robbins, & Neeb, 2013). FFT-TARS items derive from forerunning FFT observational coding scales that demonstrated strong interrater reliability, internal consistency, construct validity, and predictive validity in numerous process-outcome studies (e.g., Alexander et al., 1989; Robbins et al., 2000; Robbins et al., 1996). Again, in the current study the FFT-TARS used the same 5-point extensiveness anchors described above.

Observational Coding Procedures and Raters

A separate cohort of observational raters was trained to code each of the three sample pools. Raters in all three cohorts were trained during twice-weekly meetings via review of the relevant rating manual, in-group coding practice, and exercises to increase understanding of scale items. Study coding in each cohort commenced once raters reached a collective reliability threshold of intraclass correlation coefficient (ICC: Shrout & Fleiss, 1979) = .65 for 80% of items, and monitored thereafter. All sessions were independently coded in their entirety by two raters randomly assigned to sessions in pairs according to a balanced incomplete randomized block design ( Fleiss, 1981). The MDFT rater cohort contained 14 females (22 - 32 years): nine White Non-Hispanic, two African American, one Hispanic American, one Asian American. Seven had a Master's degree and five were enrolled in a graduate psychology program. The BSFT cohort contained six females (22 - 32 years): five White Non-Hispanic and one African American. Four had a Master's degree. The FFT cohort contained six females (23 - 33 years): four White Non-Hispanic, one African American, one Hispanic American. Four had a Master's.

Plan of Analysis

Study analyses occurred in four stages. In Stage 1: Item Selection, inter-rater reliability and descriptive statistics for each item on each coding scale were calculated separately for each sample pool. Inter-rater reliability was calculated using the one-way random intraclass correlation coefficient (ICC (1,2); Shrout & Fleiss, 1979). Based on the following decision rules, we excluded 13 items (2 MDFT; 6 BSFT; 5 FFT) from further analysis: (1) items with an ICC < .30 and with a p-value above .10 in at least one sample pool; (2) items with skew or kurtosis above 10 in at least one sample pool. The remaining 38 items proceeded to Stage 2 analyses. Prior to Stage 2 analyses, item scores were averaged across both raters to yield a single score for each item within each sample pool. The sample was randomly split into two half samples to allow for exploratory factor analysis (EFA) on one half followed by confirmatory factor analysis (CFA) on the other. The random split was conducted within each of the sample pools to ensure equal representation of each sample pool within each half sample.

In Stage 2: EFA, we used principal components EFA with direct oblimin rotation, applying the sandwich variance estimator to account for the nesting of sessions within therapists. Because our study aim was to describe how the various observed techniques clustered together in this set of exemplary sessions, principal components EFA, which describes all variance in the data set (i.e., how experts delivered each model), is an appropriate approach for distilling core practices. EFA was conducted on the first half sample (N = 151), and 1 through 6 factor solutions were extracted. The 4-factor solution (see Results) was ultimately selected based on eigenvalue decline and overall interpretability; items with factor loadings less than .40 were trimmed from the final model solution to maximize parsimony ( Tabachnick & Fidell, 2007).

Following EFA, Stage 3: CFA was conducted on the other half sample (N = 151) to confirm the fit of the 4-factor solution derived from EFA. First, preliminary CFA models were estimated for each of the factors separately to achieve adequate fit for each factor individually, before attempting to fit the full 4-factor model. Modification indices were examined to guide model adjustments needed to maximize model fit, and poorly performing items were trimmed as needed. Model fit was assessed using the model chi-square statistic and two supplementary fit indices, RMSEA and CFI. RMSEA values of .06 and below, and CFI above .95, indicate strong model fit, and CFI >= .90 and RMSEA <= .08 indicate adequate fit ( Browne & Cudeck, 1993; McDonald & Ho, 2002). Both EFA and CFA were conducted in Mplus 7.31 ( Muthén & Muthén, 1998-2017). The sandwich variance estimator was used to account for the nesting of sessions within therapists ( Asparouhov, 2005).

As described in Results, the full 4-factor CFA model failed to converge. Muthén and Asparouhov (2012) argue that the typical implementation of CFA modeling using maximum-likelhood (ML) estimation applies overly strict assumptions that often lead to model misfit, triggering a series of model modifications that may capitalize on chance and fail to replicate in future studies. As an alternative they propose using Bayesian analysis to relax these assumptions and provide "wiggle room" for researchers to specify small non-zero ranges into which these estimates can fall. Bayesian estimation provides a means for incorporating a priori knowledge from previous research directly into the statistical model ( Ozechowski, 2014; van de Schoot et al., 2014). This is accomplished by specifying a prior distribution, which expresses a priori information about how the parameters estimated in the statistical model are distributed in the population ( Ozechowski, 2014). A Bayesian analysis involves three elements: (a) prior knowledge on the parameter being tested, captured by the prior distribution (parameter estimate and its associated variance); (b) information provided by the data at hand (likelihood function); and (c) the posterior distribution, which represents the combination of the two previous elements and is derived using Bayes' theorem. The point estimate of the parameter of interest represents the mean of the posterior distribution, and the stability of the estimate, on which inferences are made, is known as a credible interval (akin to conventional confidence intervals), which comprises the 2.5 th and 97.5 th percentiles from the posterior distribution ( Ozechowski, 2014).

Parameters in these models are estimated using Markov Chain Monte Carlo (MCMC) estimation. MCMC is an iterative process in which a prior distribution is specified and posterior values for each parameter are estimated over many iterations, which in turn are used to construct the posterior distribution. MCMC is initiated from at least two randomly selected starting points to facilitate convergence of the iteration process ( Zyphur & Oswald, 2013). Convergence is indicated graphically as well as statistically via the potential scale reduction (PSR; Asparouhov & Muthén, 2010). PSR indexes the ration of total variance across chains to the pooled variance within a chain. Smaller PSR values (e.g., PSR < 1.05) indicate that convergence has occurred. Because conventional model fit indices are based on ML estimation, Mplus provides an alternative fit index to evaluate model fit, the posterior predictive p (PPP) value, which is less sensitive than chi-square testing to model misspecification. A PPP value greater than .05 indicates good model fit ( Asparouhov & Muthén, 2010). Specifically, Muthén & Asparouhov (2012) advocate using prior distributions with small variances for cross-loading factors and residual covariances. Following their recommendations, we specified prior distributions for these parameters of a mean of 0 and variance of .01, which translated to standardized values ranging between −0.2 and .2. In addition to the advantages discussed above, Bayesian estimation has the well-documented advantage over CFA of yielding optimal estimates, and more consistent convergence, with small samples ( van de Schoot et al., 2014). Thus, Stage 4 of the analysis consisted of Bayesian Structural Equation Modeling (BSEM) for the 4-factor model that failed to converge with CFA specification. We specified this model as a three-level model with sessions nested within individuals within therapists. We estimated models with informative priors using factor loadings and standard errors estimated in the EFA (see Table 1 ) for the factor loadings in the BSEM, and small variance priors (.01) for cross-loading items and residual covariances.

Table 1.

Family Therapy Model

Factor 1:
Interactional Change

Factor 2:
Relational Reframe

Factor 3:
Adolescent Engagement

Factor 4:
Relational Emphasis

Factor Eigenvalue

8.05

3.25

2.27

1.89

Factor 1: Interactional Change

Factor 2: Relational Reframe

Factor 3: Adolescent Engagement

Factor 4: Relational Emphasis

Results

Stage 1. Item Selection

One-way random ICC(1,2) was calculated for each item on each of the three coding scales within each of the three sample pools to examine inter-rater reliability. ICCs were interpreted based on Cicchetti's (1994) criteria for classifying ICC magnitudes: below .40 is poor, .40-.59 is fair, .60-.74 is good, and .75 to 1.00 is excellent. As described in the Method section, 13 items did not meet inclusion criteria (ICC > .30 and p < .10 OR skew and kurtosis < 10 in all three samples). ICCs described here are for the remaining 38 items: 11 MDFT, 18 BSFT, 9 FFT.

ICCs for the 11 MDFT items were mostly in the good to excellent range for the MDFT sample, ranging from .64 to .90. Two items had ICCs below this range at .58 and .38. ICCs for MDFT items were lower in the BSFT sample: Four ranged from .62 to .71, five ranged from .41 to .58, one was .33, and two were below .30 but were retained because significance was less than p = .10. In the FFT sample, MDFT items ranged from .79 to .90. On the BSFT rating scale, the majority of items had good or excellent ICCs in the MDFT sample ranging from .62 to .93, while three items ranged from .51 to .58. In the BSFT sample, six items ranged from .60 to .78, six items ranged from .40 to .56, four items ranged from .30 to .39, and two were below .30 but retained because significance was less than p = .10. In the FFT sample, most BSFT items ranged from .61 to .83, with two in the fair range (.51 and .52). For the FFT scale, nearly all items had good or excellent ICCs in the MDFT sample, ranging from .63 to .80. One item was .31 and one was .30; both were retained due to p < .10. In the BSFT sample, five items ranged from .62 to .70, and four ranged from .45 to .59.items. In the FFT sample, three items ranged from .67 to .71, three ranged from .54 to .59, and one was .36.

Stage 2. Exploratory Factor Analysis

EFA was conducted on half of the sample to determine the optimal factor structure. All 38 items meeting ICC inclusion criteria were included in EFA and solutions ranging from one to six factors were extracted. In the original model including all 38 items, eigenvalues were 9.67 for one factor, 4.16 for two factors, 2.72 for three factors, 2.18 for four factors, 1.73 for five factors, and 1.62 for six factors. Factor solutions for four, five, and six factors were examined, and the 4-factor solution was deemed most interpretable. Ten items that did not load above .40 on any factor were trimmed from the model (5 MDFT, 3 BSFT, 2 FFT). Three additional BSFT items that consistently loaded on a separate "Parent Engagement" factor but interfered with model fit and interpretation were trimmed as well. The final 4-factor solution included 25 items: 6 MDFT, 12 BSFT, 7 FFT. Table 1 displays the items organized by loadings on derived factors. Modest correlations between factors indicated substantial factor differentiation (non-overlap): Factor 1 and Factor 2: r = .33; Factor 1 and Factor 3: r = .14; Factor 1 and Factor 4: r = .01; Factor 2 and Factor 3: r = .13; Factor 2 and Factor 4: r = .15; Factor 3 and Factor 4: r = .16.

Factor 1 was named Interactional Change and included 10 items:1 MDFT, 7 BSFT, 2 FFT. Three BSFT items and one FFT item were dropped from analysis at the CFA stage (see below) and thus were not included on the final version of this factor. Factor loadings for the 6 items on the final version of Factor 1 ranged from .98 (BSFT: Stimulates dialogues/Directs enactments) to .55 (BSFT: Focuses on present interactions). Factor 2 was named Relational Reframe and included seven items: 2 MDFT, 1 BSFT, 4 FFT. Factor loadings ranged from .86 (FFT: Provides a family-focused rationale for change) to .45 (MDFT: Targets adult participants for change). Factor 3 was named Adolescent Engagement and included four items: 2 MDFT, 2 BSFT. Factor loadings were above .80 for both BSFT items (Joins with children/adolescents, Targets interventions toward youth) and were .45 and .42 for MDFT items (Explores adolescent ecosystem, Supports adolescent investment in therapy). Factor 4 was named Relational Emphasis and had four items: 1 MDFT, 2 BSFT, 1 FFT. Factor loadings ranged from .87 (FFT: Gathers information on relationship functions) to .47 (BSFT: Connects with all family members).

Stage 3. Confirmatory Factor Analysis

The 4-factor EFA solution was confirmed on the remaining half sample using CFA. First, preliminary CFA models were calculated for each factors individually, and modification indices were used to guide model adjustments until adequate fit was achieved. To achieve fit on the Interactional Change factor, 4 items were trimmed from the final factor model (see Table 1 ). Thus, 21 items progressed from the EFA stage to the final confirmed four factors. Model fit for each factor in the CFA model was evaluated using chi-square, RMSEA, and CFI. Fit indices for Interactional Change were: χ 2 (9) = 16.65, p = .05; RMSEA = .08 (90% CI: .00 - .13); CFI = .99. Fit indices for Relational Reframe were: χ 2 (13) = 19.41, p = .11; RMSEA = .06 (90% CI: .00 - .11); CFI = .98. Fit indices for Adolescent Engagement were: χ 2 (2) = 4.08, p = .23; RMSEA = .08 (90% CI: .00 - .20); CFI = .99. Fit indices for Relational Emphasis were: χ 2 (2) = 2.69, p = .26; RMSEA = .05 (90% CI: .00 - .18); CFI = .99. Evaluation of fit indices indicated that model fit was adequate for each of the four factors individually. However, when combined into a single CFA model, the full 4-factor model failed to converge. Measurement invariance models attempting to confirm relative equivalence of the 4-factor structure across all three sample pools (MDFT, BSFT, FFT) also failed to converge.

Stage 4. Bayesian Structural Equation Modeling

To confirm the 4-factor structure, we estimated a three-level BSEM model with small variance priors for cross-loading items and residual covariances. This model converged (PSR = 1.001 replicated over numerous iterations) and showed good fit to the data ( PPP = 0.441). Table 2 displays the factor loadings estimated in BSEM. Items loaded robustly on hypothesized factors, and with few exceptions, were minimally correlated with cross-loading factors. Likewise, residual correlations were small ( M = .004, Range = −0.16 to 0.15). Again, the derived factors were modestly correlated, indicting factor differentiation: Factor 1 and Factor 2: r = .36; Factor 1 and Factor 3: r = .18; Factor 1 and Factor 4: r = .05; Factor 2 and Factor 3: r = .04; Factor 2 and Factor 4: r = .20; Factor 3 and Factor 4: r = .30.

Table 2.

Factor 1:
Interactional Change

Factor 2:
Relational Reframe

Factor 3:
Adolescent Engagement

Factor 4:
Relational Emphasis

Provides information/guidance for new skill
.196 .529
.022

−.066

Discussion

This empirical distillation of three manualized family therapy models for adolescent behavior problems yielded four core practice elements, summarized as follows. The first element was labelled Interactional Change (defined by 6 treatment techniques) and included interventions in which therapists allow or prompt family members to interact with one another naturally in order to assess family dynamics, and also, direct in-session interactions among members in order to promote more effective ways of relating. By creating opportunities to communicate more meaningfully, therapists support families in developing new relational skills. The second element, Relational Reframe (7 techniques), involved therapist efforts to transform symptom-focused and/or adolescent-focused perceptions of clinical problems into a new understanding of those problems as being fundamentally relational, thereby motivating families to pursue changes in family relationships as the primary clinical solution. The third element, Adolescent Engagement (4 techniques), described interventions in which therapists join with adolescents by seeking their unique points of view, and also, foster treatment engagement by presenting family therapy as an opportunity to address personally meaningful issues within and outside the family. Last, Relational Emphasis (4 techniques) contained interventions that focus on the family as a whole, assessing systemic attributions and processes and intervening to improve overall family functioning. Not coincidentally, these four elements map closely onto the framework of the structural family therapy model (see Minuchin & Fishman, 1981), a common progenitor of manualized FT models and for the family therapy approach in general.

We have strong confidence in the clinical and psychometric validity of study findings. The study sample-videotaped therapy sessions-was certified by model developers as being highly faithful to their respective FT models. The distillation tools-model-specific observational fidelity scales-were produced by model developers for the explicit purpose of evaluating the implementation of essential model strategies and techniques. The analytic methods-observational coding and multilevel factor analysis-adhered to rigorous principles of data reliability and factor resolution. And all three models contributed at least one treatment technique to three of the four distilled elements (the exception being that Adolescent Engagement does not contain an FFT technique, though model experts confirm that adolescent engagement is core to the model). Thus there is strong justification that the derived factors are indeed core practice elements of the three models in question.

Though hardly exhaustive of the FT approach, the four core elements are a representative foundation of common FT strategies. Certainly, the 21 techniques that collectively define the elements do not capture the full complement of interventions prescribed by the three models. For example, all manualized FT models designed for ABPs (see also Henggeler & Schaeffer, 2016; Slesnick, Erdem, Bartle-Haring, & Brigham, 2013) feature some degree of case management interventions, including home-based wraparound services-an important category of interventions that fell outside the purview of the current study. Even so, the 21 distilled techniques are commonly shared FT interventions that are linked to client outcomes for all three observed models and therefore hold great potential for dissemination as effective practices.

Results of this empirical distillation process differed from results of the conceptual process described above ( Hogue et al., 2017) in three main ways. First, an entirely new element, Relational Emphasis, emerged. This element makes explicit the foundational concept of the FT approach: Family relations are the primary targets of assessment and change-making interventions. Therapists who work with families but maintain a fundamentally individualistic and/or intrapsychic approach are not operating with this concept as a core value. Second, two elements from the conceptual distillation (Family Behavior Change, Family Restructuring) effectively merged into a single element (Interactional Change). The new element blends FT interventions aimed at changing observable family behaviors with those aimed at changing underlying (i.e., structural-level) family attributions, roles, and relational processes. Both types of change appear advantageous for addressing ABPs. Third, interventions in the conceptual element Family Engagement that pertain to engaging caregivers in treatment were stripped away during empirical distillation, leaving the reduced element Adolescent Engagement in its place. Caregiver-focused engagement interventions instead aligned with the Relational Reframe and Relational Emphasis elements. There is no doubt that all three models emphasize the need to cultivate and balance alliances with multiple family members. This result from empirical distillation could signify that caregiver engagement is conceptualized quite differently across the three models, foreclosing the possibility of a unified element; and/or, that caregiver engagement interventions are an embedded feature of relational reframing and relational focus processes, whereas efforts to engage adolescents constitute a distinct therapeutic agenda.

These deviations from the conceptual distillation process highlight the potential value of empirical distillation procedures, which hew more closely to the observable realities of EBI implementation and thereby afford opportunities to enrich or even correct conceptually-based results. Indeed, empirical procedures open the door to distillation solutions that might differ meaningfully across service contexts. For example, how might the current FT elements, derived from sessions representing training and research activities under tight control of model developers, diverge if study methods were applied to sessions from community treatment settings wherein model fidelity varies to a greater extent ( Hallgren et al., 2018)? Such potential variations will be increasingly relevant as core element EBIs gain traction in community-based practice. Along these lines, the path seems clear to distill core elements of other EBIs for ABPs, principally cognitive-behavioral therapy ( Hogue et al., 2018; McCart & Sheidow, 2016).

It is critical to underscore that core elements are not equivalent to manualized treatments. In addition to discrete intervention techniques, treatment manuals invariably articulate principles of treatment coordination-rules for the timing, sequencing, and client- and context-specific targeting of interventions-that constitute the unique parameters and implementation nuances of a given model ( Chorpita et al., 2005). Coordination principles determine, for example, how rigidly versus flexibly a therapist should implement model content, as well as the recommended balance between fidelity versus adaptation for individual cases or clinical groups ( McHugh, Murray, & Barlow, 2009). Core elements of EBIs thus cannot supplant full treatment models or be utilized effectively as "brief" versions.

Study Strengths and Limitations

Study strengths include the innovative empirical approach to EBI distillation, notably the rigorous observational data collection and analytic methods, and the diversity of the sample, which supports the generalizability of findings. One study limitation was exclusive focus on the extensiveness (i.e., adherence), rather than the expertise (i.e., competence), with which therapists delivered treatment techniques. Therapist expertise in implementing specific techniques is quite difficult to judge reliably ( Webb, DeRubeis, & Barber, 2010) and is not directly germane to distilling which techniques are core across models. A second limitation was inability to demonstrate measurement invariance of the 4-factor solution, which leaves open the possibility that one of the sample pools exerted a disproportionately strong or weak influence on the distillation process. This possibility is contraindicated to some degree by the representative distribution of intervention techniques from all three models across all four factors. We plan to conduct additional analyses of measurement invariance on this sample in a follow-up study that will leverage item response theory; those complex analytic methods introduce an alternative conceptualization of the sample data that is beyond the scope of the current study.

One important study feature is both strength and limitation. The three sample pools represent diverse characteristics along the continua of ABP populations, treatment phases, and intervention contexts: a prevention trial involving at-risk young adolescents, a training sample of adolescents in community-based care for behavioral health problems, and a set of clinical trials involving older adolescents meeting diagnostic criteria for conduct or substance use disorder. The benefits of selecting a sample that supports generalizability across broad spectrums of clinical problems and treatment contexts are counterbalanced by sacrifice in the acuity with which findings pertain to teenagers with specific clinical disorders at specific junctures in treatment. Also, because of this sample diversity, it was not possible to use identical methods across samples when selecting high fidelity sessions. Finally, although observing high-fidelity FT sessions was necessary in order to define core techniques that validly represent the manualized models of interest, it remains unknown whether the distilled elements will be identifiable or viable in routine clinical conditions. To address this gap the authors are attempting to verify the structure and content of the four FT elements derived in this study within a new pool of ABP cases treated in usual care by community clinicians with varying degrees of FT allegiance and training.

Clinical Implications

Evidence supporting the effectiveness ( Chorpita et al., 2017; Weisz et al., 2012), sustainability ( Weisz et al., 2018), and perceived value ( Chorpita et al., 2015; Southam-Gerow et al., 2014) of core EBIs in routine practice continues to mount. Still, the potency of the FT approach in naturalistic form remains virtually untested ( Riedinger et al., 2017). Is it reasonable to believe that non-manualized interventions governed by core FT elements are a viable alternative to manualized models for treating ABPs in usual care? If the success of FT techniques for ABPs depends fundamentally upon the implementation boost provided by quality assurance procedures such as those mandated by manualized FT models, then core element FT delivered without substantial support by model experts may be ineffective. Of note, one controlled trial evaluated non-manualized (i.e., naturalistic) FT delivered by community therapists as the routine standard of care, finding that it outperformed naturalistic non-FT services for improving ABPs ( Hogue, Dauber, Henderson, et al., 2015). Moreover, the naturalistic FT condition exceeded a research-defined benchmark for adherence to FT techniques and equaled a benchmark for long-term outcomes ( Hogue, Dauber, & Henderson, 2017). If replicated and expanded, such results might influence providers to weigh the feasibility of cultivating core element FT services-perhaps factoring in upgrades to local FT supervision and quality procedures ( Hogue et al., 2013)-against the formidable barriers to importing a manualized FT model.

Of course this begs the question of what core element FT services might look like. That is, how can distilled FT techniques be implemented effectively in routine care? There are at least three implementation approaches with potential merit. First, core FT elements can be translated into a standardized quality assurance system-a de facto "manual" and companion fidelity procedures-that facilitates decision-making about when and with whom to utilize which combination of elements. This has been accomplished with core EBI elements for other youth disorders (e.g., Chorpita & Weisz, 2009). Quality assurance systems for core EBIs have proven to equal or surpass conventional manualized treatment as well as usual care for youth behavior problems (e.g., Chorpita et al., 2017; Weisz et al., 2012). Second, core FT elements can be documented in a flexible clinical protocol to be used independently by community clinicians without standardized training and fidelity procedures. Therapists would be invited to invoke their own conceptualizations about the appropriate timing, sequence, and relative emphasis of each FT element for each case, adjusting FT delivery based on client responsiveness (see Lyon & Koerner, 2016). Third, core FT techniques can be converted to a utilitarian adherence scale that provides empirically-derived FT implementation guideposts for line clinicians treating ABPs (see Stirman et al., 2018 for an example involving cognitive-behavioral therapy). Although therapists are notoriously unreliable in reporting on their own adherence to virtually every variety of EBI (e.g., Hurlburt, Garland, Nguyen, & Brookman-Frazee, 2010), FT for ABPs is one arena in which therapist self-report of treatment adherence has shown reasonable concordance with observer ratings ( Chapman, McCart, Letourneau, & Sheidow, 2013; Hogue, Dauber, Lichvar et al., 2015). Effective self-monitoring of adherence to FT elements via pragmatic therapist-report tools, in the context of ongoing case planning and supervision, might confer enormous benefits to increasing the amount, and perhaps quality, of non-manualized FT delivered in ABP services. To advance such efforts we are currently developing online training procedures to increase therapist delivery of core FT techniques for ABPs via video-based training in accurate FT self-monitoring combined with tailored feedback on self-reported FT use (National Institute on Drug Abuse: R34DA044740). As core elements distillation continues to progress for numerous EBIs, the field will discover the full potential and limits of its utility in various treatment contexts and/or with specific presenting problems.

​

Increasing implementation of high-fidelity family-based interventions would improve the quality of treatment services for adolescent conduct and substance use problems.

Acknowledgments

Preparation of this article was supported by the National Institute on Drug Abuse (R01DA037496; PI: Hogue). The authors acknowledge the dedicated work of the observational coders for this project (in addition to author MB): Kate Feiner, Alma Hidalgo, Tiffany John, Naomi Krohner, Tessa Long, Alexis Nager, Nkem Osian, Nicole Piazza, Alana Ribowsky, Lauren Ryan, Maddison Schiafo, Monique Sledd, and Elise Yenne. We also acknowledge the contributions of the Expert Review Panel to conceptualizing and interpreting study data: Guy Diamond, Genoveva Garcia, Olga Hervis, Silvia Kaminsky, Annie Niermann, and Michael Robbins. We are extremely grateful to Ms. Hervis and Ms. Kaminsky (Family Therapy Training Institute of Miami) for providing session recordings of Brief Strategic Family Therapy and for training coders; and to Holly Waldron (Oregon Research Institute) for providing recordings of Functional Family Therapy.

References

Alexander J, Waldron H, Robbins M, & Neeb A (2013). [Functional Family Therapy for Adolescent Behavior Problems: American Psychological Association. Google Scholar]

Asparouhov T, & Muthén BO (2010). Bayesian analysis using Mplus: Technical implementation. Retrived: http://www.statmodel.com/dowload/BayesAdvantages18.pdf.

Chorpita BF, & Weisz JR (2009). Modular approach to therapy for children with anxiety, depression, trauma, or conduct problems (MATCH-ADTC). Proprietary material: [http://www.practicewise.com/portals/0/MATCH_public/index.html. Google Scholar]

Hogue A, Henderson CE, Becker SJ, & Knight DK (2018). Evidence base on outpatient behavioral treatments for adolescent substance use, 2014-2017: Outcomes, treatment delivery, and promising horizons. Journal of Clinical Child and Adolescent Psychology. doi: 10.1080/15374416.2018.1466307. [[PubMed] [PMC free article] [CrossRef] Google Scholar]

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Core Elements of Family Therapy for Adolescent Behavior Problems: Empirical Distillation of Three Manualized Treatments

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J Clin Child Adolesc Psychol. Author manuscript; available in PMC 2020 Jan 18. Published in final edited form as: Family therapy has the strongest evidence base for treating adolescent conduct and substance use problems, yet there remain substantial barriers to widespread delivery of this approach in community settings.

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The U.S. Surgeon General's 2023 Social Media and Youth Mental Health advisory outlines the latest scientific evidence regarding social media's effects on youth mental health. The report recommends actions that policymakers, technology companies, parents and others can take to ensure the online safety of young people. This post highlights key findings from the advisory.

Current Levels of Teen Social Media Use

Virtually all teens (95%) ages 13 to 17 use social media, with more than 1 in 3 reporting that they use it ​"almost constantly." While most U.S. social media platforms require users to be at least 13 years old, nearly 40% of kids ages 8 to 12 use social media. The advisory also noted:

Adolescents who use social media more than three hours per day face twice the risk of experiencing poor mental health outcomes.

A recent survey found that eighth and 10 th grade students spend an average of 3.5 hours per day on these platforms.

Negative Effects of Social Media on Mental Health and Well-Being

Numerous studies show that higher levels of social media use among children and adolescents are linked to adverse effects, including depression and anxiety, inadequate sleep (which can disrupt neurological development and lead to depression and suicidal behaviors), low self-esteem, poor body image, eating disorder behaviors and online harassment. These risks are greater for girls versus boys and for those already experiencing mental health issues. Additional risks include:

Nearly 2 in 3 adolescents are ​"often" or ​"sometimes" exposed to hate-based content on social media.

Studies have found a connection between social media cyberbullying and depression among young people.

Teen girls and LGBTQ youth are more likely to experience cyberbullying and online harassment, which can lead to negative emotions.

Adolescence Is a Vulnerable Phase of Development

The mounting evidence regarding social media's adverse effects on youth is especially concerning given that adolescence is a critical period of development, when different areas of the brain begin to integrate and the prefrontal cortex develops at an accelerated pace. In this phase, the brain is especially open to learning and growing, and teens may have intensified sensitivity to the nature of social media, according to the Surgeon General's advisory. Adolescence also involves profound physiological changes - these young people are simultaneously navigating increasing autonomy, forming their identities, developing relationships and more. Thus, the potential effects of social media during this vulnerable phase warrant particular attention.

Are There Benefits to Using Social Media?

In some cases, social media can provide social support from peers or others, which may be especially beneficial for marginalized young people, such as sexual and gender minorities. For instance, according to the Surgeon General's advisory, social media may boost the mental health of LGBTQ youth by fostering connections with peers, facilitating identity development and enabling social support.

Research also indicates that social media-based mental health interventions may be useful tools for kids and teens, and they may help young people learn to seek help or professional care when needed. In this sense, social media platforms could serve as a gateway to mental health care or at least online social support as a buffer against stressors.

How to Protect Teens on Social Media

While social media offers benefits for some, growing evidence of its potential harm to many children and youth has led the Surgeon General to issue an urgent, cross-sector call to action:

For policymakers

Strengthen protections to ensure greater safety for children interacting with all social media platforms, such as developing age-appropriate health and safety standards, requiring a higher standard of data privacy for children and strengthening and enforcing age minimums.

Ensure technology companies share data relevant to the health effects of their platforms.

Support increased funding for future research on both the benefits and harms of social media use and other technology and digital media use for children, adolescents and families.

For technology companies

Conduct and facilitate transparent and independent assessments of the impact of social media products and services on children and adolescents.

Prioritize user health and safety in the design and development of social media products and services to minimize harm to children and adolescents.

Create effective and timely systems and processes to investigate requests and complaints from young people, families, educators and others.

For parents and caregivers

Create a family media plan with agreed-upon expectations to establish healthy social media boundaries at home.

Create tech-free zones and encourage in-person interactions, which may involve limiting use of devices around bedtime and mealtimes, prioritizing family relationships and building social bonds.

Model responsible social media behavior, as children often learn from what they see around them.

Overall, policymakers, tech companies, researchers, funders, families, advocates and others must work together on multi-pronged strategies to create safe and healthy social media environments for young people.

Learn More About Social Media and Teen Mental Health
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The U.S. Surgeon General's Social Media and Youth Mental Health advisory outlines the effects of social media on teens' well-being. Read the findings.

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We often hear from CEOs is that their employees don't need clinical mental health support.

Even if you think your employees don't need clinical help, there are clear reasons why they should be able to access employee counseling and other mental health services anyway.

If you want more information on what employee counseling is, its benefits, and why every employee should have access to it-you've come to the right place!

What is Workplace Counseling?

Workplace counseling (or employee counseling) is simply therapy that is provided through an Employee Assistance Program (EAP), mental health program, or traditional health insurance. Sessions can be online or in person.

Employee counseling helps employees deal with problems they face in their personal and professional lives.

Employee counseling helps employees gain the skills to cope with life's stressors.

What are the Benefits of Workplace Counseling?

There are many benefits to employee counseling. To list a few:

1. Increased productivity and performance

Employees face higher amounts of stress and burnout than in previous years, especially due to the pandemic. Workplace counseling provides a safe place for employees to work out their stressors and anxieties. We all need someone to talk to sometimes!

2. Improved company culture

Employee counseling programs help employees feel that their employer truly cares about their wellbeing-helping to foster a culture that prioritizes mental health.

3. Increased job satisfaction

All of the benefits listed previously help keep employees with you! So many companies do not provide their employees with tools to support their mental health. Your company has the opportunity to be the exception.

For more in-depth information on employee counseling, including the types of employee counseling and more benefits of employee counseling, check out our blog post: Employee Counseling-Do You Need It?

5 Reasons Why Every Employee Should Have Access to Workplace Counseling

1. Employee counseling isn't just for people with a diagnosis

Do you deal with stress? Relationship problems? Anxiety? Changing moods?

Then you can benefit from employee counseling.

Therapy is for anybody and everybody because we all have to deal with life's stressors. We all need to learn ways to cope with those stressors.

Therapy isn't always clinical. Sometimes, we just need someone to talk to confidentially and without judgment. Some people could benefit greatly from just one employee counseling session per year. Others might want to meet with a counselor twice per month.

It all depends on that person's personality and needs.

Check out our blog post on 5 Myths about Therapy for more employee counseling myths like these.

2. Employees aren't usually transparent about their mental health

While you may think your employees are doing fine in the mental health department, that is often not true.

Employees tend to hide their struggles from their coworkers, managers, and even family members.

It is scary to speak up and be honest about mental health. It is hard to ask for help.

Most employees deal with workload stress, work-life balance, and other stressors that come with working. And companies that are working remotely tend to have a more difficult time being in touch with how their employees are doing.

Read 6 Signs Your Employees are Struggling with Mental Health for ways to tell if your employees are struggling and could benefit from workplace counseling.

With Nivati, you will see how many of your employees have booked employee counseling appointments. You may be surprised at how many do!

3. Workplace counseling provides a safety net

You don't need to be in a crisis to go to therapy. Knowing that workplace counseling is a free option provides employees with security. That knowledge in itself-knowing that it is possible to talk issues out with someone-can help reduce employee stress.

Many people struggle to get access to therapy on their own, especially since the demand for employee counseling has increased. Companies like Nivati make getting an employee counseling appointment easy and highly feasible for employees.

4. Workplace counseling takes the pressure off your managers

Direct managers have insights into employees that CEOs or HR Directors may not have complete visibility into.

Managers can refer employees to workplace counseling when they feel that they cannot help them with a deeper mental health issue. Platforms like Nivati can help managers gain the skills they need to deal with their own stress, which will help them support their direct reports.

You may even want to consider training your managers on basic counseling techniques. Enable your people to help each other out.

Also, employees can choose to attend employee counseling completely anonymously if they choose. Nivati makes it especially easy for employees to set teletherapy appointments.

5. Employee counseling helps fight the mental health stigma

Do you want to attract young talent? Then you'll need to appeal to Millennials. Millennials are the therapy generation. Employee counseling is something that many employees expect to have access to.

Not only will providing workplace counseling help your company stand out to top talent, but it will also help transform your company culture into one that prioritizes mental health.

Adding employee counseling and wellness services to your employee benefits package is one of the best ways to support your people.

For more on supporting employee mental health, check out these articles:

Disclaimer

By participating in/reading the service/website/blog/email series on this website, you acknowledge that this is a personal website/blog and is for informational purposes and should not be seen as mental health care advice. You should consult with a licensed professional before you rely on this website/blog's information. All things written on this website should not be seen as therapy treatment and should not take the place of therapy or any other health care or mental health advice. Always seek the advice of a mental health care professional or physician. The content on this blog is not meant to and does not substitute for professional medical advice, diagnosis, or treatment.

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Employee Counseling: 5 Reasons Why Everyone Should Have Access | Nivati

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Even if you think your employees don't need clinical help, there are clear reasons why they should be able to access employee counseling.

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With many of us spending a lot of time in front of computer screens and phones, on apps and Facebook, at all hours, it's natural to wonder: Is it harming us?

It could be, especially if you're in front of a screen close to bedtime or even during the day if you're not taking enough breaks.

Screen time has been shown to cheat us out of sleep and hinder our mental health.

Screen time and sleep

Scrolling on your phone or laptop before you go to bed could make it harder for you to fall asleep or stay asleep, possibly leading to chronic sleep deprivation.

At night, exposing your eyes to the artificial light that screens put off can hinder your sleep as well as your alertness and mood the next day. Nighttime light exposure can trick our brain's master clock to think it's daytime, which in turn can slow the body's production of melatonin, a hormone our brain produces that helps us sleep.

As you move closer to a screen, you expose yourself to more light. The light exposure from watching a television on the other side of the room is less than the exposure from scrolling on a phone, using an app, or staring at a laptop screen. The more blue light you're exposed to, the greater the risk of insomnia.

In the middle of the night, sometimes you might have trouble sleeping and do exactly what makes it harder to get back to sleep: You reach for your phone.

Chronic sleep deprivation can cause distractedness, memory problems and potentially depression and anxiety. But we need to respond to texts and emails and work in front of screens, so what do we do?

Choose a book over your phone before bed

It's best to avoid your phone at least one hour before you plan to fall asleep. That can be challenging for many of us. Still, if you want to be able to sleep and have good quality sleep - not waking several times - you'll need to try to discipline yourself to pick up a book instead of your phone or laptop before you lay your head on a pillow.

During the day, if you're sitting at a screen a lot, take breaks at least every three to four hours. Your ability to change focus from near to far can be strained with excessive screen time. When eyes are focused close-up for long periods, they can have a tough time adjusting to seeing in the distance. And that can cause eye strain and potentially headaches.

What's a healthy amount of screen time?

We don't think there's a known answer for that. People need to have a strategy to avoid using their phones and laptops so that it's not an all day-and-into-the-night habit. If you have no way to avoid using your devices before going to bed, you can use filters on the devices that can reduce the amount of blue light they give off.

Can too much screen time affect your vision?

Most screens aren't bright enough to physically damage your eyes. Sunlight consists of mostly blue light, which is the light your computer screen puts out, but a computer screen is 1,000 to 10,000 times dimmer than the light on a sunny afternoon.

Your screen is not putting out enough light to harm the retina, the tissue responsible for your vision.

Screen time and dry eyes

Screen time can cause your eyes to get tired or even hurt. When you stare at a screen, you blink about half as often as you do when your face isn't in front of a screen. And if you're not blinking enough, the film of tears on the front of your eye degrades. Your eyes can get dry because you're not producing enough tears and you don't spread them across your eyes well. Your eyes can feel gritty, burning and tired.

Before you sit down to your computer for several hours, putting artificial tears in your eyes can prevent them from drying out.

Does screen time decrease IQ?

Screen time won't reduce IQ points directly. However, being in front of a screen stimulates fewer senses than being outside or interacting with others. We think of screens as stimulating and captivating, but screens only stimulate your senses of sight and hearing, whereas getting outside or interacting with people can engage many more senses.

Screen time and mental health

Whether at night or during the day, using screens for long periods has been associated with higher rates of depression, anxiety and other mental health disorders in adults and children. In one study, children who used screens for seven hours a day were twice as likely to develop anxiety or depression than children who used screens for an hour or less a day.

Apps and social media outlets are designed to keep you glued to them. Try to use them with caution and part with them at least an hour before you flip off all the lights and call it a night.

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How screen time really affects your health

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Too much screen time can disturb your sleep, cause dry eyes and affect your mental health. Learn how screen time affects your health from Ohio State doctors.

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Mental Illness is not a Character Defect

There are many reasons why people develop mental illness. Some are genetic or biological. Some are a result of childhood trauma or overwhelming stress at school, work or home. Some stem from environmental injustice or violence. Sometimes, we simply don't know. Regardless of the reasons, these are health problems just like cancer, arthritis or diabetes. So why does society look at people with mental illness, including substance use disorders, differently? The answer is Stigma. The real question however, is how do we stop it?

The Effects of Stigma

Fear and misunderstanding often lead to prejudice against people with mental illness and addictions, even among service providers. It's one of the main reasons why many people don't consider it a real health issue. This prejudice and discrimination leads to feelings of hopelessness and shame in those struggling to cope with their situation, creating a serious barrier to diagnosis and treatment.

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There are many reasons why people develop mental illness. Some are genetic or biological. Some are a result of childhood trauma or overwhelming stress at school, work or home. Some stem from environmental injustice or violence. Sometimes, we simply don't know. Regardless of the reasons, these are health problems just like cancer, arthritis or diabetes.

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Stigma, Prejudice and Discrimination Against People with Mental Illness

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Learn about Stigma, Prejudice and Discrimination Against People with Mental Illness