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Interview with Taylor Barragan, LMFT by Vidur Malik, LMFT, Director at Large

Vidur: Could you please introduce yourself and the work you do?  

Taylor: I'm Taylor Barragan. I am an LMFT and a psychiatric mental health nurse practitioner (NP). I work most frequently with conditions like  anxiety, depression, bipolar disorder, and adult ADHD. I’m primarily working as a therapist right now, but in the summertime I plan to relaunch my practice with an approach including medication management integrated with psychotherapy, as well as complementary interventions and lifestyle recommendations tailored to each patient's unique needs. Personalized treatment will be guided by the patient's history, specific lab results and grounded in evidence-based medicine.

Vidur: What originally inspired the shift to pursue the psychiatric nurse practitioner program?

Taylor:  It was a culmination of things. Around the time I got licensed,  my husband moved to Ohio for nursing school, and I found myself so interested in everything that he was learning. I was asking him so many questions. At some point he was like, ‘you should just go back to school.’ Around that same time, I had a few therapy clients that had tried medication and within a couple of weeks, they were not as anxious and could actually tap into the emotions or insights that they couldn't previously access in session. I realized that was like the missing piece for this client. I wanted to know more - why did a provider make that decision with that medication or how are these other lifestyle things impacting how effective that medication is?

I just really love school too. Part of that I think too is having ADHD myself. School provides a structure, and I like learning. I interviewed some colleagues who were psychiatric nurse practitioners and after researching how I could integrate my background as a therapist, I decided to make the leap.

Vidur:  What type of work do you envision doing with your background in therapy and psychiatry?

Taylor:  I have some clients that would prefer to see one provider for medication management and psychotherapy in an ideal world. What's coming down the line in the summer is relaunching my practice to include medication management.

But if somebody is already working with a therapist and that is established, I would love to be able to better collaborate with therapists and make that a cornerstone of how I practice. I don’t think school provides enough training  on how to collaborate with a patient’s psychiatrist or psychiatric nurse practitioner. I also don't think that medical schools or psych NP schools do that very well either. There is often confusion about things like “What cadence should we be talking on? How should that communication go? Who leads that? What are we reinforcing in each other's work because this is our common goal for this client?”

Vidur:  What are some ways clinicians can maintain relationships with psychiatrists and ensure coordination of care?

Taylor: It can be really hard to get a hold of psychiatrists or psych NPs. They may not have a direct number. I think that there's just a natural grittiness to the beginning of even making contact, and that takes a little bit of persistence. That gets difficult too because then you might spending a lot of time trying to get a hold of this person's psychiatrist outside of session that you’re not necessarily getting paid for. So you can reserve that time in the session with the client, because it is really important. You can use one of those sessions as a case consultation with the client there.

You can also talk through the main concerns, what you’re working on, and what would they would like you to reinforce during sessions. Getting an understanding about if that client is prescribed something, why that was the choice, and side effects that you should be looking out for. And if you are noticing that somebody is having side effects, being able to have a secure way to send a message to the provider.

In addition, psychiatric providers may only be seeing a client once a month, and then sometimes down to once every three months. So as the therapist, you're getting way more face-to-face time with that client than the provider is most likely. I don't think that everybody involved oftentimes appreciates just how much insight the therapist has; if somebody's doing well or not.

Also, if somebody is not sleeping well and they are on a medication that can cause issues with sleep. The psychotherapist can ask, ‘Hey, did you talk with your psychiatrist or psych NP? Can you take that in the morning?’ Just understanding how you can play a role in reinforcing things, being able to report back key things that you discussed with the psychiatrist.

Vidur:  It sounds like there is a lot more insight clinicians can provide to psychiatrists than we might realize.

Taylor: So much, like sleep habits and quality, medication compliance, or substance use. If somebody is having side effects from a medication and they don’t like taking it but don't want to tell their psychiatric provider, it’s important to have the conversation with the patient about how important it is to let their provider know. It’s importance to reinforce, “Hey, we’re all on the same team. Your provider should know how you’re feeling about the treatment or they have no way of knowing what is or isn’t working.”

 I think that's where things get really messy. Patients may be on a few different medications, and you can't tell if they've had an adequate trial of one because maybe they weren’t taking it because they were having side effects. If we had a better structure for how the therapist could feel empowered to help monitor and relay some of that information, it would be way less confusing and ultimately lead to better patient outcomes.

Vidur: Are there particular topics related to psychiatry that clinicians should like keep ourselves educated on in order to support our clients?

Taylor: Reducing stigma about medication can start just by referring a patient to a psychiatric provider. Patients trust us as psychotherapists, and reiterating that going to a psychiatric provider does not mean they have to immediately take what is recommended is really important. It just starts the process. I was talking to a psych NP a few weeks ago and she said that she always refers patients to psychotherapy, but not every therapist is willing to refer to psychiatry early on in treatment.

Depending on how severe somebody's symptoms are, early intervention is key. Research shows that for conditions like moderate to severe MDD, schizophrenia and bipolar disorder, the longer the delay in treatment, the more treatment resistant they do become. There is also much discussion in the field whether “treatment resistant depression” is actually a case of missed bipolarity, specifically type 2. So for patients who are seeking therapy for mild depression, for example, if symptoms are not improving and instead getting worse, it’s important to refer for an integrative psychiatric medication evaluation.

The other important thing is to remind patients to not start and stop their medication on their own. Again, therapists see the client so much more frequently than a psychiatric provider, so its important to encourage the client to discuss this with their provider and also update the psychiatric provider about any issues with medication consistency. Research on MDD, for example, shows that symptoms should be first treated to remission, and then continued at maintenance with the medication, and psychotherapy, for 6-12 months before tapering (Altamura et al., 2007; Altamura et al., 2008; Kato et al, 202; Paquin et al., 2022). So it’s important for patients to know that for everyone, medication doesn't have to be forever, but it’s really important to decrease stigma about taking medication, reinforce and provide hope for patients, and collaborate with their provider during treatment. Therapists should also be aware of new and exciting emerging treatments like esketamine, and rapid acting antidepressants that are not monoaminergic like conventional antidepressants.

About Taylor

Taylor Barragan, LMFT, PMHNP-BC, APRN, PMH-C is a Licensed Marriage and Family Therapist and Board-Certified Psychiatric Mental Health Nurse Practitioner. She earned her Master of Arts in Counseling Psychology from Santa Clara University and her Master of Science in Nursing in Advanced Practice Psychiatric Nursing from Case Western Reserve University. She is a member of Sigma Theta Tau International Honor Society of Nursing, Postpartum Support International (PSI), American Nursing Association (ANA), and SV-CAMFT.
With a focus on integrative and holistic treatment, Taylor's telepsychiatry practice, which will launch in Summer 2024, offers medication management, complementary and supplemental therapies, and psychotherapy services for teens and adults. As a Perinatal Mental Health Certified (PSI) provider, she has a particular passion for supporting neurodivergent parents through the perinatal period, from preconception through postpartum. Taylor also earned a certification as a lactation counselor to better understand the mental health impacts of lactation and related challenges during the postpartum period.
Taylor's expertise also extends to executive functioning challenges at work and during the transition to parenthood. Her strengths-based and relational approach integrates psychodynamic and cognitive-based psychotherapies, emphasizing enhancing daily functioning and quality of life. Taylor is committed to providing affirming, culturally competent care tailored to each client's needs.

Recommended resources for therapists:

Psych Meds Made Simple
Handbook of Clinical Psychopharmacology for Therapists
Clinical Psychopharmacology Made Ridiculously Simple

References

Altamura, A. C., B. Dell'Osso, Mundo, E., & L. Dell'Osso. (2007). Duration of untreated illness in major depressive disorder: a naturalistic study. International Journal of Clinical Practice (Esher), 61(10), 1697–1700. https://doi.org/10.1111/j.1742-1241.2007.01450.x

Altamura, A. C., B. Dell'Osso, Mundo, E., & L. Dell'Osso. (2007). Duration of untreated illness in major depressive disorder: a naturalistic study. International Journal of Clinical Practice (Esher), 61(10), 1697–1700. https://doi.org/10.1111/j.1742-1241.2007.01450.x

Bobo, W. V., & Shelton, R. C. (2010). Efficacy, safety and tolerability of Symbyax® for acute-phase management of treatment-resistant depression. Expert Review of Neurotherapeutics, 10(5), 651–670. https://doi.org/10.1586/ern.10.44
Kato, M., Hori, H., Inoue, T., Iga, J., Iwata, M., Inagaki, T., Shinohara, K., Imai, H., Murata, A., Mishima, K., & Tajika, A. (2021). Discontinuation of antidepressants after remission with antidepressant medication in major depressive disorder: a systematic review and meta-analysis. Molecular psychiatry, 26(1), 118–133. https://doi.org/10.1038/s41380-020-0843-0

Paquin, V., LeBaron, N., Kraus, G. E., Yung, E. C., Iskric, A., Cervantes, P., Kolivakis, T., Saint-Laurent, M., Gobbi, G., Auger, N., & Low, N. (2022). Examining the association between duration of untreated illness and clinical outcomes in patients with major depressive and bipolar disorders. Journal of Affective Disorders Reports, 8, 100324–100324. https://doi.org/10.1016/j.jadr.2022.100324

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Interview with Jeremiah Knight, LMFT and host of the Therapy House podcast, and Vidur Malik, Director-at-Large, SCV-CAMFT

Vidur: Could you introduce yourself and the work that you do? 

Jeremiah: I’m Jeremiah Knight. I’m a licensed marriage family therapist heading into my eighth year as a clinician. I graduated from Santa Clara University. I was born and raised in San Jose. I’m very happy to be back in the community. I currently run a private practice here in San Jose, working with parents on child custody and visitation within Santa Clara County. I’m also a podcast host, producer, promoter, man of many hats.

Vidur: In terms of the clinical work that you do, would you say that you have a particular specialization or area of focus? 

Jeremiah: Right now in private practice, I mainly focus on anxiety, depression, and trauma within youth and adults. I’m very fascinated with hearing stories that come from their experiences of adversity and assisting them in finding meaning through it all.

Vidur: In addition to the clinical work that you do, I know you do a lot of multimedia work. Can you share just sort of what projects you currently have going on in the multimedia realm and what drew you to just doing that work? 

Jeremiah: I produce the Therapy House podcast, which is a podcast that focuses on helping professionals as they breakdown their process and philosophy behind their work..

I had done a podcast before on Black mental health. I am really big on educating the population about therapy, especially in the Black community and trying to normalize it. I was able to learn how to develop a podcast, how to market it, all the pieces that went into it. 

Therapy House came in with the same question of how other professionals did their work, what went into it, and what happened behind the scenes. I love the idea because we don't get to see other people do therapy. I wanted to create a space where people could share what went into their craft and be vulnerable enough to get the support they needed. A couple of friends of mine from grad school, Jon Tong, Jorge Meza, Luis Abbott, and Jeremy Ramos were open to the idea. I knew how to set up the podcast and be able to distribute it on all platforms. 

A couple of them had some experience generating or working on a podcast. For the most part, we then began to create something that was unique in the podcast sphere. 

We have an upcoming episode on therapist anxiety, describing the angst within our journey and craft. We've just completed an episode on eating disorders, an episode on the experience of queer and trans clinicians, and many more that I’m really excited to share with listeners. Content and stories that I, myself, have either been curious about or have been waiting to hear. 

Vidur: There are therapy podcasts out there, but it sounds like the thing that makes Therapy House different is just that it takes you behind the scenes on the process from the clinician's perspective. 

Jeremiah: Yeah, the therapist gets a therapist, and there's a mic in front of them. Helping is a growing process and the therapist changes just as much as the client on this journey. Here we illustrate it. If you have an idea or you've been mulling something over or you felt alone in it, you’ve got an opportunity to ask another clinician. 

Vidur: What advice do you have for clinicians, even if they're not necessarily doing a multimedia project, on how to put their name out there and market what they do? 

Jeremiah: Create things. Beyond it being a nice outlet, it adds marketability. Whether it is with a soundbite or video or a clip, or a blog or worksheet, all of that helps clients either find you or at least get what they need in some way. You just have to at least try to put out something. Try to get over the piece of creating that makes you feel uncomfortable. “Create for the joy of creating and sharing it with others” has been a mantra that I've been able to remind myself of on the days where I worked all week, and the last thing I want to do, on a Sunday, is sit in front of a camera.

Vidur: Is there a particular message or idea that you'd want somebody to walk away with after they listen to an episode of Therapy House?

Jeremiah: The initial message was that therapists are human too. There are things that go on behind the scenes. We have personal lives. It's not that we're these all-knowing beings that do everything immaculately. Being able to encourage clinicians and help them to be vulnerable, be open, and to ask “what comes up within you when life outside of therapy is chaotic?” 

Vidur: Thank you so much for your time. Where can people find your podcast?

Jeremiah: People can find us on www.linktr.ee/therapy_house and Instagram at @therapyhousepodcast.

References:

Brown, T. E. (2014). Smart but Stuck: Emotions in Teens and Adults with ADHD. Jossey-Bass

Davis, P. (2021). Dedicated: The Case for Commitment in an Age of Infinite Browsing. Avide Reader Press

Siegel, D. and Bryson, P. (2021). The Power of Showing Up: How Parental Presence Shapes Who Our Kids Become and How Their Brains Get Wired. Ballentine Books Trade Paperback Edition

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Interview with Ashwini Addala and Liliana Ramos, LMFT, Director-at-Large

Liliana:  Welcome! Can we please start with an introduction of yourself.

Ashwini:  My name is Ashwini Addala; I’m a licensed marriage and family therapist who is a spiritual coach, energy healer, and spiritual seeker, with a practice in downtown Willow Glen where I see adults, families, and couples. My approach with clients is centered around self-discovery, where the Self has many parts and aspects. Self-discovery, or more specifically self-awareness, is a fundamental building block of the healing work we do in sessions.

I specialize in areas of childhood trauma, generational trauma, immigrant issues. My work differs from some other therapeutic modalities because I address the mental self, emotional self, physical self, social self, sexual self, etc., and spiritual self. My approach is about seeing a person for ALL their parts, from across lifetimes and on a path of evolution. I incorporate energy healing, grounding and protection mechanisms and guided journeys (visualizations) with clients. Although I worked with children during my training I found later that working with adults and their inner child resonated with me.  

Liliana:  What made you decide to use spirituality during therapy?

Ashwini:  As a spiritual seeker myself who underwent massive healing and transformation through my own therapy work as well spiritual and energy healing, I saw the connection between the spiritual and therapeutic healing I was doing and the improvement of my mental health. That being said, I made an honest attempt to stay true to traditional therapy but ultimately felt ineffective and inauthentic. As I experimented with slowly incorporating some techniques, I saw how effective and powerful it was, not only for treating depression and anxiety, but also in every aspect of the client’s existence, including their patience levels, their interpersonal skills, their romantic relationships, parenting of their children, and their career and professional success. I soon gained the confidence to break out of the mold of what therapy should be and made it fit to who I was as a person. I began to combine other things, such as energy work like Reiki or MotoKi to teach clients to ground or shield themselves in a different way.  Guided meditations, or journeys, as some people call them are another powerful skill and tool I’ve used to help clients heal things like childhood or generational trauma.

People often confuse spirituality with religion, but it is not necessarily the same. Sometimes spirituality can mean self-awareness or seeing the “bigger picture”. Spirituality is the evolutionary trajectory that you’re on. It holds the assumption that life has meaning, and the spiritual aspirant or in my case, the therapist, helps realign ones self to be in congruence with the big picture and one’s personal meaning or purpose of life. To me, spirituality is the mindset and the evolution of what one is aiming for in life.


Energy work is just a tool, but it isn't spirituality itself. It is just a tool some people use towards their spiritual practice. So it's like a therapist that works on trauma, but is also special, has training in yoga and does yoga-based trauma work. Likewise, a person who works with spirituality can use crystals and stones, chant mantras, use dance and movement, sing songs, or practice meditation or mindfulness, etc. When we talk about spirituality is, we can get it confused with the tools. We need to remember that the actual journey of life is the spirituality.

Liliana:  We've had numerous tumultuous years, politically and race -wise, COVID, world politics and wars. How can spirituality help as we end the year and begin a new one?  

Ashwini:  This is a wonderful time of year to take stock of our goals and desires for our lives and be actively engaged in becoming realigned with them. If we want to build a particular type of business, ask your self, “what am I doing that is aligned with building said business, and what is blocking, sidetracking, sabotaging or distracting you from this goal?” Then, with much grace and leeway we realign, adjust, and trim so that we are back on track. It is important to remember that we are in the middle of the journey and not at the end, so even if there are setbacks and detours, it’s okay. We’re not done yet. There is no judgment day.

Liliana: People might have had a crazy year personally.  How do you say your goodbyes to this year so that you can open up to a clean slate in the new year?

As we close out the year, we can look at the goals that we've set for how we want our lives to look, what we want to acheive, and what kind of experiences we want to have. We just take stock, compassionately, slowly, gently, asking, “what have I been able to accomplish and where do I still need to work on it?”

Liliana: Why do you think this is important work?

Ashwini:  This is such important work because it helps people redirect their entire life into being a conscious active participant who is living the life of their dreams now, not just not the present experience one is having. Not just surviving the present moment but thriving. It is important because whether or not we are aware of it or care for it, we are all on a spiritual journey. It is an essence of the human existence and we get to choose whether we engage and drive the boat or be swept up by the waves and tides.

Liliana: What would be the takeaway for a therapist reading this article?

Ashwini:  To try and incorporate some questions about clients’ spiritual orientation into therapy because these are really fundamental existential things that people consciously or subconsciously follow. If someone believes that there is a hell or that there are demonic possessions, that is a good indication of how they function in the world and what their moral compass is made of.

Some questions to ask:

1. What is your spiritual or religious orientation? Some folks may need more prodding with more specific questions about their relationship with the universe or God or a higher power. There is no right answer, it just helps to understand a client’s orientation in their world. It’s also informative if someone says that there’s no belief in a higher power.

2. What do you think is the purpose or your purpose in life?

3. If your life were to end tomorrow/month/year/etc, what do you want to make sure you accomplish so you don’t have regrets?

4. What do you believe happens after death?

5. How do you feel about death? About life?

Liliana:  Ashwini, thank you for this inspiring interview.  Thank you for sharing with us that as we end the year, it is a good time to look at the meaning of our life; reflecting on what we want in our life as we evolve as spiritual beings.  

I'm Ashwini, a psychotherapist and energy healer. With a deep-rooted belief in the power of holistic healing, I've spent over a decade helping individuals find healing, well-being and themselves.
My journey in the healing arts has led me to study and practice various modalities, including Reiki, chakra balancing, and mindfulness meditation in addition to other proven evidenced-based healing techniques such as CBT and DBT. I'm passionate about guiding my clients on their path to self-discovery and thriving, helping them tap into their own inner wisdom and abundance.

My work is not just a profession; it's a calling. I'm here to support clients in their quest for physical, emotional, mental and spiritual harmony. When I'm not facilitating psychotherapy or reiki healing sessions, you can find me connecting with nature or making art with my family.

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Interview with Michele Barbic and Liliana Ramos

Michele:  I’m a marriage and family therapist. I always knew I was going to be a therapist, but I didn’t go to grad school, JFK, until later in life. The story about being in graduate school in my 50’s is interesting. I told my professor, ‘I’m not going to be an LMFT until I’m in my 60’s. Is this crazy?” The professor stated, ‘Michele, you are going to be 60 anyway. Wouldn’t you rather be doing something that you are passionate about?’ That has served me through the rest of my life.  I think it has served clients as well. We are never too old to pursue our dreams and our passions.  I am 72, a wife of 44 years, and have one son and two grandchildren. My experience in those roles comes into my sessions. Our experiences support what our clients are going through, especially the aging and grieving. I work with clients on how to age gracefully: in the course of the last 14 years, I have studied Hakomi and Sex-Positive therapy, Transpersonal therapy, IFS, and trauma. My newest passion is Psychedelic-Assisted Therapy, especially for aging, chronically ill, and end-of-life grieving.

I see myself more as a guide than a therapist, especially with the work I do with aging and grief.  It’s a different therapy method than when someone comes in with a diagnosis. Both grief and aging carry spirituality. To delve into those two topics, we must delve into what we believe in with grief and aging.  I bring in different therapeutic modalities such as IFS, Hakomi, and somatic work. In addition, I hold hope for my clients when they can’t hold hope themselves.

Liliana: Jumping off from what you said, because of how society has shifted its perspective towards mental health, some older adults might not have dealt with their trauma as children.  How do you deal with that?

Michele: As people come in to work on their grief they often are able to go to a deeper understanding of themselves because they are so raw. One intricacy of working with older clients is that they were brought up in a generation where you only went to a therapist if you had severe mental health illness. In addition, language and experiences have changed for mental health, sex, and gender. Often older adults are misunderstood because they do not have the currently accepted words when talking about sex, gender, race, and culture. They don’t mean to be hurtful or disrespectful.

A second intricacy is that the word older is relational. They’re older than me. If you are 50 and see a 60-year-old, they’re an older person. There is often no acceptance of being old.  Also, there is a difference between chronological and biological age. Biology is based on how well we take care of ourselves. How vibrant are we. I know a 90-year-old extremely active psychiatrist who seems biologically 60 and walks 2- 4 miles a day. When someone comes to therapy, you see their age, you can’t assume how an older adult will appear in your office. Older people can be 65-85 and still be vibrant. There’s a book by Louise Aronson called Elderhood: Redefining aging, transforming medicine, reimagining life, that every therapist should read about how even our medication needs change as we get older. I encourage my clients to work with their doctors and I encourage all therapists to work with the doctors and psychiatrists of their older adult clients. That is important with all clients, but it’s even more important for older clients.

Another intricacy is that therapists working with older adults must have done their own work. If we still have a fear of aging and of death that’s going to come across to our clients. We get very little education in grad school about aging and grief.

Liliana:  In summary, the intricacies are language, spirituality, chronological/biological, medical issues, and our own work.

Michele:  Another part is that older clients might be on anti-depressants. Often, they do not need anti-depressants: instead, they need to process their grief. As an older adult, you have had losses: Lost relationships, career, connection with people, health, and youth.  Grief underlies many mental health issues. I search where the loss is in their life. Whenever we find a loss, I wonder if this is depression or grief and ask the client, ‘Were you depressed as a younger person?’ If they say no, can explore the grief they may be experiencing.  

Liliana:  How do you incorporate grief work when they have depression? Any other ways that you incorporate grief?

Michele:  When I worked at Hospice I noticed that older adults often had unprocessed grief from the past because they weren’t inclined to seek a therapist for grief therapy. An example was a 95-year-old woman who was grieving for her husband, aged 100. She could not get over it: Several sessions into it, she revealed that she had a son who died at three years old. She didn’t dwell on the death because she had two other young children. She didn’t have the time to grieve and address the loss of her child. It was amazing: She was able to cry and talk about how that helped! When she processed it in session, she was a different person. She had let go of something she had been carrying for years. So as we age and dig deeper, we discover more profound loss and trauma.

Liliana:  I want to capture why you think this is important work.

Michele: We all have losses and we are all going to die. Our society doesn’t talk about it. In indigenous cultures, the elders were elders of the community and wise ones. Our society is going in the opposite direction: We don’t want to deal with older people. We don’t want to look at our older people. In fact, I was deadly scared of death until my life-changing experience with my mom’s death. I don’t know how I would have been a therapist if I had not dealt with my own fear of death. Death and aging are so important. We approach it as if, if we ignore it, it will go away. As for myself, I’m not totally free of fear of death, but I thank my clients and my own work for getting me closer. I think that’s a really important message. Since I got involved in grief work, I have a desire to bring it to the forefront. A friend of mine and I organized a couple of Death Cafes: we advertised that we were going to meet for 2 hours to talk about death. People wanted to talk about their own thoughts of death or the death of someone in their life. People want to talk about it, but there is no venue for it.

Liliana: How do you bring up death and how do you talk to people about death?

Michele: What is your belief? What are your emotions around dying? When you ask about this and talk about death, people want to talk about it, especially older people who are sick. Ask ‘Are you afraid of dying?’ ‘What is it like to be in your place right now with your illness?’  For people coming in with anticipatory grief encourage them to ask questions: Are you afraid of death Mom?’ Most recipients of that question are grateful.  

Liliana: To capture two things that you said: you knew that you wanted to be a therapist when you were real young and that you can talk about death because you worked through that. How did you work through that so that you can guide your clients? Are these two questions connected?

Michele: I was an only child, shy, and a good listener. As a child, the kids in the neighborhood would always come to me with their problems because I would listen to them. My mom would tell me, ‘Michele, you always have friends with problems.’ I would say, ‘No, everyone has problems. It’s just that I listen to them.’  My mom always pushed me and encouraged me with this ability to connect with people. When she was in her last days, the hospice nurse said to me that this was going to be an incredible experience. I was upset to hear that this was going to be an incredible experience when my mom was dying, being afraid of death and not knowing how to handle all this. The nurse opened the door for me to something I was not anticipating.

I transitioned my mom. It was like I was birthing my mom into a new life.  It went from giving her spoonful of water, rubbing her head, and doing things for a newborn, except I was doing this as she was going out. The nurse told me that my mom was passing: I held my mom and all of a sudden, I felt this loving energy come out of the top of her head. The whole room was filled with her love energy. It felt like her energy was going into my pores. It was like I was consuming my mom’s love. My husband came into the room.  He said, ‘Michele, there is so much love in this room. Then my son came in and said the same thing. I get emotional just recalling it as it was 13 years ago. It totally changed my outlook on death because she didn’t die: Her energy and love remained. That changed it completely for me.

My mom’s body is buried in the ground but I absorbed her. As I was caregiving with my mom, she encouraged me to go back to school. With my experience with grief, I studied and read more. I did my practicum at Hospice. If you had told me 15 years ago that I was going to be a grief therapist, I would have told you that you were crazy because I was afraid of death. Yet, here I am. That experience was the biggest shift for me. I now run grief groups or have long-term grief clients that have stayed with me, and shared with me what they’re going through and the transpersonal experiences that happen around grief. People come in and say ‘Don’t think I’m crazy, but this crazy thing happened’: How can you deny it? One hundred years ago, it was normal that deceased Grandpa showed up last night. We really need to look at what modern technology and medicine have done to this area of our life.

Liliana:  Thank you for that.

Michele: There is a quote from Carl Jung* that says “Embrace your grief. For there your soul will grow.” I approach clients with the wonder of the gift of grief. I don’t do it initially because they’ll get upset with me, but later, we look at how their life has changed because of the grief they experienced.  

Liliana:  In working with the older adult population, is grief the most prevalent topic that you run into.  

Michele: Yes, grief is the most prevalent. Purpose is the next issue. No matter what age, if we don’t have a purpose, what is life about? As we get older and we don’t have a job or a passion, we get older quickly because we don’t have a purpose anymore. We have to find a purpose. What really excites you? What do you get up in the morning for? In a study where patients got up and watered flowers every day while the other group did not do anything showed that the patients who had a purpose did much better. Viktor Frankl (2006) quoted Friedrich Nietzsche in his book: “He who has a why to life can bear almost any how.” Frankl was responding to hope when he was in the concentration camp. Same thing with aging and grief: clients can respond with hope.  

Then there is the other side. I am the happiest I have ever been: I feel more myself now than since I was a little kid. There are all kinds of research that show that the demographic of women over 60 are the happiest group. One of them is Silver Sparks: Thoughts on Growing Older, Wiser and Happier.

One-third of our aging gracefully is our genes, and 2/3 is our lifestyle. Chronologically Gifted: Aging with Gusto talks about this. Jane Fonda also has a couple of really good YouTube videos about aging. We don’t have many mentors to help us know how to do this.  

Liliana: As we wrap things out, what do you want therapists to know about working with older adults.

Michele: Top of my list is to have them do their own work on aging and death, learning more about seniors, and search for experiences where we do a life review. Francis Weller is a writer and teacher of grief who works with rituals. I did a ritual the other day: It was a grief service for a client carrying the grief for his pet. He had a traumatic experience as a child from the way his parents dealt with his pet’s death many years ago.  We lit candles, played music, and had a ceremony honoring his pet. As he grieved, I could see the difference in his face. It’s never too late to process the grief we may be carrying.

Another take away with grief and aging, is to remember that older people have lots of stories they tend to ruminate on. The therapist should focus on the client’s inner emotional experience rather than the story.

Liliana:  Thank you so much for this hour. What you do for your clients feels so beautiful and so giving. I hope the article captures the essence of you and your work. When I say this, I also think of the essence of love of your mom.

Holding a Master's in Holistic Counseling Psychology, Michele is a psychotherapist licensed in Marriage and Family Therapy. She has worked in the mental health field for many years in various settings, including hospitals, residential care homes, schools, Hospice, and non-profit organizations. Her personal and professional experiences prompted a profound re-evaluation of her understanding of life and death, leading her to specialize in loss, grief, aging, and transformation. Michele was a bereavement therapist at Hospice, Educator for Death and Dying Classes at JFKU, Host for several “Death Café” events, Guest speaker at San Jose State on “Aging Career Changes,” and Organized “Women’s Day 1998” at Santa Clara University while in their graduate program, Spear Headed the opening and supervision of a boy’s group home in New York City and was an onsite counselor for Girls Ark Residential Home for Girls. Michele has a private practice in San Jose, CA and currently facilitates individual therapy and group counseling both for Grief and Senior Women. She also co-founded a Women’s Retreat business where she has held retreats focusing on Women's empowerment nationally and internationally for over 25 years. At this stage of her life, she is passionate about helping shift the paradigm of aging. She invites us to be curious about our true nature and purpose at any stage of life and be open to expanding our understanding of our changing world. Michele is currently studying Intergeneration Trauma and is passionate about bringing Psychedelic Therapy to chronically ill, end-of-life, and grieving clients.

Michele lives in the Santa Cruz Mountains with her husband of 44 years and has a son and two grandchildren. She is an avid hiker, having recently walked the Camino De Santiago, is a Bay Area Ram Dass Satsang member, and practices meditation and yoga daily. 

References:

Aronson, L. (2019). Elderhood: Redefining aging, transforming medicine, reimagining life.  New York, NY: Bloomsbury Publishing.

Frankl, V. (2006). Man’s search for meaning. Boston, MA: Beacon Press.

Haight B. K., & Haight, B. S. (2007). The handbook of structured life review. Baltimore, MD: Health Profession Press.

Miller, E. (2017). Chronologically gifted: Aging with gusto. Pasadena, CA: Best Seller Publishing.

Selig, M (2020). Silver sparks: Thoughts on growing older, wiser and happier. Saint Louis, MO: JETLAUNCH.

Weller, F. (2015). The wild edge of sorrow: rituals of renewal and the sacred work of grief. Berkeley, CA: North Atlantic Books.

(*Quote attributed on the Web to Jung but unable to find the source.)

Back to Summer 2023 Newsletter 

Interview with Jim Arjani, LMFT by Liliana Ramos, LMFT, Director-at-Large

Back to Spring 2023 Newsletter
Liliana: Hi!  Thank you for doing this interview.  Can you please tell us a little about yourself and your private practice.

Jim: I am an LMFT. I have a group practice, Mountain View Therapy, where I employ a few other LMFTs. We do a lot of trauma work and that’s partly because of my background. I used to work with veterans and the 129th Rescue Wing, which is part of the California Air National Guard. There’s a training at the VA—PTSD Clinical Training—that enhanced my knowledge and interest in the area of trauma. Before licensure, as a trainee and intern, I used to work at a therapeutic preschool, Building Blocks, which was part of Seneca Center. Many of these children had backgrounds marked by emotional, physical, and sexual trauma. So, when it came to my private practice, I had experience and interest in working with people who have experienced trauma.

Liliana: How many in your group practice?

Jim: I’m thinking of adding to my group practice. Right now, I have two other licensed therapists in my practice, and am planning to add associates; I have  started supervision training.

Liliana: Where did you go to school and how long have you been an LMFT?

Jim: I went to JFK University and graduated in 1997 when they had a campus in Orinda. Some of the internship sites were elementary schools. It was a nice small university. I was in the school of holistic studies, the transpersonal psychology program. That appealed to me: It was interesting to learn about the similarities between spirituality and psychotherapy.

Liliana: Do you still use it or have you headed a different direction?

Jim: I still use it. The program required us to have a spiritual practice. I was already interested in spirituality before graduate school. It reinforced this idea of taking care of yourself, working on yourself, and the value of some of practices like yoga and meditation.

Liliana: Certifications or specialties? You talked about the VA.

Jim: I have some training in hypnosis but I’m not certified in it. There is an interdisciplinary association called ASCH, American Society of Clinical Hypnosis, the gold standard for hypnosis training. Dentists, doctors, therapists, social workers, and nurses all learn hypnosis together. They also have a certification program.

Liliana: You are certified in EMDR also?

Jim: I’m trained in EMDR. Certification is a more advanced level of training through EMDRIA. Once you have completed the basic training, you need additional hours of working with patients using EMDR and supervision. I plan to do it: One more item on my list.

Liliana: You said you used to work with veterans. Who do you work with now?

Jim: It tends to be tech workers because of the area. Regardless, they have had difficult events happen whether it’s recent or in the past. I consider using EMDR with them if it’s appropriate, especially if I think some of these past situations are impactful, and they’re ready for it.

Liliana: So if I heard you right, you don’t use EMDR with everyone.  

Jim:  Yes, that’s correct. Some clients are not interested in doing EMDR therapy. Other clients may be interested but current stressors may prevent them from addressing the past trauma.

Liliana: What should the patient be ready for?

Jim: When we do the EMDR, we are often bringing up some intense thoughts, feelings, sensations, and memories. This has to be the right time for them to do that work. Maybe we go back to their childhood trauma or some significant event in their life. We want to do that, but we don’t want to overwhelm them if they don’t have the resources to address these issues. So we resource them as preparation. We do interventions such as a safe place and container exercises. Sometimes, we’ll just do the resourcing for people. I find it to be very effective. EMDR uses different modalities combined in one.

Liliana: Can you explain that more.

Jim:  In EMDR, we have someone bring up an image. Now bringing up an image is something we can do in hypnosis or imagery work. Then we help them look at the negative cognition, which is similar to CBT. What is that negative belief you have about yourself or the world? We also try to find out what would they like to believe instead of the negative, which is similar to solution focused therapy. What would be a more rational way to say things to ourselves. So, we get the image, the negative cognition, and the positive cognition.

We also ask them emotions that they are feeling now and where they feel them in their body.  We get a Subjective Units of Distress (SUDS) level—how disturbing does the memory feel for you now. We also measure how truly they feel about their positive cognition. If their positive cognition is “I am a good enough", we ask them whether bringing up this image of being good enough is truly how they feel on a scale of 1-7 (where 1 is completely false and 7 is completely true). We do these measurements as part of the assessment for each target.

We do this bilateral stimulation of the brain. The client brings up the negative thoughts and sensations in their body which is similar to somatic therapy and mindfulness.  We follow with the bilateral stimulation: it’s a very organic process. We ask “what is coming up for you now?”  The client comes up with their own memory, feeling, or thought. The therapist relies on the client for thoughts and emotions to come up. It’s really powerful as they create the insights, images, emotions, and sensations.

I think it can help people with anxiety, depression, and trauma. People think of it as trauma because it came out of that work, but it can be helpful for other disorders too.

Liliana: How have you seen it work with people who have anxiety, depression, or anger?

Jim: Sometimes the anxiety and depression are related to an event or emotion that happened.  I don’t feel good enough about myself so I’m depressed. There might be some events that they have experienced where they learned to feel not good enough. We have a process in EMDR to help them figure out what those experiences could be. What am I (the client) feeling now and link it back to what they’re feeling and where it originated from. It might not be Big T trauma but the event affected them. For example, it might be something that a teacher might have said to you. People don’t realize how these traumatic events have impacted them. In EMDR, we can often help them figure it out. While using the analytical part of their brain during EMDR, they have a chance to look at this more objectively. So they, in turn, may realize why they think, act, or feel a certain way.

Liliana: Let me just go back to the bilateral stimulation. Can you explain that a little bit more for our readers?

Jim: I’ll give you the more technical way of explaining it for therapists. These traumatic memories are locked in a dysfunctional storage state in your mind. Through EMDR, we move the memories out of this dysfunctional state into a more functional storage state. Then you can use your adult resources and experiences to process them and release them from the state they were prior to EMDR therapy.  

But for clients, I explain this as self-healing. We are going to let whatever comes up happen without judgment. You can’t do this wrong. We’re trying to integrate the adult part of you with the child part of you or the thinking part of you and the emotional part of you.  

Liliana: Thank you for that. So the bilateral connects the two?

Jim:  With bilateral stimulation, we are stimulating both sides of the brain. We can do that in a number of ways: Through eye movements (although some people find it distracting), or the client can do butterfly tapping on their shoulders, or tap the just above their knees. There is a variety of ways to do the bilateral stimulation.  

Liliana: Why do you think EMDR is important?

Jim: I think that talk therapy has a lot of value. EMDR therapy can give clients an experience of reprocessing something painful without having to talk about every detail of it. In hypnosis we use different parts of the brain. Similarly, In EMDR, we also use different parts of the brain because we are working with thoughts, emotions, body sensations, and images. It’s a different experience from traditional talk therapy. Here we are setting up the conditions so that something can get reprocessed.  

Liliana: When you talked about having worked with the techies and the veterans, is there a difference in treating these two populations?

Jim: There is clearly a difference. With veterans, because of their training, it can be difficult for them to show weakness and vulnerability. They expect so much from themselves. They’re often very resilient so it has to get really bad before they come into therapy. They may use substances, or their marriage is on the brink, or something else, before they seek support. I’m overgeneralizing of course: Many veterans don’t believe in therapy or see it as a threat to their career.  

Liliana: Are people in the tech world more ready to talk about their emotions?

Jim: The issues are different. Some of these veterans, who were in Afghanistan and Iraq had life threatening situations. They experienced explosions, had to rescue people, events that are often life threatening.

Liliana: In the tech world, are many of them immigrants and might have had trauma?

Jim: Yes, definitely. Some of them are still dealing with those immigration issues. Will I lose my job? Will I lose my visa? Will I have to leave this country? Will I lose my friends and everything I have built for myself here?

Liliana: Is there an issue that is prevalent with trauma?

Jim: In EMDR therapy we say the earlier the better when identifying trauma targets. Trauma tends to be linked in our brain. If we can identify that original situation, that can make a big difference in the healing process. We help clients process present triggers. There is also a  future template to prepare people: We have them play in their mind a situation that could potentially be triggering for them in the future to try and help them deal with issues.

Liliana: Building them up so they have the confidence to know what to do when they encounter the situation again. Where did you get your training?

Jim: I got my training at the EMDR Institute. That was started by Francine Shapiro, the founder of EMDR. They have good training that counts for certification.

Liliana: I have a question that our readers might also have. The PESI EMDR courses are more for knowledge than certification?  

Jim: I think so. However, it’s still good knowledge.  

Liliana: If there was one takeaway for readers, what would that be?

Jim: EMDR is a way for clients to make connections and integrate some memories that they may have some difficulty integrating in other therapy modalities. With EMDR, clients can connect past situations and trauma with the present day struggles they experience. The trauma is in their thoughts, images, body, and feelings. It can be eye-opening to them as to how much something still bothers them: the small T traumas that EMDR can help them understand and resolve.

Liliana: Is there something else that you would like to tell us about EMDR?

Jim: I didn’t go through the nine phases of EMDR because I think it is too much detail. One other thing: In one of the phases of EMDR called installation, people bring up the negative experience with the positive cognition. We have them do the bilateral stimulation to strengthen that, which is similar to Rick Hanson’s neuroscience research: Something else I found interesting.

Liliana:  Thank you so much for doing this interview.  The information that you shared about EMDR will be informative and helpful for our readers.  

 
References

EMDR Institute, Inc., Eye Movement Desensitization and Reprocessing (2020). https://www.emdr.com/

EMDRIA, EMDR International Association (1995-2023). Creating global healing, health & hope. https://www.emdria.org/

Shapiro, F. (2018). Eye movement desensitization and reprocessing therapy (EMDR): Basic principles, protocols, and procedures. (3rd ed.). New York, NY: Guilford Press.

Shapiro, F. (2012). Getting past your past: Take control of your life with self-help techniques from EMDR. New York, NY: Rodale. 

Jim Arjani, LMFT, is the owner of Mountain View Therapy, a group private practice that works with teens, adults, couples and families. He graduated from JFK University in 1997 and has been a licensed therapist for the past 21 years. After starting a private practice in 2002, he joined SCV-CAMFT and really values how much he has received from the chapter. Since 2018, he has been the facilitator for the SCV-CAMFT Pre-Licensed Support Group.  

Back to Spring 2023 Newsletter

Interview with Nina Reyna, LMFT and Liliana Ramos, LMFT, Director-at-Large

Back to Spring 2023 Newsletter
Liliana: Welcome! Could you please introduce yourself, who you are, what you do?

Nina: My name is Nina Reyna and I’m an LMFT, licensed in California and Texas. I’m also a veteran and the wife of a retired police officer. I joined the Navy in 2001 and served during 9/11 as an intelligence specialist. One of the most exhilarating, yet frightening assignments I had while serving, was being in Guantanamo Bay, Cuba interviewing detainees. After my time in the navy, I resided in California with my husband, who was a police officer and detective for 15 years, before being medically retired. I met my husband of 18 years while I was stationed in California. We lived through deployments apart, long separations, and acclimating when trying to live together again. Even for officers in the Bay Area, it was typical to live in a lesser expensive area. We lived the military and first responder lifestyle of living apart. I now have my private practice in Texas, but do telehealth work in California. I am EMDR trained working on my certification.

Liliana: Can you please address the intricacies of doing therapy with veterans and first
responders?

Nina: As you know, these populations are a dynamic culture. They choose to join and embrace
this culture, which requires the immersion of the first responders, military, and their families,
something important to understand in order to understand the culture. Sometimes, there is a
culture clash and there is a need to bridge that culture. This is why I thought it was important
to become a therapist, having been a veteran.

Liliana: When you say culture clash, are you saying the clash after they leave the military?

Nina: When I say culture clash, I mean society and therapists. Veterans and first responders
work more from a collaborative and directive approach. Therapists are used to think about
helping them gain autonomy. Yet, they’re used to being told what to do. We are more
empathetic, while they thrive from a directive approach. They also have a fear of being
misunderstood or judged by society. I get a lot of clients who have a hard time being
vulnerable. The other complex parts of working with first responders and military is trauma
versus complicated grief. They don’t always experience trauma. Sometimes it’s complicated
grief from the loss of significant relationships. They’re moving around, getting deployed,
transferring, leaving their families, missing out on important events, and obviously losing
comrades in the line of duty. I find myself talking a lot about military, but find this with first
responders, too.

Liliana: I was going to ask you about the missing out on family events. Is that true for first
responders too? Do they not have a choice of their duty times?

Nina: Absolutely. Their shifts often range from 12+ hours for several consecutive days a week, sometimes only getting one day off. They miss important events, such as the birth of children, birthdays, graduations, and holidays. Even when they’re physically present, they’re oftentimes not mentally present. This is true about first responders, military, and veterans. This is also the case for the veterans who go through loss of identity when they get out. They have to learn how to live outside their service and how to acclimate to civilian life.

I read an article stating there is 1% of military versus civilians. They feel alone much of the time.
The other part of that is survivor’s guilt; not just survive in life but to survive with loss of limbs and the loss of the support that they had in the military. Those are all important to keep in mind. This is a population exposed to continued and extreme levels of stress that keep their system in a hyper-arousal state, which makes this population unique. Even when they’re home, off-duty and have taken off their uniform, they are still in that high level of hyper-arousal. They’re not aware of this. Sometimes they’ve been retired from the military or department for years and still don’t understand the connection, or disconnection rather between their body and mind.

Liliana: Do you ever work with their families?

Nina: Yes. The families are immersed in this culture. I have experienced this firsthand. It’s equally important to provide them the necessary support to be a successful unit at home.

Liliana: You’ve been on both sides.

Nina: Yes, I’ve been on both sides at the same time as an active-duty service member, while my husband was an active-duty law enforcement officer. It’s stressful because the family of first responders and military are often in a constant state of distress themselves. The need to want to support and fix their partner, but don’t know how to do it and don’t have the tools to connect. They’re physically together, but unable to emotionally connect. This is true for the children of the members as well.    

Liliana: So what made you decide to do this work – changing from military to therapy and then
helping veterans and first responders?

Nina: I was most influenced in my boots on the ground, being in the military, and being the
wife of a police officer. My undergrad was criminology and restorative justice because I
thought I was going to become a cop like my husband. My internship was on mediating: I was
intrigued by that. It was through the mediation part that I saw people connecting and healing
from experiences. This is when I decided that I was going into therapy. I have this level of
empathy and compassion for all my clients. I also have this personal experience with this
population. Not all my clients are veterans and first responders, but a number of them are.

Liliana: I would think that having experience in both gives you more credibility.

Nina: Yes, having the experience of being in the military, understanding the demands and the stress that is endured, as well as being my husband’s wife while he was serving on the police force. Additionally, not only did I experience my own difficult transition to civilian life, but also witnessed my husband’s shift in him becoming a civilian after his retirement. It was really difficult to watch him struggle with depression and anxiety. We rarely talked about work while serving, so we were really great with bottling our emotions and pushing forward. As a mom and wife, I just tried to keep things calm while he was doing his job and I was taking care of the kids. Most of our first responders and military are not just dealing with the stress of their jobs and the aftermath of that, but the stress of life and the world. That’s the complicated grief part that has so many layers.

Liliana: Why do you think this is important work?

Nina: This population has a duty to protect and serve: both first responders and military. Even
veterans walk away with that mentality. Not just for their community but their family as well.
They are not able to fully do this if they are suffering in silence, which is what most of them are
doing. They need a safe place to be able to be vulnerable. It’s important as therapists, we provide them with that safe space.


Liliana: This might be a good time to talk about EMDR. There are lots of ways to treat trauma,
what made you decide on EMDR?

Nina: My first experience with EMDR was as client many years ago. I found it to be an effective treatment in reprocessing my own trauma to repair the mental injuries I had endured. After I became license, I decided to complete the EDMR training. It has been a great tool to add to my practice as it has proven to be effective for treating my clients with PTSD and trauma as well as depression, anxiety and panic disorders.

Liliana: What other techniques do you use with your clients?

Nina: There are a variety of techniques that I use in therapy with my clients. The most appropriate techniques depend on the individual needs. Cognitive Behavioral therapy, dialectical behavior therapy, solution-focused therapy, psychodynamic therapy and mindfulness-based interventions are all techniques I utilize, to list a few. It’s important to remember that therapy is a collaborative process, and the most effective technique will depend on the individual’s unique needs and preferences. It’s essential for a client to find a therapist who is trained and uses techniques that resonate with them.

Liliana: Is there one issue that is really prevalent in one or both?

Nina: Suicide is a serious public health issue that affects individuals, families and communities. Suicide is a complex issue that can have multiple causes, including mental health conditions, substance abuse, trauma and social and economic factors. First responders, active-duty military and veterans are at a higher risk of experiencing suicidal thoughts and behaviors due to the nature of their work. They are often exposed to traumatic events and high-stress situations, which can lead to mental health problems such as depression, anxiety and PTSD. These mental health conditions can increase the risk of suicidal thoughts and behaviors among first responders. It is important to reduce the stigma surrounding mental health and seeking help for mental health issues. First responders should feel comfortable seeking help for mental health problems without fear of being stigmatized or discriminated against.

Liliana: What is the takeaway that you would want therapists to have.

Nina: The takeaway for therapists is to be aware of their biases and how that might affect their clients. Show your clients that you want to learn from them, not just teach them what you want them to know. Our clinical judgment is important, but our clients know their experiences. It might be helpful to ask during their intake paperwork if the client has served in the military, or if they know someone who has served in the military. Even though not every military member has experienced trauma, checking in with that part of the client’s experience can be helpful to be aware of. They might be coming in with a present issue they want to work on, but not realize that their present issues are carried over from the past.

Liliana: Yes because during the whole military service you’re trained to not think about
yourself, rather about the mission. I’m guessing it’s the same for first responders. Families are
trained to go along with it to support that person. So when it comes to therapy you can miss
that whole rich background.

Nina: Absolutely. They might not think to bring that part of them into therapy. Although it’s embedded into their identity, they try to get away from it and don’t bring it up. It’s important to screen for it and meet them where they’re at. They might not want to talk about it, but at least you have that information.

Liliana: Is there anything else you would like to add?

Nina: I just wanted to thank you for giving me this opportunity. I will say that I take random
trainings. I know that the need for culturally competent therapists for this population is high:
they need more therapists. There is an abundance of online and in-person training (PESI and
Psychotherapy Networker), take the time to learn about them.

Liliana: Thank you for doing the interview and for all of the information. This was great. As a
retired military veteran, I appreciate the work that you do. Thank you for your service and for
your work.

Nina Reyna is a Marriage and Family Therapist, licensed in the state of California as well as Texas. She is also a United States Navy veteran and the wife of a retired police officer. She has almost 8 years of clinical experience working with family/relationship issues, trauma survivors, anxiety, depression, and addictive disorders. She is dedicated to providing safety to those she serves and utilizes her expertise to help active-duty military, veterans, first responders and their families deal with the stressors they must endure on a daily basis, including PTSD and deployment/reintegration issues. She is also trained in Eye Movement Desensitization and Reprocessing (EMDR) Level II.

References:

Schaeffer, K. (2021, April 5), The changing face of America’s veteran population. Pew Research Center. Retrieved March 17, 2023, from https://www.pewresearch.org/fact-tank/2021/04/05/the-changing-face-of-americas-veteran-population/

Resources:

COPS – Concerns of Police Survivors:  https://www.concernsofpolicesurvivors.org/national-conference

Veterans Administration - https://www.vacareers.va.gov

Military One Source:  https://www.militaryonesource.mil

Suicide and Crisis Lifeline:  988 

Crisis Text Line:  Text BADGE to 741741

COP 2 COP:  1-866-COP-2COP (267-2267); https://njcop2cop.com

FIRESTRONG:  1-844-525-FIRE (3473); https://www.firestrong.org

Back to Spring 2023 Newsletter

Interview with Jyoti Nadhani, LMFT and Liliana Ramos, LMFT, Director-at-Large

Back to Winter 2022 Newsletter

Jyoti:  I am a tech entrepreneur turned psychotherapist. I have always been passionate about working with people and mental health has been a big part of my life. After my software company got acquired, I chose to go back to school, study, and I became a therapist. Due to my professional experience, I work mostly with people who are in tech, founders, tech-entrepreneurs, and employees from tech companies. My focus is mostly on couples, although  I work with families as well: teenagers or adult children and their parents. I have an integrative approach to psychotherapy which focuses mostly on Emotionally Focused Therapy (EFT) for couples and family therapy. Internal family systems, Somatic Experiencing & Mindfulness based practices, Ketamine Assisted Psychotherapy etc.

A couple of years ago I contracted Bell’s palsy, which is a facial paralysis: I felt lost and I felt clueless. I tried Western medication. Allopathic doctors told me it could be due to stress. I tried Chinese medication and went to India for Ayurveda treatment. As a Vipassana meditator, I believe in mind, body, spirit or soul. I was perplexed as to why I had this facial paralysis. When I read about Michael Pollan’s (2017) research on psychedelic psychotherapy, I realized I needed to investigate that avenue. I got this opportunity to get psychedelic assisted psychotherapy and it was immensely helpful. From that point, I started training with MAPS (Multidisciplinary Association for Psychedelic Studies) for MDMA-assisted therapy; I moved on to  train with Fluence for ketamine-assisted therapy, and now I am in training at Berkeley University. The UC Berkeley  program emphasizes psilocybin facilitation and its applications for spiritual and psychotherapeutic care, focusing both on traditional uses of this globally recognized medicine and current Western approaches to mental health.

Liliana:  What a journey! In the spiritual world it seems that things happen for a reason. You chose to explore and went for this journey that has helped you grow personally and professionally. How do you see this in your life?

Jyoti:  Yes. I would say that the medicine found me instead of me finding the medicine. It has been a profound experience. I’ve a better understanding of myself and others. I feel more connected and not isolated.

Liliana:  How does psychedelic assisted therapy help clients?

Jyoti:  Psychedelic therapy refers to the proposed use of medicines such as psilocybin, ketamine, LSD, and others to treat mental disorders and has been helpful in spiritual and personal growth. Indigenous communities have been using psychedelic medicine for centuries. Psychedelics offer a treatment that shows best for medication and psychotherapy in a short period of time. Generally when you do psychotherapy, it might take years to see results.  When it comes to psychedelics, you only have to take the medicine a few times: changes happen and last for a long time. This type of therapy is incredibly powerful because the whole sense of self and world view shift in such a way that people often feel they have the self-efficacy and free-choice they had not recognized they had before. Our body has an innate ability to heal. Similarly, our psyche has the ability to heal if the appropriate conditions are present. Clients can access more memories or memories that lie deep in the unconscious. So that helps them change their world view for themselves or even for others. They have better clarity and understanding. Where there is awareness, change happens. They feel connected, which helps to facilitate the reconsolidation of the memories.  Humans are interconnected, so the healing has to happen for everybody. Rather than feeling lonely and isolated the clients feel the connection with family, and others. Psychedelics allow them to revisit the trauma without being emotionally charged. It helps them have greater clarity and create a new narrative about what happened; it relieves the stuck energy.

Liliana:  As a South Asian therapist, what are the main issues that other therapists need to be aware of?

Jyoti:  First, I would say that mental health is still a stigma in the South Asian community. Psychedelics is further stigmatized. Drugs are perceived as dangerous. In fact, years ago, when I first heard Michael Pollan, I thought “Oh this is drugs. I’m going to avoid it at all costs.” People might not be comfortable with using psychedelics. Basically, we have to educate people to show them that psychedelics, when used in a ritualized and contained environment, are safe.

Liliana: Does  most of your practice deal with psychedelic psychotherapy?

Jyoti: I have a mixed practice.  I have my traditional psychotherapy,  30% of which is psychedelic-assisted psychotherapy.  

Liliana: Is there anything a non-South Asian therapist should know that might be helpful to better assist the South Asian community?

Jyoti: I would say that most of the South Asian community is immigrant and immigration does impact mental health. Mental health challenges are way higher than we are willing to accept. I had lost my support system when I immigrated, I’m still trying to balance between two cultures. Racism, being a minority, being an outsider and not feeling accepted is emotionally draining. For most South Asians, children have to balance between collectivist culture and individualistic culture. So, I would say that mostly South Asian people are living two lives and acculturation can be heavy and stressful. I noticed that for adolescents and young adults it is challenging because according to country of origin cultural rules, the parents decide what the child should be doing, but the child might be wanting to do different things. The parents project on their children the hard work they had to do to settle in the US. As one loses the support that they were used to it becomes overwhelming for the parents and of course brings pressure on the children.

Liliana: What is the takeaway that you want from this article?

Jyoti: The takeaway is the benefits of psychedelic assisted psychotherapy. Psychedelics like MDMA allow one to be empathetic towards self and others. In traditional therapy, the client might be protective or guarded and might not be open. But MDMA helps the therapeutic relationship and helps the client to trust and share their struggles freely.  Mystical-type experiences occasioned by psilocybin mediate the attribution of personal meaning and spiritual significance.

Liliana: Is there anything else you would like to share?

Jyoti:  The core mystical experience is one of the interconnectedness of all people and things, the awareness that we are all in this together. It is precisely the lack of this sense of mutual caretaking that puts our species at risk right now, with climate change and the development of weaponry that can destroy life on the planet.

Liliana:  That’s beautiful how you interconnected everything.  When you said that you did EFT, IFS and Somatic Experiencing, are you certified, did you take Level 1?

Jyoti:  I did Level 1 for Somatic Experiencing.  I have also done an Internal Family System circle . I am an IFS informed therapist.  I have done advanced EFT training.  With Somatic Experiencing, when we do psychedelic work, the clients have access to the body.  It is easy for us to help the client focus on their body to relieve the tension or even to open up.  That is how Somatic Experiencing is helpful.  

Liliana:  I love how you integrated EFT, IFS, Somatic Experiencing and psychedelics.

Jyoti:  I love being a psychotherapist.  Now with psychedelics, I love it even more.  I see deep rooted issues being addressed and changes happen so quickly.  I hope it motivates more therapists to come into the field. 

The views expressed in this article are those of the speaker and not, necessarily, of SCV-CAMFT. SCV-CAMFT cannot be held liable for any damages arising from recommendations, advice, or points of view given by our contributors or any actions or decisions arising out of the content of this article. 


Jyoti Nadhani is a tech entrepreneur turned psychotherapist.  She did her Master in Business in India, then did her Master in Psychology in the United States.  She is a South-Asian LMFT who has trained in 3.4- methylenedioxy-methamphetamin (MDMA) from Multidisciplinary Association for Psychedelic Studies (MAPS) by Rick Doblin and Ketamine assisted psychotherapy from Fluence.  She is currently pursuing a certificate program in psychedelic facilitation from UC Berkeley.  In this training she will learn Psilocybin facilitation and its applications for spiritual and psychotherapeutic care focusing both on traditional uses and this globally recognized medicine and current Western approaches to mental health.  She is also trained in Emotionally Focused Therapy (EFT), Internal Family Systems, and Somatic Experiencing.  

References:
Hanagan, K. (2021, February 20). Resetting the brain and mind with ketamine. Kathleen Hanagan. https://www.kathleenhanagan.com/resetting-the-brain-and-mind-with-ketamine/
Mac, G. (2017, March 9). The psychedelic miracle: how some doctors are risking everything to unleash the healing power of MDMA, ayahuasca, and other hallucinogens. RollingStone. https://www.rollingstone.com/culture/culture-features/the-psychedelic-miracle-128798/
Pollan, M. (2018). How to change your mind:  What the new science of psychedelics teaches us about consciousness, dying, addiction, depression, and transcendence. London, UK: Penguin Books.
The ultimate guide to ketamine. (n.d.).  The Third Wave. Retrieved December 4, 2022 from https://thethirdwave.co/psychedelics/ketamine/
Trope, A., Anderson, B. T., Hooker, A. R., Glick, G., Stauffer, C., & Woodley, J. D. (2019). Psychedelic-assisted group therapy: A systematic review. Journal of Psychoactive Drugs, 51(2). 174-188.
doi: 10.1080/02791072.2019.1593559
Yale News. (2012, October 4). Yale scientists explain how ketamine vanquishes depression within hours https://news.yale.edu/2012/10/04/yale-scientists-explain-how-ketamine-vanquishes-depression-within-hours
Ziegler, M. (2016, December 2). Ketamine: A transformational catalyst. MAPS. https://maps.org/news/bulletin/ketamine-a-transformational-catalyst/

Back to Winter 2022 Newsletter

Fall 2022 Newsletter

Dominique Yarritu (DY): Tell me a little bit about what brought you to being a therapist.
Perry Clark (PC): I was in a place to be ready to receive the message from the universe to go study psychology. I made the move in a few months over 10 years ago.

DY: Had you had experience with therapy before or was it something out of the blue?
PC: In high school I was part of peer counseling. Although I did have some of the concepts down, I wasn’t ready for it. Others could see those qualities in me but I was not emotionally and mentally ready yet for what I do now.

DY: What made you choose the Institute of Transpersonal Psychology (ITP)?
PC: I have dyslexia, so I needed a place that would not require a thesis for graduation. Writing is not something I enjoy doing; I do it because it’s necessary, and if I do, it’s got to be planned out, to be very focused because it exhausts me. ITP didn’t require a GRE either. I liked the spiritual bend to it compared to the scientific evidence-based theories that we see at so many other schools. So I’m trained as a transpersonal psychotherapist and I slip that into my work as much as I can.

DY: So tell me more about transpersonal therapy.
PC: It’s looking at and including the essence of our connection to spirit or the universe in its many forms: I’m talking the universe, god, or ancestors. I tend to be dynamistic and consider all the seen and unseen connections influencing the situation. So for any client coming in, what are the obvious and unseen things that are influencing them? Having a demanding job or boss is one influence but equally they have the ghost of the oppressive parent still playing in their head. How are these two things working together or playing against each other?

DY: Is it your only approach or are you more eclectic?
PC: I’m more eclectic and I have a lot of flexibility, which can work against me at times but it means that I’m getting into things that others might not immediately get into; or I may find my way around a defense in a way that others wouldn’t have thought of. I use Brainspotting consistently. Then there is degrees of attachment, of transpersonal, my own version of narrative, some solution focused, and how family relationships impact the client now.

DY: So, when did you start practicing?

PC: I graduated ITP in 2014, did my internships, took 2 years to pass the licensing exam (due to the learning difference), and once I had passed at the end of 2018 I started my practice in 2019. So, 3 years of private practice and most of it during the pandemic.

DY: Tell me about starting your practice during the pandemic and what type of clients/patients came to you?
PC: During that period I encountered a number of clients I ended up firing: many of them with the qualities of personality disorders, either narcissism or BPD. I tried to refer them out to the dialectical behavioral folks but ultimately it didn’t go well so I had to fire them. I know lots of people will frown on it but there’s a reality to that. I do understand they need help, I’m just not the one to do it because of my own history. Many of them embodied a lot of the racism we saw come up during the election period. People said that having more exposure to POC is important for growth. Great! What does that mean for us, as POC? What price is being accounted for us? I thought and felt: “I’m not the one to rescue you, you’re doing actually more harm to me than I can help you because you haven’t gone past from what it is that is holding you in that place. Or you don’t have an interest in getting past that place”.

DY: How is it for you being a therapist of color?
PC: It’s a very tricky place to be, not including dealing with my learning disability/neuro-diversity. A lot of things are not set up to account for that; there were obstacles along the way. I understand some methodologies exist as gate keeping but there are ways in which they are inherently designed to keep some people out. In many ways the system keeps many people of color out, too. Then there are the particular philosophies of therapy: how many of them were developed for people of color verses Bob and Jane of middle America? The way I practice is sort of what I learned, what I know is not working, how I build the parts I know need to be there for other POC and LGBT, because there are a lot of things that unwittingly are still tied in “isms”. In that case how do I change it or stop using it in my practice?

DY: So what I’m hearing is the way it’s been practiced and/or used can be both healing and really damaging, which we may not be aware of.
PC: Exactly, and to use the metaphor of biological medicine: a surgeon knows that they’re using the scalpel to slice through the skin, muscle, tissue; they’re very careful to avoid major blood vessels and arteries and that takes time for them to learn that. But what happens when they’re not paying attention or they’re malicious, it’s easy for that to get damaged, for nerve damage to happen.

DY: I saw that a big part of your practice is versed in social justice as well as work with the LGBTQIA+… and I’m interested in your work with men.
PC: I have worked with men who came to me through domestic violence issues saying “I’m not the bad guy”. There’s a bias in domestic violence: “male is always the perpetrator, female is always the victim.” But people shift when I ask “what happens when it occurs in a same sex relationship?” “What happens in a nonbinary relationship?” Yes, there’s a man who’s the perpetrator but there’s also a man who’s the victim. There’s a woman who is the victim, there’s a woman who’s the perpetrator. So, it ceases to be about sexes and it becomes the human characteristics everyone holds, which we have not acknowledged. As we’re trying to rebalance our relationship with men, another untold mechanism is the expectations wrapped up in a binary paradigm as opposed to seeing it as a human characteristic. Somehow, it’s perfectly ok for a man to be the house person but there is still so much judgment about it, which also comes from women. And that may explain why they wouldn’t sit with a female therapist.

DY: So when you have these conversations with them, what happens? How do they shift?
PC: It’s the feeling of being more ‘humanized’ as opposed to being in the ‘masculine box’. As a gay man part of the LGBT community, I’ve had to deal with the question of my masculinity, where does it sit, where’s the femininity in this, where is the nonbinary, accepting that there are certain life expectations that I’m never going to fulfill or have accepted that I’m choosing not to fulfill and I’m not less than anybody because of it. “It’s ok for you to be this way”, I always say to men and boys “it’s ok that you cried”. The question is not that you cried, it’s “who did you cry in front of?” Was this the same person who was going to recognize and validate your vulnerability or shut it down because they were uncomfortable with it? That’s a recognition that is not encouraged.

DY: What other issues do men bring to you? What do they come for?
PC: A lot come for symptoms of anxiety or depression or they feel confused, disconnected and numb. There are multiple reasons: from the standpoint of the over involved or neglectful parent who want them to be a certain thing, or live vicariously through them. There are differences in relationship statuses such as non-consensual polygamy or polyamory; how they grew up in an environment where religion pushed them away because this other form is non-functional. However, men come for the same issues [as women], it’s what triggers them that’s different. It’s moving through shame for having been vulnerable, for example. One of the best ways to associate it with is how we use language and how tough became synonymous with invulnerable: that is far from the truth and one of the deeper notions that men have had to move through. There’s a well known African saying that it takes a village to raise a child and that the village is there to nurture that child. And in the same vein, if the child doesn’t get nurturance from the village, s/he is likely to burn it down to keep warm. So what have we nurtured for men, what have we nurtured for their role within a family?

DY: What about the LGBT population?
PC: Most of the time, it’s dealing with a lot of “isms” like homophobia mixed with racism, misogyny and body image issues too. Also the idea of the stereotype of the male who should be flamboyant and hyper masculinized or hyper femininity rather than seeing people as humans with variety. Any way I say this, it might come out negative but I’ve noticed that we have a strong push for trans, which is great, and there’s definitely a need there, but we’ve come to forget about the ongoing struggles for many in the LGBT community. We’re only now coming to a point when it’s more acceptable to come out. Yet, there are still a couple of generations that are late coming out and we’re still needing to deal with what it means for them to be gay or lesbian. That hasn’t gone away and it’s getting lost in the push for trans. When I work with trans, I’m here to work with them as they integrate their trans self into the rest of their life. Working with what it means to deal with sexual harassment, what it means to see the world from a masculine standpoint of view, and what it means to integrate that.

DY: What do you do outside of the business?
PC: I run a podcast called Untying Knots: Mind and Souls Untethered that focuses on mental health, is BIPOC-centered, dealing with more of the geek and nerd environment, dealing with men, LGBT issues, spirituality, and kind of the intersectionality of that. It’ll be a year next month. I also do a lot of social media around this. I listen to podcasts (reach out to Perry for the list). I was invited through LinkedIn and after realizing that the request was not a scam, I was happy to offer something that was really at the intersection of where I find myself.

DY: I heard you mentioned earlier that you went to Comicon.
PC: Yes, I went there as part of two panels presenting there: one on supporting BIPOC, the other on supporting LGBT and neurodiverse. This was an item off my bucket list.

DY: Is there anything you’d like to add.
PC: I’d like to encouraging more people to recognize the amount of stress that BIPOC and people in the LGBT community are still going through even now with the whole issue of monkeypox, which is bringing up a lot of concern, trauma for those who survived the aids crisis, let alone those who witnessed that crisis, I grew up during that crisis, so we’re seeing a lot of “isms” at play here. Otherwise, listen to my podcast.

Perry Clark grew up in Santa Clara, Ca, and is a Licensed Marriage and Family Therapist. He graduated from the Institute for Transpersonal Psychology in 2014, with an MA in Counseling Psychology. After receiving his license he opened his private practice, “Untangle and Grow Counseling'' in 2019. In early 2021, Perry became a Certified Brainspotter Practitioner, and has plans to become a consultant in the future. In the Fall of 2021, Perry launched his podcast “Untying Knots: Minds and Soul Untethered'' to discuss topics around the intersections of mental health, nerd & geek interests, creativity, LGBTQ+, neurodiversity, men’s health, and spirituality from and for BIPOC communities who share these same identities with Perry.

Fall 2022 Newsletter

Back to Spring 2022 Newsletter

by Dominique Yarritu, PhD, LMFT, SCV-CAMFT President

Hi, Kalpana, it's a pleasure to interviewing you for our next community focus. Let's start! When did you start practicing?

I started practicing in 1995, so about 25 years ago, and it is my second or third career, actually. I had a brief career in R&D in a software company in India before I came here. I studied biology here and then moved to counseling psychology. (laughs) It’s a bit of a travel plan, yes!? Since graduation from Santa Clara University and licensure, I’ve been mostly working in independent practice because that’s what worked, you know, with raising my little children at that time. So, I used to work part time.

Tell me a little bit about your path, what brought you to therapy?
I think a shift in moving from a highly privileged family to striking out independently; to kind of give up all that privilege was a scary transition and I had nobody to talk things over with. And the whole profession of therapists was unknown in India at the time. They had either psychiatrists or, you know, friends. They didn’t have psychologists who were doing this kind of work: you had to be much more ill, you didn’t have supportive psychotherapy. So I felt it quite acutely and went through a period of a lot of difficulty in that transition moving from India and being on my own in the United States. So when I found out about counseling psychology, I went like “wow”, this is exactly what I’d like to do. It was the wrong financial decision, absolutely wrong financial decision, for a recent immigrant to kind of go this path, but I had a lot of support from my partner, my husband, and so it took a long time, that’s how I got here.

So you become a therapist. What is your approach to therapy… I know that you have different interests, right?
Yes, so… I have a psychodynamic/systems/attachment and attachment aware and trauma aware approach. And I definitely use a very systems lens in terms of placing the person in their childhood, in their adolescence, to have the image of who they are in that family even in their adulthood. I like to have a good history. Now that I’m thinking about it, my father was a neurologist and his idea of getting a good history was something that I always carried in me.  And to me, even the act of the clients telling their history (is part of the therapeutic process). I’m quite active in the first few sessions, asking people more questions than they’re used to… I’m not a silent therapist, I’m a very active and engaged therapist… so, that’s a bit the kind of theories I use.

So, when you say you use a psychodynamic approach, is it more Freudian or more Jungian?
I guess definitely more Jungian… If I had to pick between the two, I would pick Jung. I like to be aware of people’s spiritual beliefs in the way they think of themselves in the world, the way they feel connected to people, in some ways what they consider sacred. And I find that speaking of what they hold sacred gets people into a very different plane… even if they don’t know the answer.

Do you use this approach also with couples or do you use for example Gottman or something similar?
I don’t use Gottman, but I use Internal Family Systems: I use some of that, which is the type of therapy I received and it’s a very quick way to get people to take responsibility for their own stuff. In IFS, you are working with your whole system of internal parts: which is the part that comes out in that neediness between you and your partner, which is the part that gets really agitated and definitely needs attention from you. So you can tell your partner: this is the part of me that’s needing this. That way you’re not only projecting on the other and wanting the other person to care of your needs: you become aware of the space between the two of you, you can be more available for it, while managing your own needs.

You said you’re very active in the first few sessions... and then what?
And then it depends on the couple or the individual client. I only work with adults. Once they feel like I got them, with some couples I don’t say anything and just wait for them to start. With others, I’d say, “what needs attention, today?”  I don’t think in that way I’m fully psychoanalytic and letting people feel their tension and what’s unconscious in the room. Yeah, that’s sort of my style. I’m very engaged.

Yes, I can relate: I am learning more about Kleinian psychoanalysis and I am not sure I can stay quiet in the room.
Well, it does depend on what your client is waiting for. There are people who want to use the space to be very introspective and see what comes up. 90% of my clients are not like that. They’re coming to me with very clear things they’re dealing with; they’re not there for the luxury of ten years of lying on the couch. It’s a more immediate thing, maybe between the couple, or something else for an individual, or many people, it’s a process of getting to know themselves better. They and I don’t have the luxury of unlimited time. … sometimes, plain talk is important too… people need to hear that what you’re dealing with your family of origin… you need to step out of it and see. It can be life changing to see the whole picture.

Another area of my specialties is working with gifted people. With them, therapy is going like that (gestures a fast movement and laughs). They make these connections much faster. A lot of the teaching to be a therapist seems to hold people like in a very much, very delicate… you don’t want to offend or upset. I agree that words coming from a therapist are very powerful and you need to be careful. But that plain speaking suits the kind of system thinking.

Do you think there’s something else about your work that you’d want people to know about?
Hmmm… I work with the nerdy girls. Women in tech: working at the intersection of misogyny and racism, especially. For all this talk in the tech world, I don’t think they’re really propping up their women and it’s still a very male-dominated, bro culture that’s hard to break into even if you’re one of the super achievers. And it’s keeping women out of that world where there is money and there is power. So, I really enjoy my work with the nerdy girls.

So how does these situations present in the therapy room?
Sometimes depression, just this sense that they’re really wondering what they don’t get. So, the men will get a pass for some kind of behaviors that the women don’t get a pass for. Especially if it’s already reflected in their family of origin where they’re not supported in the ways that, it gets unbearable when the work culture is putting them down, too. So, it presents as depression and hopelessness about the world.

I remember when we first met we talked about DEI, you were very interested in the chapter’s efforts to create more space for diversity, equity, and inclusion. I think it’s something that is close to your heart. Would you like to say a bit about how it shows up in your practice.
I think living in the Silicon Valley, we’re really privileged. We have, in spite of all the racism and misogyny that exists, still a lot of room for growth, and people are interested in new ideas and want to incorporate fair practices. I think young people are more awake and they are going to be less and less tolerant of the old ways. I do some consulting work with other clinicians about some of the family dynamics they are seeing in their South Asian clients. I make room in my work to have discussions on racism and its impact on my clients, including processing feelings of shame and internalized racism.  

Should we talk about your book?
Yes! So, I wrote that book because of what some of my clients were telling me… so this is already a population that is naïve about therapy, like it’s not a culturally familiar way of getting help. So, they’re already stacked against therapy and if they go to a therapist who asks them something very obtuse about their relationship or about being in an arranged marriage, they feel a lot of shame having to explain this and they feel some judgment whether it exists or not. And if they meet a culturally not competent therapist, they just shut the door on therapy. They don’t know enough to think ‘I should try another therapist and another therapist’. So when I began to hear more about that, I thought I should just write about five, fifteen categories that often come up in therapy that would be easy to read (not a fat book of lots of research and theories). A lot of it comes from my own experiences, my friends’, some interviews, and I don’t think I went into enough depth in any one topic, but I try to give people an overview in a very quick way. It is actually a primer on working with South Asian culture.

It all got started when I wanted to publicize to the South Asian community ‘please, don’t send your children off to be raised by your parents for one year or two years’ because I was seeing firsthand how important that disruption of the attachment process was; they just viewed it as children, babies can easily be reared there by their own parents, not as a disruption. So that’s what I wanted to convey first to the South Asian community and I wrote that in a small little opinion piece in the San Jose Mercury News, then continued to write more about it until each of these topics became a chapter in my book.

So you started to write the book as individual pieces for the Mercury News?!
Just the first one, and then I wrote them as separate essays on different topics that I thought were important and significant to the South Asian community. Including about friendships, how friendships are the replacements for the family and people go through a lot of grief when friendships break apart: it feels as intense as a family relationship breaking up.

Yes, I learned quite a bit reading your book, though I haven’t finished it yet. It’s fascinating.
Good. It is a very different culture. There is a lot of, you know… thanks for reading it!

In my own work with South Asian patients and observing some of my friends, I have become well aware of the striking difference in the dynamics of the relationships within the family. And you really have to have an insider’s eye to start making sense of it, or as someone of a different culture, it’s essential to inquire how things are done in that culture.
Yes, I think you can’t say ‘why don’t you speak to your father and tell him how you feel?’ And yes, for example, the wedding is not about the couple: it’s about the parents’ families. They’re invited because you have obligations: you’ve gone to all of their kids’ weddings, so you have to have them at your kids’ wedding. It’s not a one-way street, it’s not like you take a gift, and you’re done, you know. It’s about cultivating these relationships and keeping it going for a long time. In any case, I have taken a hiatus from writing but I am working on various ideas for a future book. At the moment, I am thinking of getting the audio book ready for this one and I’ll go back to writing. I have a volume of poetry also ready to publish again. So it was interesting how you chose the poem about the warmth in the car about the kid saying I love you. Why did you pick that.

You know, it’s a good question. I don’t remember clearly but maybe because it was winter so this idea of warmth felt really important. In hindsight, it’s mostly the part ‘I love you mama’ that really got me. I think there’s this time of the year when it’s a lot about love, being in your home where it’s very cozy, and warm, it’s cold out and you’re with people you really love, that’s what I wanted people to read. (share).
It was a good surprise.

I really love your poems. When did you start writing poetry?
As soon as I finished writing that first book: I began to write poetry. I was in a rush to finish that book because I couldn’t wait to get started on poetry. That’s the first time I’ve ever written. I’m not a trained writer but I joined a writing group that has been amazing. I need to find a flow space to write poetry. It’s only when I can relax that I can write poetry, so…

You most probably need to create a very sacred space to write poetry and to write in general.
Yes, good catch (laughs).

How do you see all of these experiences intersecting with therapy? How do they all fit together.
I think they’re all meditative experiences that allow room for unconscious awareness, to pay attention to your unconscious. So if you’re meditating or you dream, and you dream of your clients, and you are aware of that dream, you’re carrying some kind of burden for them whether that’s right or not; that feeling of being in touch with that.. writing allows me to be more in touch with how intense those experiences must be for the couples I work with. Or if I write about someone mourning the loss of her mother or father and I’m just more in touch with how powerful it was. You’ve got to get into a zone to write, to write poetry you have to be more in touch with yourself, and to be really present with your clients or patients, you have to be really present. That’s for me the intersection: it feels like a flow space.

Yes, I really like the word you use of “presence”. I read somewhere that the greatest gift one can give is presence. Thank you, Kalpana, for sharing all of this with us.

Kalpana Asok has over 20 years of experience working in her independent practice in Silicon Valley, specializing in individual and couples therapy, parenting, and career growth for women in tech. She is also a recently published author of Whose Baby Is It, Anyway? Inside the Indian Heart; and Everyday Flowers, a volume of poetry, both published by ipbooks. She can be reached through her website at www.calmtherapy.com. 

Back to Spring 2022 Newsletter

Back to Summer 2021 Newsletter

Interview with Dominique Yarritu, LMFT, President Elect

Rev. Connie L. Habash, MA, LMFT, is a Licensed Marriage and Family Therapist, yoga & meditation teacher, Ecotherapist, Interfaith Minister, and author of Awakening from Anxiety: A Spiritual Guide to Living a More Calm, Confident, and Courageous Life. Over the last 28 years, she has helped hundreds of students and clients overcome stress, anxiety, depression, and spiritually awaken. Rev. Connie is committed to nurturing a heart-centered spiritual community. She leads online programs worldwide, as well as retreats, workshops, Ecotherapy sessions, and yoga teacher trainings in the San Francisco Bay Area. Discover more at her website: https://www.AwakeningSelf.com/ or on Facebook https://www.facebook.com/AwakeningSelf

Would you like to tell us about your practice and where you graduated from?

The whole journey started at JFK; I took an extra year to finish my master’s while I was working, and then had my traineeship with JFK at their Transpersonal/Holistic Counseling Center, which sadly doesn’t exist anymore, but was an amazing place. I was fortunate to have a number of excellent internships, from grief support services to an alternative high school, and eventually private practice. I was licensed in January 1999 and have been in private practice since then in Menlo Park and Redwood City. Right now I’m online and outdoors.

What made you decide to become a therapist?

Probably similar to many other therapists: I wanted to heal myself. I wanted to understand what caused people’s suffering and what would help them find happiness, overcome depression or fear, anxiety. I didn’t have any idea I would be a therapist. I thought ‘no, I definitely don’t want to be a marriage and family therapist’ [laughs heartily]. And then life happens and you end up doing that! I knew I wanted to touch people in a deep and meaningful way. I was a spiritually oriented person as well back then, so I knew I wanted that to be incorporated into the work that I’d do: that we’re not just physical and mental beings but we’re spiritual beings too.

What came first? Being a Reverend or being a therapist?

Therapist came first although right at the time I was starting to do my first traineeship, I began to teach yoga. The more I dove into yoga and yoga philosophy, the spiritual aspect of the practice and life became more important to me. So I attended an Interfaith Seminary and became ordained in 2012.

How do these two disciplines interweave in your practice?

It absolutely comes into play every day of my life. First of all, Interfaith Ministry is really honoring the many different paths that one can take to connect to something greater than them, whatever we call that God, Spirit, the Creator… I call it the Divine. I studied many different spiritual traditions; part of what I do is I support what resonates with the client, what their spiritual path is. There’s also the aspect of my own inner work as a therapist, that I deeply trust in higher guidance for the client especially, and for myself, to help me be more effective, to connect more deeply and meaningfully with the client.

What do you like most about your job?

I love being fully present with someone, in the moment, and in that simple and yet challenging practice of being really here, right now, beyond our thoughts and reactions there’s so much depth and there’s so much connection. When we’re fully present with one another, love is naturally there. Aliveness is naturally there. Peace is naturally there. And what needs to arise spontaneously arises in that moment.

What do you specialize in? I know you’ve written a book, or more maybe?

Certainly spiritually-oriented clients. I work a lot with stress, anxiety, and worry. That’s the topic of my book, but the book is also about awakening through that, through these very challenges. I also work with people who are very connected with nature. And that’s partly why I do ecotherapy or how I got into that a couple of years ago.

Yes, so tell me about ecotherapy. I’m very, very curious.

I see ecotherapy as the process of healing and growing with and through the support of nature. You can actually do ecotherapy online but of course it’s most potent, powerful right out there in the beautiful redwoods where we live, or the oaks, or the parks.

What brought you to ecotherapy?

About 7 or 8 years ago, I wanted to connect more deeply to nature, also to overcome some of my fears about nature. There’s this deep attraction to being out there and then—fear for safety, of what could happen, right? It’s wild. So I started taking courses with an organization called 8 Shields as the beginning of my deep nature connection journey, and realized the power and necessity of nature in our healing: we have become a society disconnected from the planet that we not only live on but also depend on, that it is our source of sustenance and life in a body here.

As I explored and journeyed into it further, I realized the many gifts and blessings that doing work in nature gives us. There’s a lot of scientific research about forest bathing and about the benefits of being outdoors in nature to our immune system, to our emotional and mental well-being. It reduces stress, alleviates depression, and creates a sense of happiness and well-being.

There are a lot of powerful metaphors in nature: what better teacher to be able to really feel solid in and centered in yourself than a boulder or to be able to really stand in your strength next to a redwood or an oak tree? Or to be able to appreciate every moment when there’s always something happening.

We incorporate magical synchronicities and metaphors into the work which becomes very alive, rich. I like being out in the fresh air and in the beauty more than in the confines of an office. An office can be a very sacred space, but to me there’s nothing that compares to being outdoors, even in the rain: it can be magical and revealing and different animals show up in the rain than when it’s not raining.

You can also do art out in nature, very readily. Leaves and twigs and all kinds of things that you find there: the ground, flowers (I try to not pick things that are still living) to create a work of art that’s meaningful in the moment. I think it connects us in our sense of oneness, that we’re not separate from nature, from this planet, that we’re part of it. And when you immerse for a while, you begin to feel that in your bones.

Do clients come to you for talk therapy and you introduce ecotherapy? Or do they seek you out only for ecotherapy?

It’s been both. Some people find my website or are on my email list and they find out I’m offering an outdoor group. Other clients have been coming to me for a little while and I say ‘you know, I have a feeling that today it might be really helpful and reveling to step outside the office into the garden outside the office and see what might arise from that’ and I explain a little bit what ecotherapy is. The latter have been very profound sessions.

Have you had clients say ‘no, it’s really not my thing’?

I’ve had clients say ‘not yet’, like they’ve been intrigued by it but ‘I’m not sure I’m ready for that yet’ and that’s fine, you know, they don’t have to do it, but I let them know that it’s an option. Usually, I’ll offer it to those from whom I get a sense that they connect with nature and that it’s important to them.

You said you do groups? Do you use specific rituals or do they have themes?

Yes, sometimes they do. I do retreats: one day and weekend retreats. Currently, I’m doing a monthly morning in nature that I call the “divine nature community”. Usually we start out with a circle of gratitude: we share our name, what we’re grateful for, we have a few minutes to connect to the land around us, and to give thanks for it. To honor the ancestors before us and to just take in what we’re experiencing through our senses. They’re practices of mindfulness: I call them presence. I introduce a bit of yoga and then we all go out on the land, on a moderate hike, deep nature connection practices, and exploration. I encourage a sense of community and that what each person receives from that day can benefit all the others.


How long roughly is a day or morning.

Those are 2.5 to 2.75 hours but then I do day longs where we’ll do more yoga and more time out on the land and some solo time as well as time with the group. Same with the weekend retreats. We’ll have circles in the evening where we’ll share and deepen together as a group with all kinds of exercises outdoors and indoors.

What do you think of ecotherapy in post-COVID times?

I think it’s vital. I think it can deeply heal us from this sense of isolation, disconnection, and anxiety. I mentioned earlier some of the scientific studies: there are microorganisms in the forest that increase a sense of wellbeing, so you don’t have to deeply reflect, you can just sit out in nature twenty, thirty minutes and feel a sense a renewal. It’s part of my daily practice: every morning, I go outside, I sit maybe for 5 minutes on days I’m very busy, and close to 20 to 30 on days when I have more time. Just sit and be present with everything happening.

Is that your self care?

That is definitely part of my self-care and in the afternoons if I have time, I’ll just go and lie down out there. And then, I like to go on hikes and into the various forests that we have around here: we’re so blessed to live in the area we do. I could spend the rest of my life exploring them here.

Yes, it may sound corny but it’s like going to visit a friend. I take my dog for daily walks in my neighborhood and it’s fascinating to see how almost overnight, the trees are blooming. By going there every day, I definitely witness consciously or not, the changes that are happening.

It’s delightful. It awakens delight within us, to see that life comes forth every spring, right? And aliveness. Every time I notice new things, there’s always something to explore, to see, to hear, to learn, of the different birds I’m hearing. Who are they? Where do they live? And what are their behaviors. It’s just like cultivating relationships: when you get to know people, you find out all these amazing things about them.

Do you know this book titled The Spell of the Sensuous”? It’s a beautiful ode to nature.

No, but you’ll have to tell me about it. I’m currently reading Forest Bathing by one of the first proponents of forest bathing in Japan, Dr. Qing Li. So, yeah, there are so many amazing and wonderful books out there to read about it. Another one I’m reading, called Adventures in Opting Out, is about opting out from the traditional lifestyle to a path that you feel called to. Her first book was The Year of Less, and it was all about how she gave away 75% of her possessions, lived really simply, and went through a personal healing process. It was fascinating.

Is there a quote that you think of that you like in particular? That is really with you…

Trust the process. That is the mantra for my life and my work with my clients. They hear me say a lot that I trust the process of therapy, I trust the process of my life, and the process of what I would call the Divine. Of course, [laughs] it’s easy to trust the process when it’s smooth, but sometimes, you know, when we’re hitting the speed bumps, turns in the road that take us in directions we didn’t expect, things might be scary or challenging. But I really trust the process that everything is happening for our highest good, ultimately, eventually and/or, however you want to look at it, everything is a gift, everything is an opportunity.

I couldn’t agree more. It’s very Jungian! You’re speaking my language!

Ecotherapy is so perfect for Jungian-oriented work because everything is a symbol, something showing up from your unconscious, or from the collective unconscious, that’s emerging from the earth there. Jung spent a lot of time out in nature. So yes, it goes very well with that orientation.

Is there an author or someone in particular who has been very influential in your professional or personal life?

There are many. I’ve had a number of influences in my life over the years. I think Leonard Jacobson is a great teacher of presence. He’s who I learned this from and his books, particularly his book Journey into Now, have been impactful for me. I love that it’s clear and it’s simple, and yet very profound. He likes to say ‘you’re either present in the moment, which means no thoughts, here, or you’re dealing with what’s getting in the way of being present’.

Fully present to me is fully living our lives, you know, this is what we have now… we don’t have the future right now, and you can’t go back to the past, so let’s make the most of what is now.

Thank you, Connie, for your time and for opening a window onto the practice of soulful ecotherapy.

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