Online Therapy Questions and Answers

teletherapy

Online therapy is the method most therapists have turned to during this pandemic. Whether you are dealing with mental health issues, or any struggles caused by COVID, talking to an online therapist can help you through these challenging times and improve your overall well-being. Long before corona virus started, Dr. June and her team have used tele-therapy to help a lot of clients. You may be interested in learning more about this medium of therapy. Have questions about online counseling? We got answers for you. 

Is online therapy effective?

You may be skeptical about the effectiveness of therapy behind a screen or through a phone. Research has shown that online therapy can benefit people in the same way as it does in therapy in office when it comes to cope with mental health issues such as depression, anxiety, and adjustment difficulties, post-traumatic stress disorder (PTSD). Through these digital mediums, Similarly, CBT (cognitive behavioral therapy) through video therapy was proved to be as helpful as in-person therapy in treatment for anxiety and depression. A simple answer to the question, online therapy is as effective as in-person therapy.

How does video therapy work?

Tele-therapy through video calls, or video therapy, may feel the most similar to in-person interaction with a therapist. Video calls simulate face-to-face interaction and, in a time where social isolation is prevalent, this may help to produce a feeling of normality to a client. Meanwhile, video therapy has the benefit of showing your face without a mask. This helps the therapist to see the biggest portion of your body language to detect your feelings. 

What mental health issues can tele-therapy help me with?

Tele-therapy can help to deal with almost all issues in-person therapy covers such as,

  • anxiety in various forms such as generalized anxiety, social anxiety, OCD, PTSD, panic, phobias
  • depression
  • stress
  • anger issues
  • trauma
  • eating disorders
  • emotion regulation
  • relationship issues
  • loss and grief
  • adult ADHD
  • teenager struggles with mental health
  • couples therapy
  • family therapy

Is online therapy confidential? 

Naturally you may be concerned about the confidentiality of your online therapy. Make sure you use HIPAA compliant platforms besides the regular assurance therapists promise in therapy in office. The U.S. Department of Health & Human Services has compiled a list of platforms that are HIPAA compliant. The top 5 platforms are:

  • Zoom for Healthcare,
  • Doxy.me,
  • Simple Practice
  • Thera-LINK
  • VSee

Dr. June and her team use Zoom for Healthcare to ensure it is HIPAA compliant and protect your confidentiality.

Can we have online couples therapy? 

Yes, online therapy can benefit couples as well. When couples live in the same house, sitting together and communicating through a singular device can simulate an in-person therapy session. In fact, having to sit closer together for visibility on the camera may even make the couple feel more connected during the session; physical closeness can indicate how emotionally in touch partners feel with each other. This closeness can be important for experiencing “eye-contact and physical touch” during the session. 

In particular, online couples therapy seems more convenient and beneficial if you are in a long-distance relationship. Tele-therapy gives these couples a platform to receive therapy even though they are geographically separated. Although they cannot sit next to their partner and benefit from the physical closeness, online couples therapy may increase their understanding of each other and themselves. Clients can “see not only their partner’s nonverbal behavior, but their own as well,” through the device’s screen. Clients are able to experience what they look like from their partner’s point of view; this may help the partners work on their own “maladaptive behaviors” and better understand the other’s perspective.

How do I pay?

You can make payments online for tele mental health. This can be accomplished using a credit card or other types of electronic payment transfer. Square and Ivy Pay seem to be more popular credit card platform among many therapists on tele-therapy. 

Are there any differences between online and in-person therapy?

Understandably you may miss the cozy and private space in your therapist’s office. You can pour your heart out and share your feelings freely with your therapist. Not being in the same room as your therapist during your session seems to be the most glaring difference between online and in-person therapy. Video therapy is a way to recreate that same face-to-face feeling. Besides, some people may feel more comfortable sharing their emotions behind a screen, which might help them convey their deeper thoughts more readily. Although most therapists prefer being in-person to observe a client’s cues and body language more clearly, video therapy still allows for the client’s face/ facial expressions to be visible.  

What are the advantages of online therapy?

  • There is no more commute from your office all the way to your therapist’s office, which means you don’t need to worry about being late for your session
  • No risk running into a co-worker in the waiting area outside of your therapist’s office
  • You can sit or even lie comfortably in your own couch to talk to your therapist
  • It is convenient even if you have to travel out of town 
  • If you have social anxiety or agoraphobia, tele-therapy could be a better option for you to initially manage your fear of talking to your therapist’s receptionist.

I live in a small apartment with roommates or a partner in NYC, what can I do?

  • Communicate with the people you live with about your privacy concerns.
  • Ask your roommate to go on a walk during your 45-minute session,
  • Ask them to put headphones on while you are talking to your therapist.
  • You can use headphones during the session; this will make your therapist’s voice only available to your ears.
  • Play a white noise machine or app to help mask the conversation from other people. 
  • Type your questions or responses on the Zoom screen if you have to

How to prepare for my online therapy session?

  • Find a quiet, safe, and private place to talk to your therapist. 
  • Ensure stable internet access and a charged device to speak to your therapist will make your experience in your session run smoothly.
  • Put devices in your house on silent or low volume to minimize distraction.
  • Do what makes you feel comfortable – wear comfortably and sit in your favorite fluffy chair, in your car, or even lie in couch.
  • Prepare some tissue just in case you may need. Have water or coffee in front of you.
  • Have a pen and paper (if you still use them) or simply your phone ready to take notes in session

Dr. June and her team aim to provide the best online therapy experience you are looking for. Call us free for 15 minutes and book your session. Your online therapy session is hopefully bringing you one step closer to achieving your most successful and happy self. Be proud of yourself for looking to support. Good luck with your online therapy experience.

LSpecial thanks to the contribution of Victoria Gallo, B.A. in Psychology from The College of New Jersey.

How to Fight Depression Without Medication?

fight depression

When we all have to use self isolation to protect our health during this quarantine time,  depression is reported to occur at a higher rate. What does depression feel like? It usually affects our daily functioning and manifests through thoughts, behaviors, mood, and physical symptoms

  • In mood, you may feel sad, agitated, lonely, helpless, and hopeless;
  • In behaviors, you may withdraw and isolate yourself, easily throw temper tantrum, tend to use alcohol or drugs;
  • Physically, you could have sleep and appetite issues, easily feel tired, have low energy level, feel “lazy”, numb, sluggish, and loss of interest.
  • In terms of thinking, your concentration and memory may even be affected. You tend to have negative thoughts like “I’m a failure”, “I am useless”, “No one likes me”.

How to fight depression without medication? Many people found this tool GRAPES helpful to boost motivation and alleviate depression.  GRAPES stands for the following acronyms:

  • Gentle with Yourself
  • Relaxation
  • Accomplishment
  • Pleasure
  • Exercise
  • Social

GENTLE with yourself – Use self compassion

Gentle with yourself, simply put, is to improve self compassion. When you are hard on yourself and use those negative thoughts to judge, criticize, and blame yourself,  it is important to remember, you will not be so harsh to a friend. Therefore, to fight depression without medication, it is essential to remind yourself to change the way you talk to yourself to that  you talk to a friend. You will notice the different tone and choice of words. Such difference can help you to use positive self affirmations such as:

  • I am kind.
  • I love myself!
  • I am beautiful inside and out.
  • I am proud of who I am!
  • This is no easy job but I made it!
  • I will achieve my goals!
  • I deserve to be appreciated!

RELAXATION – Mindfulness Meditation Practice

To fight depression without medication, relaxation is a very important tool. You can practice relaxation almost anywhere. Take breathing exercise for example, paying attention to your inhale and exhale can give you both emotional and physical release. Deep breathing increases circulation, releases endorphins, and relaxes muscles. When you use relaxation to create a mindful moment, you are able to pay attention to what you are experiencing right here and right now. This way, your negative thinking turn its direction when you do not have to focus on the depression negative spiral. You are immersed in the moment, reconnect with your inner strength, and feel the peace and tranquility.

Relaxation is to use mindfulness for depression to calm your central nervous system, clear your mind, and recharge your body. Relaxation may also be taking a nap, reading a good book, taking a shower or a bubble bath, practicing yoga, swimming and feeling the water, enjoying your favorite music, cuddling with your pet, taking care of your plant, sewing, making your tea, slowly having coffee, preparing a meal, having some snacks, or simply sitting under the sun and feeling sunshine warming up your body. You may find some Apps such as HeadSpace and Calm helpful with a few minutes of relaxation exercise every day. Many YouTube videos can also guide you to practice meditation and mindfulness.

ACCOMPLISHMENT – Use an Activity Schedule

Accomplishment does not have to be as big as you walk on the moon or won Nobel Prize. It may be as small as you planned to walk outside and you actually did it. Having a daily routine is essential to fight depression naturally. Making lists or write down a daily activity schedule can allow you to visualize what tasks you actually have to do for that day or week. Even better, you can cross them off! Research shows that by checking something off a list, the brain produces dopamine, the happy hormone, to reduce depression. This could make you feel good with more energy and want to do more. A list can also be made via a mental health or motivation app on your smart phone. Even if it’s ‘brush teeth’ or ‘have a shower’, you’ll start to feel better once you’ve crossed it off.

Set small goals and reward yourself when you accomplish them. When depression drains your motivation, you have to work to create new incentive to replace what existed naturally before your mental health deteriorated. This starts with small and achievable goal setting. For example, your goal could be cleaning out your closet. If you succeed in that, reward yourself by cooking your favorite meal or watching an episode of the latest TV show. This process of small accomplishments and rewards will help restore your motivation. 

PLEASURE – Focus on your Hobbies

Depression may feel like depriving fun out of your life. What you used to enjoy doing may not sound appealing any more. Pleasure is about having fun and joy again. Encouraging yourself to plan something fun to do is a good start. Many activities can bring you pleasure, Dancing, listening to music, coloring, gardening, watching a YouTube channel, reading, eating gourmet food, having sex, cuddling a pet, and enjoying a hobby. Music for example, has been found to reduce symptoms of depression in many research studies. It can boost your mood and make you more aware of your emotions overall. This is said to be done as music releases dopamine, a chemical which increases pleasure. 

EXERCISE – Natural Antidepressant

Exercise as a treatment for depression has been highly recommended because research evidence has shown enough support that beating depression with exercise proves viable. Combining exercise with antidepressant medication is also considered an evidence-based treatment. Exercise does not have to be at the gym, especially during the COVID pandemic when gyms are mostly closed. It is simply “get moving” when you can keep social distance. This could be from the bedroom to the living room, going for a run, or taking a walk outside, whatever you feel you are capable of doing.

When you struggle with depression, one of the biggest challenges is not wanting to move from your cozy cocoon called bed. You have made it your safe haven where you feel comfy and safe but staying there will only demotivate you more. If you can encourage yourself to go outside, the fresh air clear your mind and reset your brain a little. If outside is too much, tell yourself to sit in a different room and open a window. 

SOCIAL – Reduce Isolation

Human beings are social animals and isolation could cause depression. With the continuation of the Coronavirus pandemic, it is not your choice to self isolate, but you might be feeling the social isolation or withdrawal, which can make anyone feel demotivated and depressed. How to prevent a depression spiral while quarantined? This is high time that you use those apps to stay connected, FaceTime, Zoom, Google Hangout, Skype, WhatsApp, you name it. Using FaceTime to connect with a friend or loved one can instantly make you feel less alone. You don’t need to talk about anything important, just a simple chitchat with someone you care about will make you feel more at ease.

When you try all the above strategies and still find it difficult to manage your depression, there is still a great option of talking to a therapist. Our depression specialists use evidence-based therapy approach like cognitive behavioral therapy (CBT) and mindfulness to help you to understand triggers of your depression, manage stress, improve awareness of your thoughts, behaviors, and feelings, and learn coping skills to reduce depression effectively. Call us free for 15 minutes to schedule your online therapy sessions.

Special thanks to the contribution of Alexandra Jame

COVID-19 Virtue Support Group

Many months have passed since we started social distancing, yet the feelings of uncertainty, hardship, and grief continue. Feeling stressed, lonely, isolated, and/or frustrated? It is hard not to when you cannot socialize with your family and friends, when you lost your loved ones from COVID and sadness often wakes you up at night, when you have to face issues of work, family, relationships, and mental health.

We are here for you. Our COVID-19 Virtue Support Group is a source to help you to thrive in this particular tough time! We are here to listen, to support, encourage, and provide guidance. Our group is a safe and confidential place for you to find people with common experiences and concerns, to help each other to form a community, and to have a better understanding with knowledge and skills.

Our virtue group takes advantage of online services via Zoom, makes it convenient for you to be in a comfortable place such as your home, office, car, or a private place wherever you are. Zoom is a free app that is HIPAA compliant and promises your confidentiality. You can use your computer, laptop, tablet, or your phone to connect with our group.

Starting August 15th, the group will meet every Saturday from 3:30pm-4:30pm. Our therapists Baiqian Zhang and Sally Chen will co-facilitate the group. If you are interested, please fill out our Google form. If you have any questions, feel free to contact our group facilitator Baiqian at bz1044@nyu.edu

Body Dysmorphic Disorder Signs, Causes, And Treatment

body dysmorphic disorder

Body dysmorphic disorder (BDD) is preoccupation with the belief that your body or appearance are unattractive, ugly, abnormal or deformed. You feel embarrassed, ashamed, anxious, and depressed about your “flaws”.  You may seek multiple plastic surgeries but still feel dissatisfied to the point that you may even try to hide your appearance or avoid social interactions. Sounds familiar? About 1 in every 50 people may suffer from BDD. Some celebrities may suffer from Body Dysmorphic Disorder. The questions is, do I have body dysmorphic disorder?

Signs of Body Dysmorphic Disorder

  • Excessively concerned or distressed by appearance flaws that others such as friends, family, or doctors tell you are minor or nonexistent;
  • Strongly believe that you have a defect in your appearance that makes you ugly or deformed;
  • Appearance concerns interfere with your work, study, social life, or daily functioning;
  • Believe that others take special notice of your appearance in a negative way or mock you;
  • Have had multiple plastic surgeries or procedures but still feel unsatisfied with your appearance;
  • Believe that having cosmetic procedures will transform your life or fix all of your problems;
  • Avoid social situations。

The most common features and areas people tend to fixate about include:

  • Face, such as nose, eyes, lips, wrinkles, freckles, acne and other blemishes
  • Hair, such as appearance, thinning and baldness
  • Breast size
  • Buttock size
  • Skin and vein appearance
  • Muscle size and tone, or muscle dysmorphia
  • Genitalia

Causes of Body Dysmorphic Disorder

It’s unknown what causes body dysmorphic disorder. Like many other mental health conditions, body dysmorphic disorder may result from a combination of issues. Recent research has suggested that these factors could include

Body Dysmorphic Disorder Treatment

How to treat body dysmorphic disorder? Treatment depends on your symptoms, age, general health, and severity of the condition. Treatment for BDD may include psychotherapy or medications. The best treatment is a combination of the two. Research shows that the sooner treatment begins, the better the chance for controlling symptoms and recovering.

CBT for body dysmorphic disorder

Cognitive behavioral therapy (CBT) is the most effective talk therapy. CBT is to learn how to replace negative thoughts and cognitive distortions with rational thoughts.

ACT for Body Dysmorphic Disorder

ACT, or Acceptance Commitment Therapy, focuses on tolerating thoughts and symptoms, rather than trying to change, dispute, and generate alternative interpretations to problems. Acceptance based exposure therapy has shown clinically significant improvement in symptoms reductions. ACT also increased distress tolerance and self-acceptance 

Mindfulness-Based therapy for Body Dysmorphic Disorder

Mindfulness involves the awareness of being in the present moment, acceptance without judgment, and self-compassion. 

Dr. June and her team work closely with clients to help them to reduce stress and improve acceptance. If Body Dysmorphic Disorder affects you or your loved ones, give us a call for 15 minutes free. We will work with you as a team to help you in this healing journey.

Post Traumatic Stress Disorder (PTSD)

childhood trauma

What does PTSD mean? 

Signs and Symptoms of PTSD

Do I have PTSD?

Understanding PTSD 

PTSD (posttraumatic stress disorder) is a mental health problem that some people develop after experiencing or witnessing a life-threatening event, like combat, a natural disaster, a car accident, or sexual assault. Its major symptoms include:

  1. Reliving the event (also called re-experiencing symptoms). You may have bad memories or nightmares. You even may feel like you’re going through the event again. This is called a flashback.
  2. Avoiding situations that remind you of the event. You may try to avoid situations or people that trigger memories of the traumatic event. You may even avoid talking or thinking about the event.
  3. Having more negative beliefs and feelings. The way you think about yourself and others may change because of the trauma. You may feel guilt or shame. Or, you may not be interested in activities you used to enjoy. You may feel that the world is dangerous and you can’t trust anyone. You might be numb, or find it hard to feel happy.
  4. Feeling keyed up (also called hyperarousal). You may be jittery, or always alert and on the lookout for danger. Or, you may have trouble concentrating or sleeping. You might suddenly get angry or irritable, startle easily, or act in unhealthy ways (like smoking, using drugs and alcohol, or driving recklessly.

 

PTSD Treatments

How to treat PTSD? 

Panic Disorder

Experience of sudden panic symptoms (generally out of the blue, without specific triggers) in combination with persistent, lingering worry that panic symptoms will return and fear of those panic symptoms.

Recurrent expected or unexpected panic attacks AND one or more of the following symptoms for at least one month:

Pounding heart, Sweatiness, Feeling of weakness, Faintness, Dizziness, Tingling or numbness in hands, Feeling flushed, Sense of unreality, Feeling of loss of control or losing one’s mind, Fear of dying or something physically wrong (e.g., heart attack, stroke)

Persistent concern about the consequences of the attacks (e.g. “going crazy”, heart attack) or fears of having additional attacks

A significant change in behavior related to attacks (e.g. avoiding exercise)

Duration of panic attacks: a few minutes to 10 minutes (rarely last longer than 1 hour

Obsessive Compulsive Disorder (OCD)

Repeated and persistent thoughts (“obsessions”) that typically cause distress and that an individual attempts to alleviate by repeatedly performing specific actions (“compulsions”). Examples of common obsessions include: fear that failing to do things in a particular way will result in harm to self or others, extreme anxiety about being dirty or contaminated by germs, concern about forgetting to do something important that may result in bad outcomes, or obsessions around exactness or symmetry. Examples of common compulsions include: checking (e.g., that the door is locked or for an error), counting or ordering (e.g., money or household items), and performing a mental action (e.g., praying).

  • Repetitive, intrusive thoughts or images that cause anxiety
  • Devoting more than an hour a day to the obsessions and/or compulsions
  • Experiencing distress because of the obsessions and/or compulsions
  • Interference of the obsessions and/or compulsions with work or social interactions

Social Anxiety

Excessive fear of becoming embarrassed or humiliated in social situations, which often leads to significant avoidance behaviors.

  • Significant and persistent fear of one (or more) social or performance situations in which the individual is exposed to unfamiliar people, or to possible scrutiny by others due to fear of humiliation or embarrassment. 
  • Exposure to the feared social or performance situation provokes significant anxiety.
  • The person recognizes that the fear is excessive or unreasonable. Note: In children, there may be limited insight.
  • The feared social or performance situations are avoided or else are endured with intense anxiety or distress.

The avoidance, anticipation of, or distress of the phobic object/situation must cause significant distress or interferes with the individual’s daily life, occupational, academic, or social functioning to meet diagnosis. The symptoms cannot be better accounted for by another mental disorder or be caused by substances, medications, or medical illness.

Social Phobia could be generalized, that is, fear is present across any social situations; could also be specific, such as eating in public, public speaking, talking to authority figures (e.g. boss)

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Generalized Anxiety Disorder

Excessive, uncontrollable worry over events and activities and potential negative outcomes.

  • Excessive anxiety and worry about a variety of events or activities, even when nothing is wrong or when the worry is disproportionate to actual risk.
  • The worry is difficult to control
  • The worry is associated with at least three (adults) or one (children) of the following physical or cognitive symptoms:
    • Restlessness
    • Fatigue
    • Impaired concentration or feeling that mind is going blank
    • Irritability
    • Increased muscle aches or soreness
    • Difficulty sleeping (trouble falling asleep or staying asleep)
    • Sometimes associated with other physical symptoms such as nausea or diarrhea
  • The anxiety and worry causes significant distress or interfere with the individual’s daily life, occupational, academic, or social functioning.

Therapy for Toxic Relationship

A good relationship makes you feel secure, happy, cared for, respected, and free to be yourself; on the contrary, a toxic relationship make you feel drained, depleted, and sometimes even distraught. Then how do you know your relationship is toxic? There are many warning signs indicating you might have entered a toxic relationship. 

Hostile atmosphere that makes you feel drained or on edge constantly

Constant judgment, criticism, dismiss or downplay your success that makes you feel worthless or never good enough

Control and manipulation that set you on edge, anxious and confused

Your partner may have too high a standard that makes you feel inferior

Lack of trust that you are forced to constantly prove yourself

Lack of communication and cold wars are usual conflict resolution

Filled with negative energy that avoidance has become the norm

Full of entitlement and lack of gratitude 

Never-ending drama that makes you feel in a roller coaster

Your partner never apologizes or never admits s/he could be wrong.

If you know you are in a toxic relationship and want to make a change, seek therapy from Dr. June to build a good relationship that you deserve.