Dr. Josh Kingsbury

As of the other week I have (finally) been approved with an authority to practice interjurisdictional telepsychology (APIT) through PSYCPACT.  PSYPACT is a compact between multiple states to allow for telehealth across state lines.  The are currently 27 states that participate under this compact agreement.  More states are introducing legislation to join PSYPACT, although this process usually takes a year or more.  For more information and a list of states that are currently participating in PSYPACT, as well as a list of states that are in the process of joining, please see this link.

It certainly has been a long year and a half here at the office.  As you all have, I have been following the pandemic this summer and fall as businesses start to open up.  My hope is that my office will re-open in early-to-mid November.  That is, of course, dependent on how the next few weeks go.  As demand for in-person therapy is still extremely low and due to COVID restrictions on business, the plan right now is as follows:

• I will be offering in-person appointments two days a week
• Appointments will be first-come, first-served
• Appointments will be only every-other hour
• When making requests through the client portal you will have to specify if you would like in-person or not for the appropriate slot
• Both you and I will need to be masked during the appointment
• All in-person clients will need to be fully vaccinated as well
• Of course, you are not required to do in-person slots if you do not wish to meet in person

When I start offering in-person slots, the available slots for in-person will be noted on TherapyPortal.  I will always ask you when you schedule for one of those time slots if you would prefer in-person or not.  If you do not schedule a slot as in-person and show up at the office instead, I will be unable to see you in-person.

There are of course, more facts about this transition.  I will be providing more information about this as we get closer to November.

I’ve recently been going through training and reading for the application of ACT (Acceptance and Commitment Therapy).  It is one thing that was difficult for me at the start to get the hang of.  My brain has always been very logical and sometimes the idea of “just letting go” really hits that aspect of “this doesn’t make sense.”  ACT has been the first time something illogical has actually turned out to be more logical.

In “Frozen,” Princess Elsa sings about letting go of expectations and feelings.  It is a great idea (and I’ll let the parents debate how catch they lyrics are), but it also goes very unexplained.  The song simply teaches us to do it, but not why.

The idea of “just tolerating” a particular feeling or thought runs counter to a lot of the assumptions behind CBT (Cognitive Behavioral Theory).  In reality, they work very well in conjunction with each other.  CBT teaches you how to re-frame and challenge unwanted thoughts.  ACT teaches you that you will not always be able to do this.  Then it moves on to teach you how to accept the uncomfortable feelings and thoughts.  (Acceptance does not mean you agree with them or that you want them, only that you can acknowledge them.)

The biggest challenge with ACT, and where I think it stands out from CBT, is this: you may try something that should be helpful, but that effort may fail, and it is okay if it fails.  For example, you can go to the gym for a month but still not lose weight.   Should you get upset that you didn’t lose weight?  You could, but is that feeling of frustration helpful?   Generally, it’s not.  Doing something good for yourself will not always result in a positive outcome.  Getting swept up in the expectation that you should have a positive result is almost always a recipe for disaster.  If you can re-frame your thinking to be glad that you still put in work to move toward your value (being healthier), instead of focusing on your goal (losing 10 pounds), you will be better able to handle disappointment if it happens.  If I’m always striving towards a value, I’m usually making progress whereas if I’m only looking at goals those are things you either achieve or you don’t.  That is certainly more logical for me than just “let it go.”

If you’re interested in knowing more about the ideas behind this, I’d suggest the book The Happiness Trap by Russ Harris.

I recently had the pleasure of presenting at a conference around continuing education for providers around better work with clients who identify as transgender or gender nonconforming.  As this is one of my clinical specialties, I love to do these kind of trainings.

When I was initially doing my research for this presentation, I was really struck by a continuing theme.  Despite clinicians knowing how valuable it is to LGBTQ clients to have some acknowledgment of our offices as being a safe space, very few of us do it.  This is especially important to transgender clients as they often have had negative experiences in the medical/mental health professions that have sometimes been bad enough that it caused them to avoid seeking further treatment.  In fact, studies have found that only 10-28% of clinicians put up stickers or books to indicate their office is a safe space.  Less than 60% of clinicians have transgender inclusive language in their forms (Gugliuci & Weaver, 2014; Brooks & Gottfried, 2017).

These research findings mean that we can, and should, do much more to help our clients.  I am amazed at how frequently clients comment on the books on my bookshelves and how seeing those lets them know they are in an accepting space.  Acknowledging on your website that you treat clients with concerns around LGBTQ-related issues can also go a long way.  If you wish to educate yourself more, the following are great resources for reading:

• Affirmative Mental Health Care for Transgender and Gender Diverse Youth: A Clinical Guide
• The Gender Affirmative Model: An Interdisciplinary Approach to Supporting Transgender and Gender Expansive Children
• Affirmative Counseling and Psychological Practice with Transgender and Gender Nonconforming Clients

Things have been busy here in the office and I have not had the chance to post in a while.  One of these newer changes has been the addition of a new service!  I now have the ability to do teletherapy (therapy over the internet).  I see this as a way of reaching clients that are not always able to come in to the office due to illness or that live too far away to make weekly visits practical but who would benefit from services.  As one of my specialties is working with individuals who identify under the LGBTQA umbrella I see teletherapy as a way of offering services in areas where a specialist may not always be available.

Many studies have demonstrated the benefits of teletherapy.  While simply connecting with someone online can be helpful, I still value the importance of an in-person connection as well.  That is why the policy for teletherapy involves meeting at least once for a 90-minute intake before allowing the ability to meet online.

After researching many opportunities for hosts for teletherapy, I decided to use WeCounsel as it is one of the only HIPAA compliant options (that means they are up to governmental standards of privacy and ethics).

If you are interested in teletherapy, please reach out to me to learn more.

Now that summer has finally arrived in Maine people want to get out and enjoy it.  Part of enjoying this is the ability to disconnect from our work lives and online lives.  Research has shown that refocusing on areas away from work can be a significant recharge, but that often needs to be a complete disconnect.  This has been a common theme in sessions over the past few weeks.  In particular, people have been interested in how they can use technology to help them achieve their disconnect goals.

Here is a listing of some apps that can be helpful:

Offtime – This app lets you shut off reminders from apps and closes out some apps.  You can still receive/make calls and your phone still functions as a smart phone.

Flipd – This app completely locks your phone for a set amount of time.  Until that time is up, you cannot unlock your phone.  During it however, you can still receive calls and make emergency calls.

Digital Detox – This is the ultimate detox app.  It completely locks your phone except for emergency calls.

Sometimes one of the hardest things to do is to stay focused on a task.  This is even more true when you have a reason to avoid it; fear, discomfort, difficulty.  I certainly know I face this even on small tasks.    I’ve found one of the most helpful ways to work through this is the “face everything technique.”

This is a very simple technique that is relatively easy to practice.  It is also brief and can be applied to many areas.  Leo Babauta described this exercise in mindfulness well.

1. You ask yourself what you are doing
2. You ask yourself what you are avoiding
3. You acknowledge and face the physical discomfort in your body
4. You take action around the task

I remember a client years ago that was finding themselves watching tv all day long.  When we discussed it we noted that they were watching tv because they were so anxious about opening their mail.  They had some medical bills coming due and were afraid of how they would pay the bills.  So instead of confronting the bills they were ignoring everything, even falling behind on their house payments and other bills.

We worked together to explore the fear and discomfort the client was avoiding.  Much to their surprise the client found out it was not as intolerable as they had feared.  We then discussed ways in which to break the task down into workable chunks that would help them gain control of their anxiety.  Day by day their pile of bills next to their door grew smaller. Often we realize that the thing we are avoiding we already have the tools to deal with.  Our anxieties and discomfort gets in the way of us remembering these tools in our tool belts.

This past month I joined many others around the country for National Novel Writing Month.  I set myself the goal to write something, anything, each night.  It did not matter how much, just that I did it.  I am happy to say that I was able to make this goal 26 days out of November.

The whole process got me to thinking about the recent uptick I noticed with clients coming to my office to discuss difficulty with being motivated.  These conversations reminded me of a lesson I used to teach with my Intro to Psych students.  The lesson is very simple, but the impact can be very profound.

 I recently read an article about getting started and why it is difficult to do even when it is a task that you actually want to accomplish.  Many of my clients encounter difficulties around this concern, even when they know they are making a positive change for themselves.  The akrasia effect dovetails nicely with what I notice with my clients and what I already encourage them to do.

If you want to move beyond difficulty with getting started with something, there are three behaviors you can alter to create progress:

• Plan ahead for how you want your actions to look.
  • If you are trying to lose weight and you know you tend to overeat, buy prepackaged food or make your own food and place it in one serving sized containers.
• Make the actual starting easier
  • It is easier to start a project and get momentum for it if you can make smaller steps. Break larger steps down into more manageable ones.
• Schedule your behaviors
  • Planning ahead with certainty makes it more likely that you will do something than if you say you will get to it vaguely sometime in the future.

Being able to do these three behaviors will make it more likely that you will be able to accomplish what it is you set out to do.  Sometimes one of these may be easier than the other two, so go with what works best for you.  I know that I tend to make huge steps on my to-do lists, so I’ve gotten used to breaking them up into more manageable steps that make me feel that I am accomplishing a lot.  This feeling helps me stay motivated to continue.

This time of year, I always get a lot of clients coming in working on ways to make their new year a better year for themselves.  One of the biggest mistakes people make is when they are so excited to get a good start on the year, they set goals to high for themselves.  You want your goals (whether for the new year or any time) to be moderately difficult, not too hard and not too easy.

Research has demonstrated that people that set moderate goals for themselves have better self-esteem.  They are not making tasks that they are sure to fail nor are they making tasks they know they will accomplish without much work.  Realistic goals give you a better sense of what you can achieve.

Having achievable goals also means you want some flexibility.  Making it so that you can never miss a day at the gym is going to fail pretty soon after the first major storm we have.  Once you’ve missed this one day you may think you’ve ruined your “perfect” streak.  A more reliable goal is “I want to commit to making it to the gym three days a week.”  If you’re making resolutions to lose weight, build in days where you don’t stick to a diet.  These “free days” (I dislike the term “cheat days”) are ways in which to keep you feeling like you’re making progress and that you still can enjoy a favorite food or treat.