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Trauma – Do you know how to treat a trauma survivor?

Trauma – Do you know how to treat a trauma survivor?


By: Erica Goodstone, PhD, LMHC, LMFT, LPC

Do you really know how to treat a trauma survivor?  Would you even recognize the signs and symptoms if such a client appeared in your office? Would your words and actions possibly add another layer of trauma, a “small T”, instead of helping the client to heal from their “big T” trauma?  Statistics reveal that 1 out of 4 girls and 1 out of 6 boys have experienced trauma by the age of 18 (and those figures are obviously low because many people are afraid and ashamed to report the abuse).  Trauma is a big part of living in our society and therapists need to be educated about how best to serve our clients.

Recently I had the pleasure of interviewing a highly experienced therapist, Tracey Rubenstein, who has worked in the trenches of trauma and abuse for many years.  She has experienced, first hand, men and women who have survived from sexual assault, domestic violence, child abuse, stalking, human trafficking and more.  Her explanation of what trauma is and how our brain processes the traumatic event was an eye opener for me.

She breaks it down into two components:

  1. Cultural and societal values and victim blaming
    The attitudes and behaviors of others makes it difficult for victims to safely share their story without feeling ridiculed, shamed, invalidated or even re-traumatized.  Therapists may inadvertently stop the trauma survivor client from telling his or her story by asking lots of questions, assuming the client has told this story too many times already, or not understanding the client’s need to say it over and over until it can be put to rest.
  2. Psychology of trauma and how the brain responds
    We seek to learn from our experiences to avoid pain.  In our attempt to “learn” from a trauma, we think, “I shouldn’t have done x, y or z”, so we may become overly cautious about never doing that again.  “This is the brain doing what it is supposed to do.”  However, we can take this too far and become rigid, fearful, unwilling to get close to others, keep a stiff upper lip, and keep the traumatic feelings and memories stored deep within our consciousness.


The interview ends on a helpful note.  “As humans we are resilient beings.  We have lots of healthy ways to cope with trauma.  Therapists need to understand how they can help to build and support their clients’ resiliency and sense of personal empowerment.  The very first and most essential quality is the providing of safety – a safe environment in which the traumatized client can finally tell his or her story, develop new ways of thinking and more empowering self-talk, and finally have the sense of relief that comes from letting go of their secret shame and guilt.  Find out more about how you can better help your clients at http://www.S2SBoca.com

Click here to read Dr. Erica Goodstone’s bio.

Plantain Weed for Health

Plantain Weed for Health


Published June 8th, 2015 in Alternative TherapiesDigestive HealthInflammatory IllnessesTravel Tips

by Tammera J. Karr, PhD

Nutr_Tipps_Nov15Plantain is a persistent weed in gardens, on lawns and even in driveway cracks in the Pacific Northwest. But plantain is one of the most medicinally powerful “nuisance” plants in gardens and yards not being taking advantage of for health, perhaps to our detriment. The green leaves and small, stalk-like buds of the plantain “weed” bear distinctive health potential for those with severe menstrual cycles, acne and painful arthritis. For hundreds of years, plantain has been used as one of nature’s most powerful medicines, and for excellent reason.

One of Plantains many uses is, that of astringent for wounds and bug bites. Simply chewing plantain leaf or crushing and grinding it makes an effective poultice to draw out poisons from the skin and prevent infections and scarring. “Because it draws toxins from the body with its astringent nature, plantain may be crushed (or chewed) and placed as a poultice directly over the site of bee stings, bug bites, acne, slivers, glass splinters, or rashes,” explains Life Advancer.

A little herbal history

“Plantain has been known by many names throughout its history, band-aid plant, broad-leaved plantain, cart grass, buckhorn plantain, Che Qian Zi, common plantain, cuckoo’s bread, devil’s shoestring, dog’s ribs, dooryard plantain, Englishman’s foot, hock cockle, kemp, lance-leaved plantain, pig’s ear, plantane, ribwort, round leafed plantain, rubgrass, slan-lus, snakeweed, waybread, and white man’s foot.

Nicholas Culpeper listed plantain in his herbal printed in 1652, The English Physitian. Today it is titled Culpeper’s Herbal and is still among one of the most popular books written in English. Even back at that time plantain was a well-known plant. Culpeper stated, “This groweth so familiarly in meadows and fields, and by pathways, and is so well known that it needeth no description.” (Thulesius pg. 51).

Nicholas Culpepper also provided the following information: “The clarified juice drank for a few days helps excoriations or pains in the bowels, and distillations, of rheum from the head. It stays all manner of fluxes, even women’s courses, when too abundant, and staunches the too free bleeding of wounds.

The seed is profitable against dropsey, falling-sickness, yellow jaundice and stoppings of the liver and reins. The juice, or distilled water, dropped into the eyes cools inflammation in them. The juice mixed with Oil of Roses and the temples and forehead anointed with it eases pains in the head proceeding from heat. It can also be profitably applied to all hot gouts in the hands and feet. It is also good to apply to bones out of joint, to hinder inflammations, swellings and pains that presently rise thereupon.” (Plantain By Margaret l. Ahlborn)

Plantain has been used all over the world, and the Saxons listed it as one of their nine sacred herbs. Early Christians viewed it as a symbol and many cultures today refer to it as an aphrodisiac. Native American populations referred to it as Whiteman’s Foot due to its tendency to spring up around European settlements.

Bulk and certified organic herbs like dandelion and plantain can be purchased from Oregon company Mountain Rose Herbs (mountainroseherbs.com). Here is a sampling in real English of the many medicinal benefits listed in the herbal formularies today. Keep in mind this information has been proven with the test of time and is used in many countries.

Medicinally listed for the following:
Plantain leaf is approved by the German Commission E for respiratory catarrhs and mild inflammation of the oral and pharyngeal mucosa. It is traditionally used for upper respiratory support and is topically used for minor cuts, bruises, and stings.

A rich source of the mineral silica, plantain works as an expectorant, actually improving coughs, colds, and various respiratory ailments.

“Plantain acts as a gentle expectorant while soothing inflamed and sore membranes, making it ideal for coughs and mild bronchitis,” wrote David Hoffmann, FNIMH, AHG, in his bookMedical Herbalism: The Science and Practice of Herbal Medicine.

Plantain is high in vitamins A, C and a rich source of calcium.

Why you want Plantain: Plantain soothes, cools and heals burns/sunburns. Draws out toxins from bug bites, bee, wasp, hornet stings, relieves the swelling and pain from these bites. Useful for skin issues: eczema, impetigo, rashes and reactions to poison ivy/oak. Plantain contains natural allantoin a phytochemical, and allantoin produces its desirable effects by promoting healthy skin, stimulates new skin cells and healthy tissue growth. Plantain is an anti-inflammatory and speeds wound healing.
Historical references indicate plantain is a beneficial digestive aid. If you experience constant digestive problems due to antibiotics, food allergies, or genetically modified organisms (GMOs), plantain just might be a simple solution for you. The leaves and seeds reduce inflammation in the digestive tract and help repair damage to the gut lining.

The seeds of plantain can be used as a fiber supplement, acting similarly to psyllium husk in absorbing toxins and creating firmer stools, and improves hemorrhoids. When steeped, plantain leaves can be turned into an extract for gut health.

According to The American Materia MedicaTherapeutics and Pharmacognosy, written by Dr. Finley Ellingwood, MD, in 1919, “plantain is effective against virtually all blood diseases, many glandular diseases, mercury poisoning, diarrheal conditions, female disorders, and injuries, bites and rashes on the skin.”

Safe for adults and children.

How to use: The leaves of plantain are quite edible and are cooked as greens or used raw in salads. Older leaves have a stronger flavor and may be considered objectionable. These older, stringy leaves may still be used in herbal teas, and are particularly suitable for survival situations where the tough fibers may be converted to rope or fishing line. Eaten raw and fresh in salads, as a tea, in tincture form and as an external compress.


http://www.ncbi.nlm.nih.gov/pubmed/10483683?dopt=Abstract _ Medical Herbalism_ by D. Hoffmann pg. 574
Edible and Medicinal Plants of the West by Gregory L. Tilford pg. 112
Ashton, Megan “The Health Benefits of the Plantain Leaf” Livestrong.com, 29 April 2011. Web. 22 May 2013



Book Review: Hypnobirth: Theories and Practices for Healthcare Professionals

Hypnobirth: Theories and Practices for Healthcare Professionals

Written By:

Yulia Watters


Rowman and Littlefield, 123 pages


Reviewed By:

Dr. Susan Stuntzner PhD, LPC, CRC, NCC, DCC, FAPA

Assistant Professor

University of Texas – Rio Grande Valley

School of Rehabilitation Services and Counseling

College of Health Affairs


Hypnobirth: Theories and Practices for Healthcare Professionals is a book for mental health and medical professionals, as well as caregivers intimately involved in the birthing processes of expectant mothers.  It is intended to inform readers about the relevance and role of hypnobirthing during pregnancy and birth, and to help readers understand the connection between medical and alternative health practices: one does not have to necessarily exclude the other, and there is a place for both throughout the birthing process.

Hypnosis is often viewed with skepticism or caution by those who do not fully understand its meaning and value.  It is not something necessarily done to a person, as is often thought, but rather a “way of being” that helps connect the experiences of the mind and body while at the same time, enabling problem-solving (p. xvii).   Hypnosis can be a means to preparing women for all of the expected, and unexpected, events that go into pregnancy so that women can accept these events as they come, and not be locked into one idea of what the “perfect birth” is.  Hypnosis is also a set of individualized and meaningful hypnobirthing techniques chosen by the expectant mother that best meets her personal, emotional, and mental needs.  It is a sense of support, helping the mother reduce anxieties and/or problems (rather than eliminate them) and connect with the infant throughout the birthing process.

In Chapter One, the author explains the history of hypnosis, myths associated with hypnosis, and frequently asked questions.  This lays the foundation for how hypnosis came to be and provides information about the ways it has evolved over time.  Of particular interest is the discussion of myths people hold about hypnosis.  If not recognized, explored, and addressed, these myths may inhibit the understanding and use of hypnosis as part of the birthing process.  For instance, some perceive hypnosis as being the same for everybody, involving the same needs and techniques, etc.  As the reader proceeds, however, he or she soon learns that hypnosis can be specifically tailored to each woman’s needs, concerns, values, and circumstances.  Thus, a key component to a successful hypnobirthing process is the awareness of the expectant mother’s needs.  Professionals involved should have an open dialogue with the mother about the approaches and skills that can be used and incorporated into the birthing process.

Another important concept for professionals to understand is that hypnobirthing can be incorporated into births other than those considered “natural” births.  Women vary in the type of birth they hope to have and the setting they prefer to be in (hospital, home, birthing centers).   Hypnobirthing can prepare women for giving birth in the way they hope it will occur, but it can also be useful for those who find that changes must be made on the spot.  An example of this is the woman who plans on having a vaginal birth, and throughout the birthing process learns a C-section is necessary.  Unexpected alterations such as this can be disappointing and stressful for the expectant mother, but when trained and supportive professionals are there to remind her to use her hypnobirthing skills, she can restore her ability to connect her mind and body to the experience.

The author discusses a number of points that may interest professionals involved in birthing.  First, professionals can work with the expectant mother in conceptualizing and practicing hypnotic techniques prior to the actual birth.  Professionals are afforded an opportunity to learn about the expectant mother’s hopes and desires by exploring questions such as: What does being pregnant mean to you?  What does the ideal or desired pregnancy look like?  What supports are needed for you to have the best experience possible (pp. 35-36)?  Exploring the mother’s desires is an important part of making her fully involved in her birthing process and “making a strong connection to her child” (p. 36).

Second, it is valuable to help women learn about and identify techniques that they can use later, during the birthing process.  Some of those techniques include visualization, breathing, relaxation exercises, yoga, and music.  Professionals can also provide expectant mothers with the opportunity to reflect on their individual, cultural and personal values and needs as those relate to the birthing process.  This gives women the opportunity to create a vision and a plan to help achieve a successful birth.  It also empowers them to become active participants throughout the birthing process and to be aware of their own bodies, feelings, and experiences (pp. 42-43).

Third, it is important to remember that the skills and approaches used by women are likely to vary; the same techniques do not work for every expectant and new mother.  Some women may require smells, memories, specific words, touch, or settings to help them establish a meaningful connection and to feel peaceful and comfortable.  Part of the helping professional’s role is aiding the expectant mother in identifying these needs and supporting her in accessing them during the birthing process.

One point mentioned that is essential for professionals to consider is the value and role of language used during the pregnancy and birthing process.  The author points out that the language professionals use to describe what is taking place can help or hinder the mother’s feelings and experiences.  Professionals can assist expectant mothers by learning about words and preferences that mothers find supportive and helpful versus those that they do not.

While much of the book’s focus is on the preparation and use of hypnobirthing techniques, the author reminds readers that mothers and partners may continue to use and build on these skills long after giving birth.  These same techniques can be used to assist with the parent’s “emotional, social, and personal” formation, the development of a close and meaningful relationship with the newborn infant, and in becoming a supportive and loving parent.  Women can understand their roles as mothers, their baby’s needs, the interconnectedness between her own needs and her baby’s needs, and so forth (p. 93).

Professionals interested in learning more about hypnobirthing and its application to expectant mothers are reminded that much of the process is about “being open” to the information and skills presented.  The author reminds the reader how possible it is to explore and incorporate hypnobirthing techniques into birthing, and that professionals do not need to be “experts” in order to consider hypnobirthing’s value.  Also of use are the appendices and glossary of terms the author includes, even listing “unfamiliar” terms.  Professionals wanting to explore hypnobirthing are encouraged to learn more about it and the ways they can use the information provided to assist expectant mothers in having the most meaningful and pleasant births possible.

About the reviewer:

Stuntzner_SDr. Susan Stuntzner PhD, LPC, LMHP, CRC, NCC, DCC, BCPC, DAPA, FAPA is an Assistant Professor  in the School of Rehabilitation Services and Counseling at the University of Texas Rio Grande Valley. She currently trains students to become rehabilitation and rehabilitation counseling professionals and to work directly with individuals with disabilities in numerous employment settings. Her research interests include: adaptation and coping with disability, resiliency, self-compassion and compassion, forgiveness and spirituality, development of intervention techniques and strategies, and mentorship of professionals with disabilities. She has written three books pertaining to coping and adaptation and/or resilience-based skills. Her works are entitled, Living with a Disability: Finding Peace Amidst the Storm, Reflections from the Past: Life Lessons for Better Living, and Resiliency and Coping: The Family After.  Dr. Stuntzner has researched and written articles on self-compassion and forgiveness and their potential relationship to the needs of individuals with disabilities. She has also developed two interventions (i.e., resilience, forgiveness) for persons with disabilities to assist them in their coping process. These works are entitled, “Stuntzner and Hartley’s Life Enhancement Intervention: Developing Resiliency Skills Following Disability” and “Stuntzner’s Forgiveness Intervention: Learning to Forgive Yourself and Others”.  Additional information can be found on her website: www.therapeutic-healing-disability.com. Questions concerning this article can be directed to her via email: susan.stuntzner@utrgv.edu

How Does CAM Contribute to Variations in Older Adult Depression? An NHIS Study

How Does CAM Contribute to Variations in Older Adult Depression?

An NHIS Study

Ryan Harrison, PsyD, DAAIM

Director of Resident Life & Wellness

Hillcrest Retirement Community

2705 Mountain View Drive

La Verne, CA 91750


(909) 392-4392



Depression in older adults is frequently misunderstood and under-diagnosed, with poor treatment compliance and marginal efficacy when medications or psychotherapy are prescribed.  Some older adults turn to Complementary and Alternative Medicine (CAM) to help treat or manage their depressive symptoms.  The effects of CAM on depression and depressed older adults are not well-known, and the degree to which CAM therapies contribute to any variation in depressive symptoms in older adults has not been fully researched.  This study investigated the extent to which the use of CAM therapies contributes to the variation of symptoms of depression in older adults over a 12-month period.  Four distinct hierarchical multiple regression analyses were run on data collected by the Centers for Disease Control and Prevention’s 2012 National Health Interview Survey (NHIS) and its supplemental CAM questionnaire.  Main outcome measures comprised adjusted R2 and beta weight values of risk factors for depression and the relative impact of CAM therapy use on incidence of depressive symptoms over a 12-month period.  Analyses revealed that CAM therapy use exhibits mild protective effects against depressive symptoms, relative to the effect sizes of risk factors for older adult depression.  CAM therapy use is a significant predictor of the variation in incidence of depressive symptoms in older adults.  CAM therapy use appears to exert its strongest preventative effects in older adults with a history of depression.


Keywords: older adult, depression, psychology, complementary and alternative medicine, NHIS

Target Audience: Psychologists, Psychiatrists, Social Workers, DO, MD, ND, Nurses, Wellness Directors, Geriatricians

Learning Objectives

  • Recognize the difficulty inherent in determining the prevalence of depression in the older adult population
  • Distinguish the different classifications of Complementary and Alternative Medicine
  • Recognize the differences between depression in older adults and younger populations
  • List risk factors for older adult depression
  • Discuss the potential contribution of Complementary and Alternative Medicine to depressed older adults’ frequency of symptoms.

Program Level: Advanced


  • Practicing health or mental health professional
  • Experience working with older adults in a health-related capacity
  • Basic familiarity with statistical analyses

The American Association of Integrative Medicine® provides this continuing education opportunity to fulfill 1hr of Continuing Education Credit for all certified members. Certified members are required to obtain 30 hours of continuing education credits in the 3 year recertification period to maintain their certification status.



Depression is one of the most common mood disorders experienced by older adults (Centers for Disease Control and Prevention [CDC], 2012b; Geriatric Mental Health Foundation [GMHF], n.d.; National Institute of Mental Health [NIMH], n.d.a).  Although there are valid screening measures for this population, the American Psychiatric Association’s (APA, 2013a) Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) lacks specific guidelines for diagnosing depression in older adults.  Additionally, older adults may present different depressive symptoms than those of younger people.  This makes it difficult for researchers to determine the prevalence of depression among the elderly and can produce skewed data (GMHF, n.d.; NIMH, n.d.a; Rojas-Fernandez & Mikhail, 2012; Steinman et al., 2007).

There is ample literature describing the numerous risk factors associated with older adult depression and its multiple adverse effects.  Risk factors include gender, prior depression, chronic disease, sleep disturbance, and physical limitations (Cole & Dendukuri, 2003; Fiske, Wetherell, & Gatz, 2009; Tong, Lai, Zeng, & Xu, 2011).  Adverse effects of older adult depression include deleterious effects on health, such as the worsening of chronic illnesses and greater mortality, and also negative influences on financial well-being.  Resources suggest there is little indication of a decline in what appears to be a steadily growing financial burden associated with depression (Bosworth, Voils, Potter, & Steffens, 2008; U.S. Department of Health and Human Services [USDHHS], 2011).  Yet, diagnosing depression in the older adult population is frequently confounded by several factors, with implications for the effective treatment of the mood disorder; researchers suggest that a large number of older adults go undiagnosed, and as a result, untreated (Lakey et al., 2012; Wancata, Alexandrowicz, Marquart, Weiss, & Friedrich, 2006).

Treatment of older adult depression primarily comprises prescription medications or psychotherapy, although research has indicated that combining the two approaches can be significantly more effective than either used alone (Blazer, 2003; NIMH, n.d.a.; Rojas-Fernandez & Mikhail, 2012).  Regardless of the treatment option, remission rates are low, and many older adults become noncompliant.  In part, this reflects patients’ discomfort with the adverse effects, or perceived stigma, of standard therapy (Blazer, 2003; NIMH, n.d.a.; Rojas-Fernandez & Mikhail, 2012).

Noncompliance with standard (i.e., allopathic) care does not mean, however, that depressed older adults are not seeking treatment elsewhere.  Some may turn to Complementary and Alternative Medicine (CAM) therapies as supplemental or substitute treatment options (Barnes, Bloom, & Nahin, 2008; Nemer & McCaffrey, 2010).  Yet, to date, there has been no research investigating the extent to which CAM therapy may contribute to a significant variation in depressive symptoms among older adults.

Materials and Methods

The sample for this study was drawn from the 2012 National Health Interview Survey (NHIS) Sample Adult component and its supplemental CAM questionnaire.  Data were used only for respondents aged 65 and older.  The 2012 NHIS procedures were designed to collect data representative of the national population.  As a result, participants aged 65 and older who were Black, Hispanic, or Asian had a higher likelihood of being selected as the sample adult from each household (CDC, 2012a).

Participants who were selected to complete the Sample Adult survey were also invited to participate in the supplemental CAM questionnaire (N = 34,525).  Of this group, 7,935 older adults (58% female, 42% male) completed the survey and the CAM questionnaire.  Whites/Caucasians made up the majority of sampled adults (44%), with African American/Black being the second most prevalent reported ethnicity (7.5%).

The NHIS is a cross-sectional household interview survey with sampling and interviewing occurring continuously throughout the year (CDC, 2012a).  According to the Centers for Disease Control and Prevention (2012a), the NHIS sampling plan “follows a multistage area probability design” (para. 7) that is redesigned after every census.  For the 2012 NHIS, 428 primary sampling units (PSUs, consisting of counties, contiguous counties, or metropolitan areas) were drawn from all 50 states and the District of Columbia.  Within each PSU, four to 16 addresses were used.  For the adult sample of the 2012 NHIS, one civilian adult per family was randomly selected to self-report responses to survey questions, including those asked as part of the CAM supplement.

Study Design and Models

This study was correlational and quantitative in design.  It used hierarchical multiple regression analysis to account for distinct variations in the incidence of depressive symptoms experienced by older adults when CAM therapies were used.  This study operationalized the term depression to refer to incidences of clinically diagnosed major and minor depression, as well as the experience and expression of depressive symptoms.  This aligns with a majority of the studies represented in the literature.  Further, the NHIS and supplemental CAM questionnaire did not screen for depression.  Rather, respondents were asked whether they had ever been told by a health care practitioner that they had depression or some form of depressive disorder.  A secondary approach used in the NHIS comprised several items regarding distinct depressive symptoms that may have been experienced within the prior 30 days.  Thus, the term depression was used throughout this study, as it was noted to occur at various times throughout the literature to refer to all cases of identified depressive disorders, as well as to depressive symptoms as identified in the NHIS.

In general, CAM comprises non-mainstream therapies that are either used in conjunction with standard care (i.e., complementary) or used in its place (i.e., alternative).  Since CAM’s scope is wide, it is important to operationalize the term complementary and alternative medicine such that researchers are aware which therapies are considered CAM, and which are not, within a given study.  For this study, the term CAM reflected what appears to be the most widely accepted definition, which has been put forward by the National Center for Complementary and Alternative Medicine (NCCAM, 2013a).  This definition divides CAM into five distinct classifications: (a) alternative medical systems, (b) mind-body medicine, (c) biological-based therapies, (d) manipulative and body-based therapies, and (e) energy-related therapies (Bomar, 2013; NCCAM, 2013a; Park, 2013).  In sum, these five classifications capture most, if not all, of the nonstandard therapies considered CAM.  In particular, this definition of CAM coincides with the therapies included in the 2012 NHIS’s CAM supplemental questionnaire.  The term CAM was further operationalized to refer to the 23 specific CAM therapies included in the 2012 NHIS supplemental CAM questionnaire.  These 23 therapies (chiropractic/osteopathic medicine, massage, acupuncture, energy healing, naturopathy, hypnosis, biofeedback, Ayurveda, chelation therapy, craniosacral therapy, herbs/non-vitamin supplements, homeopathic treatment, meditation, mindfulness based therapy, guided imagery, progressive relaxation, yoga, Tai Chi, Qi Gong, Feldenkrais, Alexander technique, Pilates, and Trager psychophysical integration) constituted the CAM independent variable of the hierarchical multiple regression model (Fig. 1).

Four distinct hierarchical multiple regressions were performed based on a regression model (Fig. 1), with risk factors and CAM therapy use variables used to predict the incidence of depressive symptoms among older adults.  Gender, sleep disturbance, chronic disease, prior depression, and physical limitation were presented as controlled variables and entered as the first and second blocks of the regression.  These variables were generated through the summation of NHIS items related to each risk factor (Table 1).  CAM therapy, indicated by a positive response to any of the 23 NHIS items regarding use of specific CAM therapies over a 12-month period, was entered in the third block as the independent variable.  The dependent variable was the reported incidence of depressive symptoms provided by the sum of five NHIS items related to symptoms of depression.

The first hierarchical multiple regression was performed according to the original model, with data from all older adult respondents (n = 7,935).  In the interest of providing additional clarity, the sample was then split into two subgroups: older adults with a prior history of depression (n = 1,158) and those without (n = 6,773).  Regression analyses were performed on each of these groups separately, with the control factor “prior depression” removed from the model.  Finally, a fourth hierarchical multiple regression was run on a sample of older adults who reported at least one depressive symptom and the use of at least one CAM therapy within the prior 12-month period (n = 1,131). 

Table 1
Variable Coding

 Dependent variable Definition
Depression The sum of five items coded on a 5-point Likert scale measuring symptoms of depression as coded in the NHIS, with 1 = all of the time, 5 = none of the time.  Items are: During the past 30 days, how often did you feel… so sad that nothing could cheer you up?… hopeless?… that everything was an effort?… worthless?; and Altogether, how much did these feelings interfere with your life or activities? (Reverse scored such that high scores indicate higher levels of depression)
Control variables

Block 1
Gender One item, coded on a binary scale, measuring gender with 0 = male, 1 = female
Block 2
Chronic disease The sum of eight items related to chronic diseases, coded on a binary scale, measuring incidence of chronic diseases with 1 = yes, 0 = no.  Items are: Have you ever been told by a doctor or other health professional that you had… coronary heart disease?… stroke? … emphysema?… COPD?… asthma?… cancer?… diabetes?… arthritis?
Sleep disturbance The sum of two items coded on a binary scale, measuring disturbance in sleep with 1 = yes, 0 = no.  Items are: During the past 12 months, have you… regularly had excessive sleepiness during the day?… regularly had insomnia or trouble sleeping?
Physical limitation The sum of 12 items related to physical limitation coded on a 5-point Likert scale with 0 = not at all difficult, 4 = can’t do at all.  Items are: By yourself, and without using any special equipment, how difficult is it for you to… walk a quarter of a mile? … walk up 10 steps without resting?… stand or be on your feet for about two hours?  … sit for about two hours?… stoop, bend, or kneel?… reach up over your head?… use your fingers to grasp or handle small objects?… lift or carry something as heavy as 10 pounds such as a full bag of groceries?… push or pull large objects like a living room chair?… go out to things like shopping, movies, or sporting events?…  participate in social activities?… do things to relax at home or for leisure?
Prior depression One item coded on a binary scale measuring prior depression with 1 = yes, 0 = no: Have you ever been told by a doctor or other health professional that you had depression?
Independent variable
Block 3
Complementary and alternative medicine The sum of 23 items measuring use and frequency of CAM therapy within the past 30 days to 12 months; items are coded variously, using either Likert scales or binary scales, and are enumerated in the appendix.

Note: Adapted from 2012 National Health Interview Survey Sample Adult questionnaire and complementary and alternative medicine questionnaire.


The first regression, based on the original model, produced a significant equation, F(6, 1124) = 86.521, p < .001, with an adjusted R2 value of .312, signifying that approximately 31.2% of the variation in depressive symptoms was explained by the model.  This included the use of CAM therapies.  This R2 value was 30.5% better than gender alone and 0.3% better than addition of all other risk factors, represented in Block 2.

The second regression, using the subsample of older adults with no prior history of depression, did not produce a significant equation, F(5, 899) = 31.686, p < .001.  Although the model accounted for roughly 14.5% of the variation in incidence of depressive symptoms in this sample, the adjusted R2 value was not significant due to the addition of CAM; prior to its block entering the equation, the model accounted for 14.6% of the variation, at a significance value of p < .001.

The third regression analysis, based on data from older adults with a prior history of depression, did produce a significant equation, F(5, 219) = 17.014, p < .001, that explained approximately 26.3% of the variation in incidence of depressive symptoms (Adj R2 = .263).  This was 26.7% more predictive than gender alone and 2.9% more than gender, and the other risk factors, combined.

The final regression, using data from older adults who reported at least one depressive symptom and use of at least one CAM therapy over the prior year, also produced a significant equation, F(6, 1123) = 102.670, p < .001, demonstrating that approximately 35.1% of the variation in incidence of depressive symptoms was accounted for by the model (Adj R2 = .351).  The small difference in adjusted R2 values between Blocks 2 and 3 suggested, however, that CAM use explained only a negligible amount of the variation, at less than 1%.  Although the overall model was found to be significant at the p < .05 value, the effect size indicated that CAM’s contribution to the predictive power of the model was relatively trivial.


Extant literature emphasizes both the commonness and the severity of depression in the older adult population (CDC, 2012b; GMHF, n.d.; NIMH, n.d.a).  Further, treatment for older adult depression is impeded by a variety of factors that complicate not only depression management but also compliance with treatment and its efficacy (Bosworth et al., 2008; Chapman & Perry, 2008; Feliciano & Arean, 2007; Ivanova et al., 2011; NIMH, n.d.a).

At the same time, it is possible that a number of older adults with depression selectively use CAM, either in conjunction with or in lieu of standard allopathic care.  There is scant research, however, to suggest the extent to which such CAM therapy use may account for any variation in symptoms of depression experienced within this population.  This study was undertaken to elucidate the complex relationship between older adult depression and CAM.  The purpose of the research was to examine the extent to which self-reported CAM use could predict variations in depressive symptoms experienced by older adults.

The major findings of this study show that CAM therapies have a place in the treatment or maintenance of older adults who experience depressive symptoms, although there is insufficient evidence to suggest that CAM use produces large effects as a predictive measure of depressive symptomatology.  An initial regression revealed that 31.2% of older adults’ incidence of depressive symptoms could be accounted for by the original model.  However, the largest effect was seen within the second block, with 30.9% of the predictive value due to the combined risk factors of gender, chronic disease, sleep disturbance, physical limitation, and prior depression.  CAM use contributed less than half of 1% (i.e., 0.3%) toward the overall model’s predictive value.

This small effect size was seen repeatedly in three additional, but distinct, regressions. The second and third regressions used subsamples of older adults; data from older adults without a prior history of depression were analyzed in comparison with data from older adults who had experienced depression earlier in life.  In the former analysis, only the second block was found to be significant, with the largest adjusted R2 value (.146) in the model.  Indeed, the addition of CAM use to the model lowered this value, indicating a lower overall predictive ability than without CAM (R2 = .145).  In the third analysis, involving older adults who had experienced prior depression, the model was found to be stronger overall, accounting for 26.3% of the variation in incidence of depression within the prior year.  However, of this amount, only 2.9% was directly attributable to CAM therapy use; 23.4% was accounted for by the risk factors included in the second block.

Finally, the last hierarchical multiple regression analysis was run on data contributed only by older adults who had experienced at least one symptom of depression and self-reported any amount of CAM use within the previous year.  In this case, 35.1% of the variation in incidence of depressive symptoms was accounted for by this model.  Of that amount, however, 34.8% was attributable to the risk factors for depression (i.e., Block 2).  Although CAM use was significant at the p < .05 level, its beta weight (-.059) indicated that its overall effect size was negligible.

This finding is not surprising and is supported by the literature.  As noted by several researchers, there are distinct risk factors for depression, such as those used as control variables in Block 2 (CDC & NACDD, 2008b; Chapman & Perry, 2008; Cole & Dendukuri, 2003; Gellis & McCracken, 2009; Hamer et al., 2011; NIMH, n.d.a; USDHHS, 2011).  Further, it is possible that the “complex interactions among genetic vulnerabilities, cognitive diathesis, age-associated neurobiological changes, and stressful events” (Fiske et al., 2009, p. 363), such as those correlated with the control variables in Block 2, have a greater synergistic effect on older adults toward depressive symptoms than CAM use might exert in a preventative manner.

This was seen, at least marginally, via the beta weights resulting from the data analysis.  In the third regression model, in which CAM use had the largest beta weight (-.182), both sleep disturbance and physical limitation had larger beta weights (.294 and .342, respectively).  Thus, although CAM use may exert preventative effects, these may not be strong enough to outweigh the contributions to depression produced by a combination of common risk factors.

It appears that CAM use may exhibit its greatest efficacy toward the ability to predict variation in the incidence of depressive symptoms in older adults who have experienced prior depression.  This is illustrated in the marked difference in adjusted R2 values between the regressions run on data from older adults with no history of depression versus those with prior incidence.  In the former, the regression model accounted for approximately 14.6% of incidence; when CAM use was added to the regression, the predictive ability decreased to a statistically non-significant 14.5%.  When the same regression model was applied to data provided by older adults with incidence of prior depression, however, it accounted for 26.3% of incidence, with a significance that exceeded the p < .05 level.

Additionally, the highest beta weight of CAM use was achieved in the analysis of older adults with a history of depression.  In this case, the beta weight of -.182 was higher than even the beta weight of -.059 produced by the strongest of the hierarchical multiple regression models, run on older adults who had used CAM within the prior year.  This suggests that CAM use’s ability to predict a variation in incidence of depressive symptoms is strongest in connection with older adults who have experienced prior depression.

The literature supports this possibility.  For example, several studies have revealed that individuals with depression, and perhaps older adults in particular, are more likely to use CAM than their non-depressed counterparts (Adams, Sibbritt, & Lui, 2012; Elkins, Rajab, & Marcus, 2005; Grzywacz et al., 2006; Montazeri, Sajadian, Ebrahimi, & Akbari, 2005).  Although this does not suggest that CAM therapies are more effective as treatment for depressed persons than for those without depression, it could suggest that individuals with depression may seek out CAM therapies more readily or that CAM therapies exert a greater effect on persons with a history of depressive symptoms.  If so, some of the biopsychosocial dynamics involved in CAM therapies may synergistically potentiate various CAM therapies’ helpful effects.  That is, depressed patients who seek CAM therapies may respond better to them than those people who are not depressed and who do not actively seek CAM therapy.

If this is the case, then the helpful effects cannot be solely attributed to the placebo effect; a meta-analysis conducted by M. P. Freeman et al. (2010) found that depressed persons receiving CAM were less likely to have a placebo response than those who were using standard antidepressant medications.  Rather, it is probable that the synergistic effects of multiple CAM therapies produce a preventative outcome built on a range of biopsychosocial dynamics.  There may be a precedent in the literature for this position.  Sarris (2011a) found that several CAM therapies, when used with conventional medication therapy, resulted in better outcomes and reduced relapse rates in clinical depression than were found with standard care alone.


Several implications for theory and research result from this study.  First, the results of the data analysis suggest that CAM use can help predict the variation in incidence of depressive symptoms in older adults, particularly those with a history of depression.  Further, the inverse relationship between CAM therapy use and depressive symptoms within this subpopulation implies that CAM therapies may be helpful for inhibiting recurrence or prolonging the remission of depressive symptoms.

Second, this study provided a unique look at an aspect of the complex relationship between CAM therapy use and depression in older adults living in the United States.  Although there is a large body of literature exploring depression and specific CAM therapies’ utility in treating depressive symptoms, to the author’s knowledge, this is the first study of its kind to explore the unique contribution of CAM therapies in predicting the variation in incidence of older adult depressive symptoms over a 12-month period.  This research contributes to the literature in a meaningful way, as it increases the degree of our general understanding of how CAM and older adult depression intersect.

Third, the results of the data analysis posited a distinct difference in CAM therapies’ utility as a predictive (and preventative) agent between older adults with no history of depression and those with prior history.  This finding may provide clues for further research into the mechanisms of different CAM therapies within a biopsychosocial framework.  This framework is large, encompassing several factors including those of biological, psychological, social, and environmental parameters (Garcia-Toro & Aguirre, 2007; Nemade et al., 2007).  Although additional research would be necessary to discern, from within a biopsychosocial framework, precisely how older adults without prior depression differ from those with prior depression, the finding that CAM therapy use may be preventative for the latter group indicates that some CAM therapies may have a significant biopsychosocial influence on certain people.

As a result of this correlational study, there are several recommendations for further research.  For example, this research revealed CAM’s potential preventative effects in particular for older adults with a history of depression.  Although the effect sizes of some risk factors for depression were stronger than CAM’s influence overall, future research could reveal the degree of CAM’s preventative effects in the absence of such risk factors.  This would represent an important discovery of CAM therapies’ preventative effects when unimpeded by countervailing dynamics.

Additional studies could also elucidate more precise relationships between CAM therapies that depressed older adults use and the efficacy of these therapies as either a preventive or treatment measure.  Randomized, controlled, double-blind studies of distinct CAM therapies used for preventing recurrence of depressive symptoms or for treating depression in older adults have been conducted.  However, sample sizes tend to be small, and such studies typically suffer from weaknesses in research design.  Additionally, the operationalization of CAM for this study did not include a number of emotionally supportive nutrients including vitamins, minerals, essential fatty acids, or amino acids, which are widely marketed and available to older adults.   Correcting for these limitations would constitute meaningful research.  Further, conducting a comparative analysis of the results of similarly methodologically strong studies could help determine the relative utility of some CAM therapies over others in regard to older adult depression.

Additionally, although this study determined a significant relationship between CAM therapy use and predicted variation in incidence of older adult depressive symptoms, it did not explore why such use has apparent preventative effects.  This determination could be made through rigorous clinical trials exploring the biological, psychological, and social (i.e., biopsychosocial) aspects of distinct CAM therapy usage by older adults with depressed mood.  Although this would represent a large undertaking involving the measurement of various biomarkers, standardized depression scales or screens, and both qualitative and quantitative research methods, such a multidimensional study could go far toward elucidating the precise mechanisms of various CAM therapies’ utility in treating or otherwise mitigating older adult depression.



Adams, J., Lui, C., & McLaughlin, D. (2009). The use of complementary and alternative medicine in later life. Reviews in Clinical Gerontology, 19(4), 227-236.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Barnes, P. M., Bloom, B., & Nahin, R. L. (2008). Complementary and alternative medicine use among adults and children: United States, 2007. National Health Statistics Reports, 12, 1-24.

Blazer, D. G. (2004). The psychiatric interview of older adults. FOCUS: The Journal of Lifelong Learning in Psychiatry, 2(2), 224-235.

Bosworth, H. B., Voils, C. I., Potter, G. G., & Steffens, D. C. (2008). The effects of antidepressant medication adherence as well as psychosocial and clinical factors on depression outcome among older adults. International Journal of Geriatric Psychiatry, 23, 129-134.

Centers for Disease Control and Prevention. (2012a). About the National Health Interview Survey. Retrieved from http://www.cdc.gov/nchs/nhis/about_nhis.htm.

Centers for Disease Control and Prevention. (2012b). An estimated 1 in 10 U.S. adults report depression. Retrieved from http://www.cdc.gov/Features/dsDepression.

Centers for Disease Control and Prevention & National Association of Chronic Disease Directors. (2008a). The state of mental health and aging in America: Issue Brief 2: Addressing depression in older adults: Selected evidence-based programs. Retrieved from http://www.cdc.gov/aging/pdf/mental_health_brief_2.pdf.

Cole, M. G., & Dendukuri, N. (2003). Risk factors for depression among elderly community subjects: A systematic review and meta-analysis. American Journal of Psychiatry, 160(6), 1147-1156.

Elkins, G., Rajab, M. H., & Marcus, J. (2005). Complementary and alternative medicine use by psychiatric inpatients. Psychological Reports, 96(1), 163-166.

Feliciano, L., & Arean, P. A. (2007). Mood disorders: Depressive disorders. In M. Hersen, S. M. Turner, & D. C. Beidel (Eds.), Adult psychopathology and diagnosis (5th ed., pp. 286-316). Hoboken, NJ: John Wiley & Sons.

Fiske, A., Wetherell, J. L., & Gatz, M. (2009). Depression in older adults. Annual Review of Clinical Psychology, 5, 363-389.

Freeman, M. P., Mischoulon, D., Tedeschini, E., Goodness, T., Cohen, L. S., Fava, M., & Papakostas, G. I. (2010). Complementary and alternative medicine for major depressive disorder: A meta-analysis of patient characteristics, placebo-response rates, and treatment outcomes relative to standard antidepressants. The Journal of Clinical Psychiatry, 71(6), 682-688. doi:10.4088/JCP.10r05976blu.

Garcia-Toro, M., & Aguirre, I. (2007). Biopsychosocial model in depression revisited. Medical Hypotheses, 68(3), 683-691.

Geriatric Mental Health Foundation. (n.d.). Depression in late life: Not a natural part of aging. Retrieved from http://www.gmhfonline.org/gmhf/consumer/factsheets/depression_latelife.html.

Grzywacz, J. G., Suerken, C. K., Quandt, S. A., Bell, R. A., Wei, L., & Arcury, T. A. (2006). Older adults’ use of complementary and alternative medicine for mental health: Findings from the 2002 National Health Interview Survey. Journal of Alternative & Complementary Medicine, 12(5), 467-473. doi:10.1089/acm.2006.12.467.

Hamer, M., Bates, C. J., & Mishra, G. D. (2011). Depression, physical function, and risk of mortality: National diet and nutrition survey in adults older than 65 years. American Journal of Geriatric Psychology, 19(1), 72-78.

Ivanova, J. I., Bienfait-Beuzon, C., Birnbaum, H. G., Connolly, C., Emani, S., & Sheehy, M. (2011). Physicians’ decisions to prescribe antidepressant therapy in older patients with depression in a US managed care plan. Drugs & Aging, 28(1), 51-62.

Lakey, S. L., LaCroix, A. Z., Gray, S. L., Borson, S., Williams, C. D., Calhoun, D., . . . Woods, N. F. (2012). Antidepressant use, depressive symptoms, and incident frailty in women aged 65 and older from the Women’s Health Initiative Observational Study. Journal of the American Geriatrics Society, 60(5), 854-861. doi:10.1111/j.1532-5415.2012.03940.x.

Montazeri, A., Sajadian, A., Ebrahimi, M., & Akbari, M. E. (2005). Depression and the use of complementary medicine among breast cancer patients. Support Care Cancer, 13(5), 339-342.

National Center for Complementary and Alternative Medicine. (2013a). Complementary, alternative, or integrative health: What’s in a name? Retrieved from http://nccam.nih.gov/health/whatiscam.

National Institute of Mental Health. (n.d.a). Depression. Retrieved from http://www.nimh.nih.gov/health/topics/depression/index.shtml.

Nemade, R., Reiss, N. S., & Dombeck, M. (2007). Depression: Major depression and unipolar varieties. Retrieved from Gracepoint-Mental Health Care website: http://www.gracepointwellness.org/poc/view_doc.php?type=doc&id=438&cn=5.

Nemer, D., & McCaffrey, A. M. (2010). Complementary and alternative medicine in the United States. Retrieved from http://improvehealthcare.org/wp-content/uploads/2011/08/1-4-1-PB.pdf.

Rojas-Fernandez, C., & Mikhail, M. (2012). Contemporary concepts in the pharmacotherapy of depression in older people. Canadian Pharmacists Journal, 145(3), 128-135.e2.

Sarris, J. (2011a). Clinical depression: An evidence-based integrative complementary medicine treatment model. Alternative Therapies in Health & Medicine, 17(4), 26-37.

Steinman, L. E., Frederick, J. T., Prohaska, T., Satariano, W. A., Dornberg-Lee, S., Fisher, R., . . . Snowden, M. (2007). Recommendations for treating depression in community-based older adults. American Journal of Preventive Medicine, 33(3), 175-181. doi:10.1016/j.amepre.2007.04.034.

Tong, H. M., Lai, D. W. L., Zeng, Q., & Xu, W. Y. (2011). Effects of social exclusion on depressive symptoms: Elderly Chinese living alone in Shanghai, China. Journal of Cross Cultural Gerontology, 26, 349-364.

U.S. Department of Health and Human Services. (2011). The treatment of depression in older adults: Depression and older adults: Key issues. Retrieved from http://store.samhsa.gov/shin/content/SMA11-4631CD-DVD/SMA11-4631CD-DVD-KeyIssues.pdf.

Wancata, J. J., Alexandrowicz, R. R., Marquart, B. B., Weiss, M. M., & Friedrich, F. F. (2006). The criterion validity of the Geriatric Depression Scale: A systematic review. Acta Psychiatrica Scandinavica, 114(6), 398-410.


About the Author

Harrison_42Dr. Ryan Harrison, PsyD, DAAIM, is the Director of Resident Life & Wellness at Hillcrest, a continuing care retirement community in southern California.  After having practiced privately as a board certified health and wellness consultant for over ten years, Ryan completed his doctorate in Health & Wellness Psychology at the University of the Rockies, where he focused his research on the intersection of older adult health and well-being and Complementary and Alternative Medicine.  He currently leads a team of dedicated staff to optimize older adult health, fitness, and wellness.

What Do Marketers Know That Therapists Need to Learn?

What Do Marketers Know That Therapists Need to Learn?


Erica Goodstone, PhD, LMHC, LPC

As licensed professionals in private practice, coordinating our own clinic or employed at an agency or hospital setting, we work hard.  Every day we deal with phone calls, client issues, treatment plans, insurance payments, reading professional publications, getting our CEU’s, attending professional meetings and events, and so much more.  Many of us are totally absorbed in our work and do not necessarily collaborate well with other therapists for the betterment of all the potential clients out there.

Marketers also work hard at what they do but right from the start their goal is to collaborate.  They know they cannot reach their vast target market if they work totally alone.  Therefore, they connect with other marketers and cross-promote each other’s products and services through affiliate marketing and joint ventures.  In affiliate marketing, one person creates a product to sell and invites other marketers to help promote this product with the assurance that the second person will receive an agreed upon percentage of the profit.  Together the marketers can reach many more people than either one alone.  Joint ventures result from an agreement between 2 or more marketers to create and promote a product or to use their separate skills, e.g., one is a technical geek and the other is great at writing excellent sales copy.

Therapists tend to attempt to promote their practice all alone.  Sometimes they work with a supervisor or a colleague in a joint venture or partnership but rarely do they cross-promote with lots of other therapists.  I see it online all the time.  Join any therapy group and you may get a sense of “Each man (or woman) for himself/herself”.  Each therapist posts an image and link to the wonderful workshop or group or specialty treatments they provide.  Each therapist attempts to show how much they have to offer.

What marketers know, and do so much better, is to promote each other.  They comment on each other’s articles and blog posts.  They share each other’s products and services on their own social media pages and they send ads about other people’s products to their email lists.

So the next time you go online at LinkedIn, Facebook or any other social media site, forum or private group, make it your business to comment on 3 to 5 other people’s posts before posting about yourself.  Show an interest in the work of your colleagues, those in similar niches and those in completely different areas.   Share about other people’s work to your followers.  Imagine how powerful that would be if all of us started sharing the posts of our colleagues first, before posting about our own work.

What is the goal of the therapeutic community?  Aren’t we here for the purpose of helping to improve society, to reach out and help men and women of all ages who are suffering in some way?  When we focus only on our own small area of expertise and only the services that we offer, we may be depriving potential clients of the possibility for healing what ails them.  On the other hand, when we promote each other we immediately provide more credibility and authority for the person we are promoting and the work they do.  And if a large group of therapists spend just a little extra time each week to comment on each other’s blog posts, event promotions, articles, videos, and podcasts, we are helping to expand awareness of the valuable gifts that licensed professionals offer to help people heal.

Just for this week, make a definite effort to comment on your colleagues’ posts and articles before you post anything about yourself.  If you do that consistently, you will build some solid relationships and a much larger referral base than you may now realize.

Please feel free to send me your questions, comments, subjects you want to see covered, and topics which you, as an expert, would like to share here.  DrErica@DrEricaWellness.com if you are ready to collaborate and share on social media, join the Marketing Our Practices Facebook group: https://Facebook.com/groups/MarketingOurPractices
I look forward to working together with you to strengthen our professions in the coming months.


Erica Goodstone, PhD, LMHC, LMFT, LPC

GoodstoneDr. Erica Goodstone, Love Mentor and Relationship Healer, is a Licensed Mental Health Counselor/Professional Counselor and Marriage Therapist, Licensed Massage Therapist practicing body psychotherapy, AASECT Certified Sex Therapist, American Academy of Pain Management Diplomate, and BCC Certified Personal/Life and Health/Wellness Coach.  She has been a member of AAIM since the inception, having presented at the joint conference with APA in 2005 in San Diego, CA.  Her article, “What is Body Psychotherapy” appeared in the first JAAIM, Online AAIM Journal.  Her books include: Love Me, Touch Me, Heal Me: The Path to Physical, Emotional, Sexual and Spiritual Reawakening (available complete or as smaller books, ebooks, Kindle and Smashwords.combooks), the romantic novel Love in the Blizzard of Life (completed during the NANOWRIMO National November Writers Challenge), and chapters in several collaborative books including “Holistic and Touch Therapies” in The Continuum Complete Encyclopedia of Sexuality.  She has also published hundreds of articles about love, relationships, aging, healing, and more for Examiner.com (as Miami Relationships Examiner and West Palm Beach Healing Examiner), for Self-Growth.com (where she was selected as Official Guide to Intimacy), YourTango.com (prominent relationship site), Boomer-LivingPlus.com and several others. As a Diamond Author for Ezinearticles.com, Dr. Erica was showcased as 1 of top 20 out of 400,000 Expert Authors.  Her first web site was SexualReawakening.com and her early blog sites include:  CreateHealingAndLoveNow.com/blog and HealthyBabyBoomersNetwork.com.

Dr. Erica served as chair of the AMHCA Body Therapy Special Interest Network from 1992-1998, chair of the AASECT NYC Metropolitan Area Section from 1994-2002, Science and Research Committee Chair (on the Board of Directors, original Steering Committee, and newsletter editor) for the U.S. Association for Body Psychotherapy from 1996-2002, Marketing Committee Chair for the International Association of Rubenfeld Synergists from 2001-2002, as well as AMTA Educational Programming Subcommittee Chair from 1992-1995.

Since 2008, Dr. Erica has been training with master marketers to learn about virtual presentations and online marketing.  She created a web site, MarketingOurPractices.com to showcase the important work of psychotherapists and to educate them on the value of collaborating and sharing rather than competing and only self-promoting.  To facilitate this, Dr. Erica created the Marketing Our Practices Facebook Page to share valuable articles and events as well as the Marketing Our Practices Facebook Group, a place for psychotherapists to connect and share on social media.  In addition, she will use her BlogTalk Radio Show to interview psychotherapists and other professionals to advance the Best Practices information.

Her virtual courses include Healing Through Love Seminar Series and the Love Touch Heal Relationship System.  Her current 30 Day Love Challenge is a comprehensive 30 day experience of delving into the many components of healing through love, including the brain, hormones, emotions and spirituality.

Get a more thorough understanding of Dr. Erica Goodstone’s philosophy, experience, offerings or schedule an appointment at DrEricaGoodstone.com and DrEricaWellness.com.

Essential Oil Use on the Rise

Essential Oil Use on the Rise

Published May 19th, 2015 in Alternative PerspectiveAlternative TherapiesWhat’s in the News by Tammera J. Karr, PhD

Over the last year more and more clients are asking me about essential oil use for the prevention of super bugs and illnesses. The use of essential oils for health dates back to beyond the ancient Egyptians. Herbal medicine has been used for more than burial and religious rites, it has also have been used for treating minor ailments and disease. The history of essential oils is intertwined with the history of herbal medicine, in most ancient cultures, people believed plants to be magical, and for thousands of years herbs were used as much for ritual as they were for medicine and food. While researching more information on this topic I was surrounded by texts both physical and electronic.

According to medical herbalist and healer Andrew Chevallier, the presence of herbs in burial tombs attests to their powers beyond medicine. In addition, fourth-century Greek philosopher Aristotle noted his belief that plants had psyches. The modern era of aromatherapy is dawned in 1930 when the French chemist Rene Maurice Gattefosse coined the term aromatherapy for the therapeutic use of essential oils. He was fascinated by the benefits of lavender oil in healing his burned hand without leaving any scars. He started investigating the effect of other essential oils for healing and for their psychotherapeutic benefits.

So instead of completely reinventing the wheel let me share with you the following article from the Alliance for Natural Health–April 14, 2015, A New Tool for Antibiotic-Resistant Killer Bacteria: Essential Oils; What should you stock to protect yourself?

A few weeks ago, we reported that, while many across the country are concerned about measles, which occurs in a largely vaccinated population and has caused no deaths, a larger threat wasn’t receiving proper attention: drug-resistant tuberculosis—and antibiotic-resistant “superbugs” in general. These infect at least two million Americans each year and kill 23,000, according to the Centers for Disease Control and Prevention (CDC)1.

As we’ve reported previously2, superbugs are created through antibiotic overuse—both by doctors who rely too heavily on antibiotics and by industrial farming operations. Consider these statistics: a Medscape poll found that 95% of healthcare professionals said they prescribe antibiotics when they aren’t even sure they’re needed3. A whopping 70% of all antibiotics4 used in the US are used on livestock.

But there is another, lesser-known contributor to what is regarded as one the world’s largest public health threats: pharmaceutical companies.

According to Karl Rotthier5, the chief executive of a Dutch-based pharmaceutical firm, antibiotics are making their way into rivers and waterways due to lax safety measures. Some of the drugs are flushed directly down the toilet, while others pass through the patients first—and it all ends up in the water supply. Too many drugs come from manufacturing waste. Some rivers in India, in fact, have higher concentrations of active antibiotics than have been consumed by all the patients who were prescribed the drugs.

“Poor controls mean that antibiotics are leaking out and getting into drinking water,” Rotthier said. “They are in the fish and cattle that we eat, and global travel and exports means that bacteria travel. That is having a greater contribution to the growth of antibiotic resistance than overprescribing.”

To make matters worse, a recent Texas Tech study6 found evidence that antibiotic-resistant bacteria from feedlots can be dispersed through the air. It has been known for a while that resistant bacteria can spread through manure and water, but this study is the first study7 to indicate that superbugs can become airborne and infect humans that come into contact with them.

As dire a problem as antibiotic resistance now is, conventional medicine’s answer is to research and develop ever more drugs and continue down the same path of “one-size-fits-all” medicine that, as we’ve seen, is not sustainable.

Fortunately, and as many regular readers will know, there are alternatives to using pharmaceutical antibiotics:

  • • We’ve reported on8 the anti-pathenogenic properties of colloidal silver, the world’s oldest known antibiotic.
  • • Two studies have now linked vitamin D to the successful prevention and treatment of TB. In the first study9, white blood cells converted vitamin D to an active form of the vitamin, which helps make a protein that kills the TB bacterium. In the second study1o Indonesian scientists compared vitamin D to a placebo, testing both on seventy patients for nine months. The patients who received 10,000 IU of vitamin D (rather than the 600 IU recommended by conventional medicine) had an astounding 100% cure rate.
  • • Some evidence suggests11 that vitamin C could be effective in fighting antibiotic resistant infections.
  • • There have also been studies12 showing that ozone therapy—which increases the amount of oxygen in the body—can be an effective treatment for TB.

Further, a recent article in The Atlantic13 magazine highlighted the antimicrobial qualities of plant extracts and essential oils. The article notes that “various oils have also been shown to effectively treat a wide range of common health issues such as nausea and migraines, and a rapidly growing body of research is finding that they are powerful enough to kill human cancer cells of the breast, colon, mouth, skin, and more.”

The article indicates that the most immediate, practical application of this knowledge is on farms to reduce antibiotics used on livestock, one of the largest drivers of antibiotic resistance. But preliminary results have been encouraging for human use as well:

  • • An Italian study14 found that thyme and clove essential oils were effective in treating bacterial vaginosis.
  • • A US study15 found tea-tree oil was a more effective treatment for staph-infected wounds than conventional treatments.
  • • Additional research16 found that lemongrass oil could reduce MRSA.

It is becoming increasingly clear that conventional medicine cannot continue on its present course—otherwise, superbugs will certainly infect (and potentially kill) large percentages of the population. Integrative approaches offer a number of alternatives. Conventional medicine and the Big Pharma-financed media may scoff, but the science is firmly on our side.

As always a big thank you to the Alliance for Natural Health and their work.

To Your Good Health and Information
Article printed from The Alliance for Natural Health USA: http://www.anh-usa.org
URL to article: http://www.anh-usa.org/a-new-tool-for-antibiotic-resistant-killer-bacteria-essential-oils/
URLs in this post:
[1] according to the Centers for Disease Control and Prevention (CDC): http://www.cdc.gov/drugresistance/
[2] we’ve reported previously: http://www.anh-usa.org/superbugs-will-millions-die-needlessly-before-we-act/
[3] prescribe antibiotics when they aren’t even sure they’re needed: http://www.medscape.com/viewarticle/842160
[4] 70% of all antibiotics: http://www.washingtonpost.com/blogs/wonkblog/post/wonkbook-why-you-should-care-about-antibiotics-in-animal-feed/2012/04/12/gIQAOEfZCT_blog.html
[5] According to Karl Rotthier: http://www.telegraph.co.uk/news/science/science-news/11351611/Drug-companies-to-blame-for-antibiotic-resistance-says-pharmaceutical-boss.html
[6] recent Texas Tech study: http://ehp.niehs.nih.gov/1408555/
[7] this study is the first study: http://www.huffingtonpost.com/2015/04/01/texas-scientists-find-ant_n_6972362.html
[8] reported on: http://www.anh-usa.org/oldest-antibiotic-shows-promise-as-anti-cancer/
[9] first study: http://www.sciencemag.org/content/311/5768/1770.abstract
[10] second study: http://www.ncbi.nlm.nih.gov/pubmed/16479024?dopt=Abstract
[11] Some evidence suggests: http://www.anh-usa.org/do-antibiotics-contribute-to-mercury-poisoning/
[12] studies: http://www.ncbi.nlm.nih.gov/pubmed/1906618
[13] a recent article in The Atlantic: http://www.theatlantic.com/health/archive/2015/01/the-new-antibiotics-might-be-essential-oils/384247/
[14] Italian study: http://www.ncbi.nlm.nih.gov/pubmed/21428248
[15] US study: http://www.ncbi.nlm.nih.gov/pubmed/23848210
[16] research: http://www.bioline.org.br/abstract?id=pr13110

Combined Treatment of a Substance-Abusing Offender with Auditory Hallucinations

Combined Treatment of a Substance-Abusing Offender with Auditory Hallucinations


Terry K. Sanderlin, EdD, LPCC, FAPA

The treatment aspects of this case study are accurate, but certain case information and identity data has been altered to protect the identity of the client.


Isaac was a 30-year-old male with a significant history of substance abuse dating back to his 14th birthday.  Isaac’s introduction to drugs and alcohol began in middle school with his peers, who drank alcohol and smoked marijuana.  Isaac had little parental supervision at home, as he had an absent father and a mother who worked long hours to pay the household bills.  As Isaac’s drug and alcohol use progressed, his school grades declined, until he finally dropped out of school in 10th grade, by his 16th birthday.  After dropping out of school, Isaac worked in menial jobs at minimum wage and continued to increase, and vary, his drug use to include cocaine and amphetamines.  Isaac’s first contact with the criminal justice system came when he was 16 years old, shortly after he dropped out of school.  Isaac was arrested for auto burglary.  He appeared in juvenile court and received a probated sentence and community supervision.  As part of his probation, Isaac was required to complete high school or obtain a general equivalency diploma.  He chose the latter option, completing his GED prior to his 18th birthday.  By age 30, Isaac had two felony convictions and was on parole supervision for residential burglary after completing a term of incarceration.  Isaac was required to submit weekly urine samples to his parole officer to ensure he didn’t use drugs and alcohol.  One of Isaac’s urine samples had been positive for amphetamines, and Isaac’s parole officer issued a warrant for Isaac’s arrest.  He was subsequently arrested and incarcerated at the local detention center.  During his jail stay awaiting a parole hearing for violating conditions of his community supervision, Isaac began experiencing auditory hallucinations and was placed in the psychological services unit of the jail.  During his stay at the jail’s psychological services unit, he was administered a trial of neuroleptics, which failed to eliminate the auditory hallucinations.  Isaac also developed a sense of anxiety as a result of the auditory hallucinations, which he experienced in the form of threatening animal growls and significantly curtailed his ability to sleep.

Community Corrections Program

My agency was a community correction’s provider, so I was contacted to interview the subject to determine whether he would be acceptable for entrance to my outpatient-counseling program.  During my interview with Isaac, I also administered a House Tree Person test (HTP).  Results of the HTP showed a number of factors, in his drawing that supported substance abuse and trauma-related background.  Emphasis of the mouth, when he drew the person on the HTP, suggested possible oral conflicts.  Many times, this is representative of alcoholism and verbal outburst.  His drawing of a person was slanted, and the person had short folded arms, faint lines, and no feet.  This can be indicative of anxiety.  His tree figure was placed to the left side of the paper, and this can suggest an emotional imbalance, and possible conflict with, his mother.  Also of interest was the presence of scars on his tree.  A knothole in the bottom quartile of the drawing suggested both feelings of inadequacy and a trauma background dating back to when he was about 6-8 years old.

Psychiatrist Interview

Isaac was approved for outpatient counseling and released into community corrections with an electronic monitor and daily contact with his parole officer.  He was released the day of his appointment with my consulting psychiatrist, who noticed signs of a history of anxiety, depression, trauma, and substance abuse.  Isaac was prescribed Zoloft, a serotonin re-uptake inhibitor designed to increase the levels of serotonin in the brain, and weekly psychiatric visits until he was more stable.  Isaac was scheduled to see me for additional test measures two days later, and he was found to be free of auditory hallucinations at that time.

More Testing and a Treatment Plan

Isaac was administered the Personality Assessment Inventory.  The results and follow-up interview suggested not only a significant history of substance abuse, but also post-traumatic stress disorder (PTSD).  In order to give Isaac the best opportunity for a positive treatment outcome, a multiple treatment plan was developed between Isaac, his psychiatrist, and myself as his primary therapist.  Isaac’s treatment plan included two monthly visits with his psychiatrist for medication monitoring and adjustments.  He was placed in individual therapy utilizing cognitive therapy to process the cognitive aspects of his trauma background.  Hypnosis became a tool in Isaac’s therapy in order for Isaac to recall previously forgotten memories of abuse by his father.  Isaac was also placed in a small social skills group, which focused on relapse prevention, assertiveness skills, relaxation training, and the redevelopment of his life-task skills that included leisure time pursuits, vocational testing and career exploration, relationship skills, and values identification.


Isaac was a success story.  He was able to successfully complete his parole supervision without further incident.  He completed his counseling program and was able to manage his emotions, be substance-free, maintain employment, and develop positive relationships.



About the Author

SanderlinDr. Sanderlin began his introduction to counseling by initiating a drug withdrawal program for military personnel addicted to heroin during his service in the Republic of Vietnam. Upon his return to civilian life, he studied psychology and sociology at the University of New Mexico and was a volunteer family counselor for first time offenders. After completing a bachelor’s degree, Dr. Sanderlin worked as a counselor at a halfway house for recently released inmates on parole supervision.  He also was employed with the inpatient wards of the Bernalillo County Mental Health Center, providing individual and group counseling for both axis I and axis II diagnosis. In 1983, after completing his Masters degree in counseling, Dr. Sanderlin began a private practice in Albuquerque, New Mexico.  Dr. Sanderlin adopted the philosophy of treating the individual with regard to life-task skills, which incorporates family relations, peer associations, vocational aspirations, leisure time pursuits, and the patient’s belief system. Dr. Sanderlin also completed a doctorate with a major in Training and Development, and a minor in Counseling in 1993.

During the early part of 1989, Dr. Sanderlin began a group social skills training program for bad check writers pending prosecution. These programs were run in cooperation with the McKinley County and Bernalillo County District Attorneys’ offices. Dr. Sanderlin also began programs with criminal offenders on probation and parole within Bernalillo County. From 1991 through 2001, Dr. Sanderlin was awarded state grants to provide individual, group, and social skills interventions to offenders within the Community Corrections program. Dr. Sanderlin also was awarded a grant to provide clinical services to mentally ill criminal offenders on community supervision. Dr. Sanderlin has also been awarded federal grants to provide vocational services to drug offenders.

From June 1991 through September 1998, Dr. Sanderlin was employed as a Counseling Psychologist with the Department of Veterans Affairs, Vocational Rehabilitation and Counseling Division. Dr. Sanderlin provided test assessments, counseling, and vocational rehabilitation plans to physically and mentally disabled veterans. Dr. Sanderlin has also provided training at the Department of Veterans Affairs Training Academy on the management of disruptive and angry individuals. While with the Department of Veterans Affairs, Dr. Sanderlin revised the testing procedures and initiated a group-testing program in the Albuquerque office to speed intervention to veterans. Dr. Sanderlin also received three consecutive superior performance awards from the Department of Veterans Affairs. Dr. Sanderlin has a number of journal publications on offenders, anger management, substance abuse treatment, and technostress. He has also developed a social-skills manual for offenders and a video training tape on inhalant abuse prevention for elementary aged children. Dr. Sanderlin has also been employed as a school counselor. His biography appears in Who’s Who in America, and he is a Fellow of the American Psychotherapy Association.   

Use of the Finger Labyrinth in Solution-Focused Therapy

Use of the Finger Labyrinth in Solution-Focused Therapy

Benjamin Nieves-Serrano, MSW

George A. Jacinto, PhD, LCSW, CPC
University of Central Florida School of Social Work

Reshawna Chapple, PhD, MSW
University of Central Florida School of Social Work

Originally published in Annals of Psychotherapy, July, 2015


This paper presents a plan for using the finger labyrinth in association with Solution-Focused Therapy (SFT).  The introductory sections provide an overview of the association between SFT and the phases of labyrinth work.  A literature review includes a description of SFT, and the history of using the labyrinth in psychotherapy is discussed.  The single and Intuipath® types of finger labyrinths are presented.  Phases of labyrinth work in the context of SFT are described.  A case study describes the implications for the use of SFT in association with labyrinth-tracing.

Keywords: Solution-Focused Therapy, Labyrinth, Walking Labyrinth, Finger Labyrinth

Learning Objectives:

  1. 1. Discuss the use of the labyrinth in SFT.
  2. 2. Summarize the phases of SFT labyrinth work.
  3. 3. Examine the use of the three phases of labyrinth work in the context of a case example.

The American Association of Integrative Medicine® (AAIM) provides this continuing education credit(s) for certified members, who are required to obtain 30 credits every 3 years to maintain their certification.

To take CEs click: HERE


The finger labyrinth, in the context of Solution-Focused Therapy (SFT), is a kinesthetic approach offering clients a robust therapy experience.  The kinesthetic movement within the labyrinth may enhance the cognitive, emotional, and spiritual dimensions of therapy.  Use of the labyrinth involves all of the senses by employing visual, auditory, and kinesthetic learning pathways.  As clients move through the labyrinth, they can be holistically focused on solutions to the problem on which they have chosen to work.  They will develop a sense of how the issue is impacting their daily lives.  When discussing previous approaches that have been used to address life issues, clients are helped to build cognitive resources that can be used to address current circumstances.  As therapy proceeds, the next step involves clients addressing the problem and the development of goals.

First, a review of the literature examines the kinds of therapeutic uses of the labyrinth currently in practice.  Second, a brief discussion of the types of labyrinths is presented.  Third, an explanation of the phases of finger labyrinth work set the stage for a more in-depth example.  Fourth, a hypothetical case example demonstrates how each phase of the labyrinth process can work with SFT.  Fourth, implications for the use of SFT and the finger labyrinth explore current and future potential uses of the Intuipath® in the therapeutic process.  Finally, the conclusion reflects on the implications for further study.


Literature Review


Solution-Focused Therapy

SFT empowers individuals to build strengths, resources, and support systems.  In SFT, problem-solving is accomplished through focusing on solutions intended to overcome problems or barriers.  The client is viewed as an expert in the helping process, and is capable of producing positive change while maintaining self-efficacy.  SFT is founded on the strengths model and encourages individuals to become involved in the helping process (Shulman, 2011).  The therapist develops a therapeutic alliance with the client that reinforces self-determination, and encourages the client to find solutions to the problem.  In SFT, the therapist assumes the role of a guide or helper on the client’s journey toward solutions and positive outcomes.  The therapist utilizes an array of SFT questions to build rapport, develop insight, and formulate treatment plans.

There are a few questions and techniques that enhance the SFT process.  Coping, exception, scaling, and miracle questions provide unique insights into possible strengths, resources, support systems, and solutions.  A brief description of each technique follows (refer to Table 1 for additional questions):

  • Coping Questions: The therapist asks clients how they manage to keep going despite the difficulties they face.  The client then discusses personal strengths and resources when having faced similar problems in the past.  These questions are used when a client’s normal approach to problem-solving is not working (Langer, 2011).  For instance, “when this happens, how do you deal with the situation so that you can function?”
  • Exception Questions: On the assumption that the problem is less serious some of the time, and sometimes absent, the therapist explores with the client the frequency and severity of the problem.  For example: “Can you think of a time when you did not have a problem with gambling?” or “Can you talk about what happens that is different when the problem does not happen?” (Djukic, 2007).
  • Scaling Questions: The therapist may use scaling questions to assess client progress in therapy.  The client considers a scale from 1 to 10, with 10 meaning that the client is certain the problem can be solved.  The therapist might ask: “What number represents where you are on the scale today?” (Langer, 2011).
  • Miracle Question: The miracle question asks the client to visualize life after solving the problem.  This way of visualizing the future draws the client toward the solution.  The therapist might ask: “Think of yourself experiencing a miracle while you sleep tonight, and when you awaken in the morning your current problem is solved.  When you wake in the morning, what would be the first indication that the miracle has happened?” (Djukic, 2007)


Focusing on solutions fosters positivity, hope, and well-planned resolution of problems.  One tenant of SFT is that the future can be created and negotiated by the client (de Shazer, Dolan, & Korman, 2007).  SFT theorists suggest the future has opportunities for hope, and clients are able to capitalize on those possibilities.  Hope and expectancy are vital components to psychotherapy, accounting for 15% of outcome variance (Lambert, 1992).  Hope and expectancy lead to a therapeutic environment of possibilities.  This engenders motivation, as achievable goals are developed by the client and therapist.


Table 1.  SFT Question Examples
Question Type

Examples of Questions

Coping What keeps you hopeful for the future? What do you do to keep things from getting worse? Discuss a time your problem occurred, and you were able to overcome it.
Exception Are there times you notice the problem does not exist? Describe a day in the last month when your problem did not occur. What is different during the times the problem is not happening?
Scaling On a scale of 1 to 10, 10 being that the problem is completely solved and 1 being the problem is a complete disaster, how would you rate your situation right now? How would things have to be in order for you to feel you were at a 9 on the scale? Describe a time when you were at 3.  How did you progress to the 6 you are today?
Miracle If a miracle occurred while you slept tonight, how would you know a miracle has occurred? What would have to be different in your life after the miracle occurred? What would tell you the problem is never going to return?


The Labyrinth

The labyrinth is a symbol of wholeness that consists of an unhindered path from the entrance to the center (Artress, 1995; Bord, 1976; Jung, 1968).  The labyrinth is different from a maze, because a maze has obstructions intended to confuse the person seeking to find the center.  Walking labyrinths have been used for over 1,500 years (Westbury, 2001).  Numerous walking labyrinths have been built in the United States since 1995, and a listing can be found at www.labyrinthlocator.com.  Most contemporary labyrinths are patterned after the eleven-circuit labyrinth on the floor of Chartres Cathedral in France (see Figure 1).  There are other labyrinth patterns, such as the classic seven-circuit labyrinth and Cretan labyrinth that are also used by some psychotherapists (see Figure 2).  We will explore the two primary types of labyrinths appropriate for psychotherapy.


Figure 1. Eleven Circuit Chartres Labyrinth

Figure 2Seven Circuit Cretan labyrinth

fig1_468 fig2_468

Types of Labyrinths

There are two types of labyrinths: walking labyrinths and finger labyrinths.  However, one type can be used more effectively in psychotherapy (Hong & Jacinto, 2012).  Walking labyrinths are often found in public spaces or places of worship.  Because of the public nature of the walking labyrinth, it is not as conducive to psychotherapy because of the problems with privacy and confidentiality.  The finger labyrinth is preferred for psychotherapy practice and is the focus of the discussion in this paper.  The finger labyrinth can be used in the privacy of the therapist’s office.  There are two options in using the finger labyrinth. A single labyrinth (refer to Figure 3) and the Intuipath® (refer to Figure 4).

Figure 3. Single Finger Labyrinth


Figure 4Two-person/Two-Handed Intuipath®Finger Labyrinths


25”x13”x1/2” Plastic Children’s 2-Handed/2-Person Chartres Intuipath ®


36”x18”x3/4:” Extra Large 2-person/2-Handed Finished Maple 11 Circuit Chartres Intuipath ®

Finger Labyrinths

The finger labyrinth is an option that addresses privacy and confidentiality concerns since it is used in the therapist’s office.  The finger labyrinth is similar to the walking labyrinth except in the finger labyrinth, the client traces the path with a finger (Harris, 2008; Hong & Jacinto, 2012).  The therapist can keep a finger labyrinth in the office, thereby providing easy access.   The finger labyrinth can be facilitated in two ways (Hong & Jacinto, 2012).  The first method would be to have the client hold or place the single labyrinth (Figure 3) on the table and use a finger to trace the path of the labyrinth while conversing with the therapist.  The second method involves use of the Intuipath® that consists of two labyrinths (See Figure 4).  One side faces the client, and one faces the therapist.  Some may find the use of a marble to trace the path of the labyrinth easier than using the finger.  The Intuipath® can be placed on a desk or table for easy access.  Harris (2008) says the use of the Intuipath® leads to relaxation and quick establishment of rapport between the therapist and the client.  Jacinto has observed that finger-tracing provides a rhythmic distraction allowing for the client to more fluidly engage in therapeutic talk (Hong & Jacinto, 2012).

Use of the Finger Labyrinth in Psychotherapy

A review of the literature reveals several studies about the use of the labyrinth in clinical mental health practice.  The Intuipath® is reported to assist clients in experiencing insight into current life circumstances, problem-solving, and goal-setting (Harris, 2002; Hong & Jacinto, 2012).  The use of the finger labyrinth may reduce the number of sessions needed for clients to reach their goals (Harris, 2002, 2008).  The use of the labyrinth in the context of Reality Therapy was demonstrated by Hong and Jacinto (2012).  The questions of Reality Therapy nicely parallel the stages of the labyrinth walk.

Other therapists have used the labyrinth to assist clients with insight and healing, with positive results (Artress, 1995, 2009; Bloos & O’Connor, 2004; Harris, 1999, 2002, 2008).  In the DVD: Rediscovering the labyrinth: A walking meditation, clients talk about how the labyrinth has affected their lives when working through illness, artistic pursuits, spiritual growth, and mental health issues (Artress, 2009).

Phases of Finger Labyrinth Work Within the SFT Process

Preparation for the Labyrinth Walk and Processing of the Experience

While engaged in the therapeutic process, the therapist must decide whether or not it would be beneficial to use the labyrinth in SFT.  When considering the use of the labyrinth, the therapist may want to: (a) evaluate clients’ progress in therapy to determine if shifting focus would assist in a break-through; (b) determine if clients are interested and ready to use the labyrinth in therapy; (c) decide if using the labyrinth would assist clients in shifting their perceptions of the problem, thereby leading to a solution; (d) consider whether the use of the labyrinth metaphor fits with the clients’ way of viewing their situations; and (e) consider whether the clients’ past way of addressing adversity has them stuck, and the labyrinth may facilitate movement toward a solution to the problem.

While the timing depends greatly on each client, the use of the labyrinth may be beneficial in the early to middle working stage of psychotherapy.  It is important to note that therapy unfolds in stages, and the first stage is to establish rapport with the client.  The therapist then completes an assessment and intervention plan with the client.  In SFT, the client will articulate the problem and begin to work on a solution with the therapist.  While there are a number of opportunities to use the labyrinth in psychotherapy, the therapist must use discretion as to when to discuss use of the labyrinth with a client.  Labyrinth work may lead to a significant amount of therapeutic material that will be processed over several therapy sessions.  The therapist may also have the client trace the labyrinth several times during the course of psychotherapy.  Repeating the labyrinth experience may reinforce the clients’ progress and assist clients in finding new insight and solutions to their problems.  Each time in, the labyrinth brings with it new inspirational words to ponder since the words help solve the problem.

SFT Working Phases in the Labyrinth

The use of the finger labyrinth within SFT is divided into three working phases: Entering Phase (beginning to trace the labyrinth from the entrance to the center); Centering Phase (arrival and work in the middle of the labyrinth); and Threading Phase (exiting the labyrinth from the center to the entrance).  The phases in working with the labyrinth involve specific SFT questions at each phase.  The client is prepared to work on subsequent questions after spending an appropriate amount of time discussing each question in the appropriate order.  The Entering Phase of labyrinth prepares the client for the journey through the labyrinth.  The client is provided a description of the process of finger-tracing the path of the labyrinth.  The client’s motivation for change, perception of the problem, and hope for solutions are areas on which the therapist continues to build.  The labyrinth in literature is often a metaphor for the unconscious.  By entering the labyrinth, the client symbolically explores her or his unconscious strengths and resiliency, leading to solving problems.  The individual should be encouraged and supported for initiating this journey.

Coping questions are used during the Entering Phase since they can help to identify ego dystonic or ego syntonic coping mechanisms.  Coping questions help to identify patterns of behaviors whereby the client maintains homeostasis.  When a problem arises, how does the client overcome or solve the question?  Coping questions assist in the identification of the client’s strengths, resiliency, resources, and support systems while engaging the client in the therapeutic process.  Coping questions at this phase empower the client and assist in cultivating self-efficacy.  Coping questions stimulate and help prepare the client for the Centering Phase.  In addition to discussing coping strategies, the therapist also uses scaling questions.

While scaling questions are not exclusive to the Entering Phase, they are used when appropriate in all phases of the client’s work.  Scaling questions serve a vital role throughout the use of the labyrinth, and they are utilized through each of the working phases of the labyrinth.  Scaling questions that begin during the Entry Phase gauge the client’s progression or regression through the working phases of labyrinth work.

The Centering Phase involves further processing and exploring the client’s struggles in order to establish the desired balance identified by the client.  Throughout life, clients are searching for balance, hope, and peace.  The client’s pathway through the labyrinth symbolizes the journey of life.  It enables individuals to develop insight and connection with the self and the unconscious.  However, much like life, the path toward the center is not always linear or direct. There can be many turns and redirections along the way.  The labyrinth serves as a metaphor, which becomes evident in the client’s journey through the labyrinth.  The discussion and questions prior to reaching the center prime the client for work to be completed in the center.  When the client arrives at the center of the labyrinth, there should be a brief celebration.  The client is encouraged to bask in the arrival at the center.  Then he or she reflects on the direction the path is leading at this point in the labyrinth walk.

The process of change and empowerment continues as the therapist asks a miracle question.  The therapist explains the miracle question and provides an example (see Table 1 for examples of miracle questions).  Then the therapist asks the client to consider the optimum outcome of therapy.  Responding to the miracle question helps the client concretely envision the outcome goals.  This provides insight for the individual and therapist and assists the client in developing a clear plan to overcome the problem.  The miracle question is a critical intervention in the client’s journey because solutions, strengths, resiliency, and goals are uncovered.

The miracle question aids in identifying a desired state or “miracle reality” for the individual.  The miracle question introduces a time distortion that aids in facilitating the client’s creative abilities.  The miracle question assists the client in creatively visualizing a positive outcome to psychotherapy (Kreider, 1998).  The future becomes negotiable, and the client is no longer constrained by the barriers or restrictions of the present reality.  The freedom provided by the miracle question allows the client an open environment suitable for exploration.

The therapist engages the client to explain and identify the details of the envisioned miracle reality.  The miracle-self discussion, introduced by the therapist, further encourages the client to experience the miracle-reality.  The therapist guides the client in a role-play with the miracle self that the client visualized.  The impact of using the miracle question is further enhanced by role-play and promotes positive and creative visualization of the future.  In subsequent discussion, the client further negotiates and understands the keys necessary to attaining the image of the miracle-self.  The ability to negotiate the future empowers the client and instills hope.  Hope is an invaluable component to the healing process in SFT.  While trying on the miracle-self persona, the image of the miracle-self includes ever-evolving images of potential strengths, resources, resiliency, and solutions.

The therapist and client begin to operationalize the miracle reality through reflection and analysis of the client’s present state.  Following the current analysis, the client will project the necessary steps to attaining the miracle-self.  The therapist will utilize the identified strengths and resources to assist the client in developing a bridge between the present and the future miracle-self.  At this point, the therapist may ask the client if an inspirational word would be helpful. If the client says yes, then the therapist would have the client select a word from a container with a number of inspirational words (a list of inspirational words is found in Table 2).  The client reads the word and talks about how it is associated with the current life problem.  The inspirational word will become an anchor that the therapist and client use to inspire the client toward the solution to the problem.  Prior to exiting the center of the labyrinth, scaling questions are introduced (see Table 1).  Scaling questions, discussed during the labyrinth walk, gauge the client’s progression or regression in finding a solution.

Table 2. Inspirational Words

Ending and Beginning









Change of Direction




New Start



New Vision







Goal in Sight










Inner Calling
























Letting Go












The Threading Phase takes place as the client begins the journey from the center of the labyrinth.  It is here where the client strives to attain the miracle vision.  The Threading Phase involves exiting the labyrinth in a victorious manner, as in the Greek myth about Theseus.

Theseus was assisted by Ariadne’s thread, which led him out of the labyrinth after conquering the Minotaur:

In the Cretan myth, the protagonist, Theseus, had to enter the labyrinth and conquer the Minotaur (a terrifying creature wreaking havoc throughout Crete) while finding his way through the many turns of the labyrinth.  Theseus was able to conquer the Minotaur at the center of the labyrinth and find his way out of the labyrinth with the assistance of the Greek Princess Ariadne.  The only way for an individual to find his or her way out of the labyrinth is by entering and exiting the same path.  Theseus overcame the labyrinth with the help of a thread that Princess Ariadne provided him before entering the labyrinth.  He used it to trace his way back.  The Cretan myth serves many metaphorical parallels to the therapist’s and client’s work with the labyrinth.  The labyrinth in literature represents the unconscious, the Minotaur represents the issue causing disruption to a client’s homeostasis, and the client’s work within the labyrinth represents one’s journey toward insight and centering.

The client and therapist continue to build upon the differences between the entering and exiting of the labyrinth.  Exception questions are asked by the therapist to identify moments in the client’s life where the problem is no longer present.  At this point, the therapist asks the client to describe how the miracle reality is being fulfilled.  The client identifies the differences between the present reality and miracle reality.  This line of questioning builds upon the coping questions earlier discussed, and now expands to recognizing all the moments where the miracle reality is being achieved in the individual’s life.

After tracing the labyrinth, the therapist further explores awareness, goals, and visions in subsequent sessions with the client.  To assist the client in continuing to reflect on the miracle reality, the therapist can provide homework assignments, such as journaling.  The client may record times when the miracle reality was present between sessions.  The homework assignments help the client experience the miracle image and will empower the client to reach the goal of therapy.  The client becomes the fully realized expert about his or her life and draws upon recognized and inherent strengths, resources, resiliency, and supports.

Case Example Using SFT and the Finger Labyrinth

The therapeutic effectiveness and practicality of SFT is well-documented (Berg & Dolan, 2001; Guterman, 1996; Guterman, Mecias, & Ainbinder, 2005; Hubble, Duncan & Miller, 1999; Simon & Nelson, 2007; Trepper, Dolan, McCollum, & Nelson, 2006).  While the labyrinth is growing in use among social workers and mental health therapists, there is limited evidence-based research as to its use in psychotherapy.  There are a few anecdotal accounts of its effectiveness (Artress, 2005; Bloos & O’Connor, 2004; Harris, 2008; Hong & Jacinto, 2012).  The authors believe that the use of the labyrinth in the context of SFT facilitates clients in reaching their therapy objectives.  The authors have used several role-plays conducted with students and therapists over the past several years.  The authors have demonstrated the use of the labyrinth in SFT at a state social work conference with graduate social work students, hospital social workers, and juvenile justice workers in East Central Florida.  The following example is a role play that took place during a state social work conference in 2013.

Kathy, a 39-year-old female, comes to therapy after her 14-year-old adolescent son, Jimmy, committed suicide 11 months ago.  She is the mother of two other children, an 11-year-old girl, Betty, and an 8-year-old boy, Tommy.  She has been married to her husband, Robert, who is an aerospace engineer, for 15 years.  Kathy is a nurse at the local doctor’s office.  A coworker at the doctor’s office was worried about Kathy’s mental state after her son’s suicide and encouraged her to seek counseling.  The first three sessions consisted of establishing a therapeutic environment, building rapport, and preparing Kathy for working with the labyrinth.

During the fourth session, Kathy is greeted and celebrated for continuing to engage in the helping process.  Kathy is asked if she wishes to work with the Labyrinth.  Kathy agrees, and the therapist provides a brief explanation of how the labyrinth will be used in this therapy setting.  The Intuipath® is used for this session, and the therapist emphasizes he will be working within the labyrinth with Kathy.  Before entering into the labyrinth, Kathy is asked a series of scaling questions.  On a 10 point scale, with 10 being the highest likelihood of change, Kathy is asked how likely she believes it is that she will find a solution to her situation.  At the beginning of her journey into the labyrinth, Kathy selects 5.  The therapist highlights the neutrality of her selected number and accentuates the possibility of progressing toward the positive spectrum of the scale.  The therapist asks Kathy to describe what a 7 would look like if it were occurring in her life at the present time.  At this point, the therapist encourages Kathy to begin traveling through the labyrinth.  Kathy begins to explain that she would begin to spend more time engaging in activities with her family and with her support systems.  She describes a time where she would go out with friends to restaurants, movies, and dancing.  She illustrates a life she once had and feels she has lost since her son’s suicide.  She has become more isolated and feels trapped.  She admits she has become fearful of what others think about her as the mother of a child who committed suicide.

The therapist begins to ask Kathy how she coped with the times she felt isolated and ashamed.  Kathy begins to describe the joy and peace that painting would bring her.  She describes the freedom and relief that painting provided her as an outlet, transferring her feelings to a canvas.  Kathy informs the therapist that she has a studio in her home where she can paint.  Kathy shares with the therapist a time last week where she went to see a play with a friend from work and explained the positive impact it had on her.

The therapist facilitates a transition to the center of the labyrinth.  Kathy is affirmed for making it to the center of the labyrinth and continuing the journey with the therapist.  The therapist explains the miracle question to Kathy and how it will be used in the helping process.  The therapist has Kathy close her eyes and visualize how her life would look if a miracle occurred.  The therapist inquires how Kathy would know a miracle had happened.  Kathy, with her eyes closed, explains her miracle-reality in which she is less restricted by pain and guilt related to her son’s suicide, and she sees herself continuing on her life journey.  The therapist asks Kathy what differences she notices or how she knows she is no longer restricted.  She reports that she sees herself smiling more.  The therapist asks Kathy to explain what would make her smile more.  She shares that she would be engaging in the routine activities she pursued prior to her son’s suicide.  Kathy discusses that she can see herself painting again in her studio.

At this point, the therapist encourages Kathy to imagine she was able to communicate with her miracle-self.  The therapist asks Kathy what types of questions she would ask if she had a chance to talk with her miracle-self.  Kathy claims she would ask how she was able to free herself from the pain of her son’s suicide.  The therapist asks Kathy to put herself in the role of the miracle-self and respond to her questions.  Kathy’s miracle-self says, “you are not free from the pain of your son’s suicide; however, you have chosen to no longer allow the pain to control or overwhelm your life.”  The therapist asks Kathy to ask her miracle-self how to make progress in reaching her goal, and her miracle-self responded, “the past cannot change; however, the mother you choose to be now can change.”

The therapist affirms Kathy for continuing to take steps toward positive changes.  The therapist now asks Kathy to select an inspirational word from a container with a number of positive words (see Table 1 for ideas).  The word Kathy selects is Courage.  The therapist and Kathy discuss what the word courage means to her.  The therapist reinforces Kathy’s courage for coming to counseling, her courage in sharing, and her courage to participate in the healing process.  The therapist encourages Kathy to continue to reflect on her inspirational word and to utilize it as anchor when the difficult days arise.  The therapist reintroduces scaling questions prior to exiting the center of the labyrinth.  Kathy is again asked how likely it is, on a scale of 1 to 10, that she will reach a solution to her situation.  Kathy responds to the question this time by saying an 8.  The therapist asks Kathy to describe what has occurred to cause her response to shift dramatically to the positive spectrum of the scale.  At this point, the therapist and Kathy continue toward the Threading Phase.

Kathy says she has a glimpse of what she was missing and a vision of what she wants in her future.  The therapist asks Kathy to discuss moments in the past days or weeks where she experienced her miracle-reality.  Exception questions assist in illustrating an alternate reality where the problem no longer exists and where positive change has occurred.  Kathy shares how last week she went on a picnic with her husband and how much it meant to her to enjoy time alone with her spouse.  The therapist and Kathy come to the entrance of the labyrinth.  The therapist encourages Kathy to continue noticing and looking for exceptions in the following week to discuss next session.  The therapist completes a reflection and discussion with Kathy regarding the use of the labyrinth.  The closing discussion assists the therapist in examining Kathy’s experience and response to working with the labyrinth, including whether to continue utilizing the labyrinth in future sessions.

Implications for Psychotherapy

The finger labyrinth provides a therapeutic environment that allows clinicians and clients to engage in the symbolic journey of life that results in solving problems.  The labyrinth serves to reinforce the therapeutic relationship as the therapist assists the client in his or her efforts to solve the presenting problem.  The labyrinth enforces the guidelines of SFT by allowing the client to assume the role of expert in his or her therapeutic work.  At the same time, the therapist assumes the role of a guide for the client.  The metaphorical journey through the labyrinth assists the client in recognizing his or her self-determination, and allows the client to reframe the notion that one’s path in life is not always linear.  The circuitous nature of the labyrinth can more accurately represent the journey of life.  The suggested circuitous nature of one’s life path, drawn from the labyrinth exercise, can allow the client to accept and progress in life more successfully.  The client develops skills to work on future problems.  In the past, the linearity of one’s journey would have suggested that the client was stuck or regressing at certain points.  Alternatively, the labyrinth presents the notion that the client’s journey is continuing, and the client is still progressing towards the center.  The labyrinth exercise enhances the SFT techniques by reframing how the client views not only the self, but also how he or she views life.  The labyrinth exercise, coupled with SFT techniques, allows for more negotiation and acceptance of the future, which can bring about positive therapeutic outcomes.

One of the authors has demonstrated the finger labyrinth in graduate clinical social work over the past five years.  In one online role play using synchronous technology, the student playing the client observed that she did not know how emotional she would become until she began to finger-trace the labyrinth.  The student playing the therapist and the student playing the client were pleased with the outcome of the labyrinth practice.  The student playing the client remarked that she liked the finger-tracing because it provided her with a focused circuitous distraction while she comfortably engaged in solution talk.

In a face-to-face role play, the person playing the role of the client stated that she found the finger-tracing to be relaxing and that selection of the inspirational word nicely integrated into her work to that point.  She said as she traced the path from the center to the entrance, the inspirational word was a confidence-builder for her.  The word gratitude helped her realize that solutions in her life were providential.  She further asserted that this insight helped her see that gratitude had become a theme in her life.

A 32-year-old workshop participant wanted to work on forgiving a family member.  She was informed that she was going to be doing her work in front of the group, and she agreed she wanted to do so, even signing an informed consent.  The role-play did not seem to be going well at first, and then when entering the center of the labyrinth, she breathed deeply.  She realized that she was very much like her mother.  In response to a scaling question when she entered the labyrinth, she said she thought the likelihood of reaching forgiveness was around a 3.  As she talked about her relationship with her mother, she decided she wanted to forgive her.  In the center of the labyrinth she drew the words letting go and started to laugh.  A particularly hurtful incident had happened when she was a teenager, and her mother would not let it go.  The incident was driven like a stake into their relationship.  The student decided she would let go of the pain and talk with her mother about reconciling.  She was surprised about her progress using SFT.  Often, when clients want to work on some form of forgiveness, it is likely they will succeed at reaching that goal in therapy.  After the demonstration, several students reported that they used the labyrinth in their practice with adolescents and disabled individuals with success.  The nature of SFT is brief, and often a therapist may only use the finger labyrinth once.  For instance, if one is working on forgiveness and succeeds, then the therapeutic goal is met and therapy would end.

Further research that explores the efficacy of the finger labyrinth with SFT will most likely support the early work with the labyrinth SFT.  There is a dearth of literature on the use of the labyrinth in therapy.  Therefore, disagreement with the use of the labyrinth was not found in the literature.  Certainly, the use of SFT and the finger labyrinth is not appropriate with clients whose reality testing is impaired, or do not wish to engage in the use of the labyrinth.  There is some indication that the Intuipath® has been used successfully with children who are diagnosed with ADHD (Yutalas &Harris, 2013).  In a study with 87 children, results indicated that children moving both hands while tracing the path of a Cretan Intuipath® and running both hands through a sand tray experienced behavioral benefits over time.


SFT and the finger labyrinth process engage the visual, auditory, and kinesthetic learning pathways.  The kinesthetic element of labyrinth-tracing, with its circuitous pattern, assists in integrating the two sides of the brain (Harris, 2002).  Upon arriving at the center of the labyrinth, the client experiences brain synergy that enhances the client’s insights and understanding of current life circumstances.  Once these insights are enhanced and the client is more aware of issues surrounding the presenting problem, the therapist facilitates the process of change, which is the goal of therapeutic healing.  Through the process that occurs at the center of the labyrinth, the client explores life circumstances and is better able to visualize the change that needs to occur.  It is at this point that the client selects an inspirational word and begins to envision the solution that is best for his or her life’s circumstances.  Next, as the client walks out of the labyrinth, the client is encouraged to discuss how to become the miracle-self.  Once the client leaves the session, he or she will continue to use the inspirational word to solidify the resolution to the dilemma.

The finger labyrinth is an engaging tool for use in the practice of SFT.  Its circuitous path integrates miracle, scaling, and exception questions.  The Center Phase of the work provides a stage for significant change where the client often is able to shift focus when responding to the miracle questions.  The accompanying inspirational word provides an anchor with which to memorialize the vision and path toward solving the client’s current issues.



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About the Authors

Benjamin Nieves-Serrano

Nieves-SerranoBenjamin is a MSW Social Worker for the Case Management department at Cape Canaveral Hospital.  Benjamin Nieves-Serrano earned his MSW degree from the University of Central Florida, BS degree in Psychology from the University of Central Florida, and A.A degree from Brevard Community College.  He has developed a Bullying Psycho-Educational outreach tool for the Crosswinds Youth and Family Services Non-Residential program.


George A. Jacinto

JacintoDr. Jacinto is an Associate Professor at the University of Central Florida School in Social Work. His research interests focus on caregiver issues, spirituality in clinical practice and community development.  He is interested in the use of the labyrinth in psychotherapy practice and wants to learn more about the kinesthetic efficacy in psychotherapy.  He has published 13 peer reviewed articles, 11 book chapters and currently has 3 manuscripts in submission with peer reviewed journals.


Reshawna Chapple

ChappleDr. Chapple is an Assistant Professor at the University of Central Florida School in Social Work. Her research interests include Black and African American families, culturally competence social work practice, disability studies and deafness and mental health. Dr. Chapple’s dissertation entitled: Being a Deaf Woman in College is Hard. Being Black Just Adds: Understanding the Complexities of Intersecting the Margins, explored issues of intersectionality, identity and belonging in college students who are Black, deaf and female.

Bio of Dr. Erica Goodstone

GoodstoneDr. Erica Goodstone, Love Mentor and Relationship Healer, is a Licensed Mental Health Counselor/Professional Counselor and Marriage Therapist, Licensed Massage Therapist practicing body psychotherapy, AASECT Certified Sex Therapist, American Academy of Pain Management Diplomate, and BCC Certified Personal/Life and Health/Wellness Coach.  She has been a member of American Association of Integrative Medicine (AAIM) since the inception, having presented at the joint conference with APA in 2005 in San Diego, CA.  Her article, “What is Body Psychotherapy” appeared in the first Journal of the American Association of Integrative Medicine (JAAIM).  Her books include: Love Me, Touch Me, Heal Me: The Path to Physical, Emotional, Sexual and Spiritual Reawakening (available complete or as smaller books, ebooks, Kindle and Smashwords.com books), the romantic novel Love in the Blizzard of Life (completed during the NANOWRIMO National November Writers Challenge), and chapters in several collaborative books including “Holistic and Touch Therapies” in The Continuum Complete Encyclopedia of Sexuality.  She has also published hundreds of articles about love, relationships, aging, and healing for Self-Growth.com (where she was selected as Official Guide to Intimacy), YourTango.com (prominent relationship site), and several others. As a Diamond Author for Ezinearticles.com, Dr. Erica was showcased as 1 of top 20 out of 400,000 Expert Authors.  Her first web site was SexualReawakening.com and her early blog sites include:  CreateHealingAndLoveNow.com/blog and HealthyBabyBoomersNetwork.com.

Dr. Erica served as chair of the AMHCA Body Therapy Special Interest Network from 1992-1998, chair of the AASECT NYC Metropolitan Area Section from 1994-2002, Science and Research Committee Chair (on the Board of Directors, original Steering Committee, and newsletter editor) for the U.S. Association for Body Psychotherapy from 1996-2002, Marketing Committee Chair for the International Association of Rubenfeld Synergists from 2001-2002, as well as AMTA Educational Programming Subcommittee Chair from 1992-1995.

Since 2008, Dr. Erica has been training with master marketers to learn about virtual presentations and online marketing.  She created a web site, MarketingOurPractices.com to showcase the important work of psychotherapists and to educate them on the value of collaborating and sharing rather than competing and only self-promoting.  To facilitate this, Dr. Erica created the Marketing Our Practices Facebook Page to share valuable articles and events as well as the Marketing Our Practices Facebook Group, a place for psychotherapists to connect and share on social media.  In addition, she will use her BlogTalk Radio Show to interview psychotherapists and other professionals to advance the Best Practices information.

Her virtual courses include Healing Through Love Seminar Series and the Love Touch Heal Relationship System.  Her current 30 Day Love Challenge is a comprehensive 30 day experience of delving into the many components of healing through love, including the brain, hormones, emotions and spirituality.

Get a more thorough understanding of Dr. Erica Goodstone’s philosophy, experience, offerings or schedule an appointment at her main website DrEricaGoodstone.com and DrEricaWellness.com.

Click here for Dr. Goodstone’s Amazon listing.

Let’s Work Together

Let’s Work Together


by Erica Goodstone, PhD, LMHC, LMFT, LPC

When I was invited to create this Best Practices column, I felt both grateful and humbled.  My goal is to encourage psychotherapists and allied professionals to work together to support each other in our efforts to educate the world about the life-transforming work that we do.  None of us can do it alone.  We must work together.  At a time when coaching practices are proliferating, and many people suggest that therapy is not necessary, I plan to be a strong voice reminding you each month that YOUR WORK MATTERS more than you know.  The amount of ongoing education, training, supervision, caring, and commitment that goes into developing competent therapeutic skills is not generally recognized by the public at large.  Although there are some highly qualified coaches, I have personally known many who use good sales techniques, quick-fix strategies, and personal life experiences, without adequate training or supervision, to coach others about how to live their lives.  They get high fees without having to deal with cumbersome insurance companies.  Their promises of easy and quick formulas for success, rather than doing the sometimes difficult internal work to truly heal from the past can sometimes prevent emotionally unbalanced people from seeking the therapeutic help they desperately need.

In the aftermath of increasing senseless violence, the general population tends to point a finger at gun control.  Since my focus has been about creating love, I have often said that if people feel loved, then they cannot and will not want to hurt another person.  Every time I see one of these horrendous abuses and murders, I repeat that to myself.  And then, in the August 2015 American Mental Health Counselors Association magazine, The Advocate, I read an article explaining the upsurge of violence from the perspective of mental health care.  Norman E. Hoffman, Ph.D., LMHC, LMFT, revealed what he believes may be the underlying cause of much of the violence we have seen in recent years.  He tells us about the Community Mental Health Act of 1963 (CMHA), which provided federal funding for community mental health centers in the U.S.  Then he recalls that around 1974, “the funding for these centers dried up, and at-risk patients no longer received treatment for many of their mental health needs.”  Dr. Hoffman warns that what we need is “early identification, diagnosis, and treatment of those who are at-risk and in need.”

No well-meaning psychotherapist alone can educate and influence the leaders, lawmakers, and general population of this country about the importance of treating mental health issues at all ages.  If we work together, we CAN spread the word about the many ways we help our patients to heal.  We need to develop a mindset of collaboration, cooperation, joint ventures, and supporting each other.  Social media provides a perfect opportunity for mutual support, yet too many therapists seem to use it merely as a way to self-promote in an attempt to build a bigger practice.  However, every one of us is so much more believable and credible when touted by our colleagues, rather than promoting our own work.  Here, we will present some of the best marketing practices and the most productive ways to use social media for the benefit of all.  We will discuss how to handle legal matters, the pros and cons of solo vs. group practice, local vs. virtual/global practice, the requirements and availability of specialty trainings, evidence-based treatments for specific diagnoses, and more.

Please feel free to send me your questions, comments, subjects you want to see covered, and topics that you, as experts, would like to share here.  DrErica@DrEricaWellness.com

Join the Marketing Our Practices Facebook group https://Facebook.com/groups/MarketingOurPractices if you are ready to collaborate and share on social media.

I look forward to working together with you to strengthen our professions in the coming months.


Erica Goodstone, PhD, LMHC, LMFT, LPC