What Are Some of the Differences Between EMDR and Brainspotting?

Clinicians often ask me about the differences between Brainspotting and EMDR. I hope you find this chart helpful and I welcome your input.

As an Approved Brainspotting Consultant and training assistant, I have the privilege of certifying other therapists in Brainspotting. Brainspotting training is offered through Dr. David Grand’s website www.brainspotting.com. Attendees are encouraged to begin using Brainspotting after they complete the first three-day training (Phase 1). Certification requires attending Phase 1 and Phase 2 trainings and six consulting sessions.

If you are interested in getting trained in EMDR, I did my initial training with the EMDR Institute https://www.emdr.com/ which teaches the Standard EMDR protocol. I completed the certification process over the following year. Next, I attended Laurel Parnell’s Attachment Focused EMDR training and became an approved Attachment Focused EMDR provider. Parnell’s training was more aligned with my theoretical orientation, and I found her streamlined protocol easier to use than the standard EMDR protocol. You can learn more about her trainings at https://drlaurelparnell.com/training/

Whichever path you choose, I recommend investing in consultation. These are both powerful, trauma modalities and you will benefit from building a strong foundation in your skills.

If you are trying to decide which training to take, do your homework. Read about each modality and see what resonates with your theoretical orientation; talk with your colleagues. If you are an over achiever like I am, you might decide you want to learn both. My website, mariagray.net offers links to EMDR and Brainspotting resources. The comparison chart on the last page may help you with your decision. I hope this article helps explain some of the difference between these two powerful, healing modalities. Feel free to reach out to me through my website with any feedback or questions you may have.

Exploring Our Financial Countertransference

One of my business practices is to examine my finances practically and psychologically. This consists of reviewing my financial progress on a weekly basis and exploring my countertransference in my own individual therapy. My early experiences with money shape the way I react in the present and examining those responses informs my clinical work. As therapists we are faced with the task of collecting our fees while simultaneously helping our clients explore their feelings and processing our own financial countertransference. This is not easy!

When I started my practice, my desire to help a potential client sometimes superseded my own monetary needs. I hadn’t yet learned how to tolerate my empathic responses during business transactions and sometimes the fees I set were too low; fortunately, my private practice supervisor helped me deepen my awareness of what was happening for me during these calls.

The choice to offer a reduced fee or lower a client’s existing fee can impact our clinical work. A therapist may feel resentful when their fee is too low and the client reports that they just returned from a two-week trip to the Bahamas. Or the client may end up feeling infantilized or indebted to the therapist which could be a reenactment of their relationship with a parent. These are two extremes, and a wide range of possibilities exist in between.

Unexamined financial countertransference can impact a therapist’s economic wellbeing and deprive the client of the opportunity to explore their uncomfortable feelings about money and experience the increased self-esteem that is a byproduct of investing in one’s own mental health. There are countless opportunities to discuss money with our clients including: late cancellations, fee increases, declined credit cards, and missed payments.

In group therapy we discuss late or missed payments with the entire group. I’ll say something like “Is anyone aware of not having paid for group this month?” Members have a chance to explore their reactions in the moment and the process sometimes evokes historical feelings or anger toward me. Sometimes members’ late payments could be an indirect expression of their desire to leave the group.

The discussion of payment in group offers members an opportunity to talk about a subject that our culture tries to politely avoid. We take the time together to explore what the client may be communicating with their late payment. Often this leads to a highly fruitful group discussion. The last time I raised my group fees one of my clients reacted so strongly that she later realized she needed to ask her boss for a long overdue raise.

In his book Difficult Topics in Group Therapy: My Journey from Shame to Courage, Jerome Gans, MD, advises therapists to prioritize the exploration of clinical material over managing financial transactions. He explains that so much can be gained by discussing the client’s feelings about money, especially if it’s done in the moment. Gans writes that managing the transaction first can shut down clinical discussion, whereas waiting to process the charge creates space for the client to express their feelings about the possibility of being charged.

In the example of a late cancellation for an individual session, I don’t charge my clients until we see each other at our next appointment. I’ll mention that I noticed they did not send their payment for last week; Then I wait. Sometimes this leads to an expression of anger toward a partner who failed to come home on time and care for their child while the client was in session. Other times we end up talking about their credit card debt, or feelings of resentment toward me for charging them for the missed appointment. If it’s relevant, I’ll ask my client how they are feeling about our work and our progress toward meeting their goals. In some cases, they simply forgot to pay me and there is nothing to explore.

Talking with our clients about money should be just like talking about any other topic we discuss in therapy. We must be willing to do our own money work so we can feel comfortable exploring financial issues with our clients.

References
Jerome S. Gans (1992) Money and Psychodynamic Group Psychotherapy, International Journal of Group Psychotherapy, 42:1, 133-152, DOI: 10.1080/00207284.1992.1173258

Buckets of Money

Most people are uncomfortable talking about money and I’m committed to helping my clients understand the psychology of money and the impact it has on our lives. I’ve read many books about money and I’m fascinated by the way our attitudes about money and worth influence our countertransference and the fee setting process. One of my favorite money books is Bari Tessler’s- The Art of Money. Tessler is a somatically trained financial therapist who teaches a yearlong online money course which I took several years ago. One of the many valuable practices I learned was to divide my money into separate “buckets”. These buckets help me organized my finances and avoid “surprises” at tax time.

My first bucket is a business savings accounts labelled “quarterlies”, I transfer money to this account every week so that when the end of the quarter comes, I have enough money to pay my taxes. My second business savings account is labelled Gray’s Bank which I use for my rainy-day fund to cover me during slower times and to save money for training and other “big ticket” expenses.

I use the same system to manage my personal finances, and the structure is based on my personal values and interests. I value fitness and I invest in yoga and Pilates classes (currently online) which I purchase in packs of 20. I’ve created an account called “Pilates and Property Tax” for my property taxes, yoga and Pilates, and an “Adventures” account that I use to save for vacations. In the past I’d charge my vacations on a credit card which resulted in having to pay off a large debt when I returned home. Now I have the money ready and I can pay for my vacations immediately without any pressure.  I have a main savings account where I’ve saved six months of living expenses. Most financial professionals recommend saving at least a year of expenses, so I’m working on building up that account. 

Maybe this sounds like too many accounts to you, perhaps you’d prefer just one or two. I’ve found that paying myself first and planning for emergencies, vacations, fitness expenses and taxes has created more ease in my financial life. It helps me manage the ebbs and flows of income that come with being self-employed.  What buckets might you use if you were organizing your money this way?

Rest: Why You Get More Done When You Work Less

I’m currently reading a book entitled “Rest: Why You Get More Done When You Work Less” by Alex Soojung-Kim Pang, which explores our relationship to rest and work. Pang is the author of four books and the founder of Strategy and Rest, a consultancy devoted to helping companies and individuals harness the power of rest to shorten our workdays, while staying focused and productive.

Pang believes that you can work better if you learn how to rest better, he challenges our culture’s “respect” for overwork, citing William James’s 1899 essay “Gospel of Relaxation” in which he argued that Americans had become accustomed to overwork and lived with an “inner panting and expectancy” bringing a spirit of “breathlessness and tension’ to work. James could have been describing my years working in the corporate world, prior to following my calling and changing careers.

I enjoy being a psychotherapist and have found that I am at my best when my days are shorter and include a long midday break. I see clients Monday through Thursday and use Fridays for administrative work, yoga/walks and Brainspotting consultation. In the early days of my practice, I was more interested in creating a sustainable business than focusing on work/life balance, so I worked on Saturdays and late into the evening; this was hard for me but it helped me grow my practice. Now that my practice is established, I can see clients during the hours that work better for me. I have more energy in the mornings, so I schedule more sessions early in the day, followed by a ninety-minute lunch break and two clients in the afternoon.

Pang states “If you want rest, you have to take it. You have to resist the lure of busyness, make time for rest, take it seriously, and protect it from a world that is intent on stealing it.”

I wrote this post shortly after returning home from five glorious days in Santa Barbara, the place where I go to hike, bike, eat delicious food and rest. Prior to the pandemic I scheduled time off every three months and this vacation was my first in six months. When I decided to plan a trip, I spoke to my primary care physician and she advised me about how to stay healthy during the trip. My five days felt blissful, with no access to email or voicemail and most of my time spent out in nature.

As a therapist, I sometimes experience a sense of “fullness” at the end of the day where I cannot imagine taking in any more information. It feels like my mind needs to be emptied and time away from work creates room in my brain and body; Pang’s book cites research explaining how rest can create space in our brains for creative thinking. Sometimes just a small amount of restful, quiet space is all I need after a busy day. I like to create a clear divide between my sessions and my evenings, sometimes I’ll take a short walk or sit outside on my patio. I notice that on the nights when I don’t have enough quiet time after work, I struggle to stay asleep. Pang explains “While you sleep, your brain is busy consolidating memories, repairing physical damage, and generating dreams. Most of the time you’re not aware of all this work, but it’s been going on your whole life. And your life depends on it.”

Are you allowing yourself enough time to rest?

Are We There Yet? Deciding When to Return to In-Person Sessions

Throughout the pandemic therapists have been engaged in social media debates about when/how to return to in-person sessions with their clients. I’m writing my article after watching a video where the Executive Director of CAMFT, Nabil El-Ghoroury, PhD, CAE weighed in about seeing clients in-person during the quarantine. He suggested we carefully consider the decision and cautioned his readers not to pressure themselves into making a hasty decision. El-Ghoroury stated that he planned to continue to see clients via telemedicine through Labor Day and would revisit his choice at that time. After watching his video, I took some time to reflect on the logistics of in-person sessions; my feelings about it deserve a separate blog post.

I knew I wasn’t ready to return yet, but I wanted to consider my options for the future and writing this post helped me gather my thoughts. The first question was masks. Right now, I wear a mask when I am out in public, except for my early morning runs when very few people are outside and the world seems almost normal. The thought of wearing a mask does not feel conducive to my work as a trauma therapist, where facial expressions help me attune to what’s happening inside of my clients and my face helps regulate their nervous systems. Some of my clients choose not to wear a mask, how would that work?

I’m concerned that my clients’ journey from their cars to my therapy room could be activating. We have seven offices in our suite and approximately twenty other suites in our large, three-story building. As I considered the entrance to the building, keypad, and elevators, I realized that on the way to my office my clients could encounter people who might not be wearing masks or practicing social distancing; I wondered how these encounters might impact their sessions, there would certainly be “grist for the mill.”

Antibacterial wipes would be available at the entrance to the suite. Once they made it to my office, clients could text me to bypass the waiting room and I could meet them in the outer hall. How would we handle it if another person’s client was walking out when I was escorting my client in? There is no way to stagger the schedules of seven clinicians, even if we all started and ended our sessions precisely on time, which is never going to happen.

Once we made it to my office, I imagined my chair being six feet away from my client, which feels way too far. To handle the credit card payment I’d have to roll my chair over to my client, and once they handed me the card I could swipe it, show them the amount on the screen and sign for them. Once I gave the card back, we could have another round of hand sanitizer. I realize I can keep a credit card on file, however, the fees are significantly more expensive, and it eliminates the chance to explore any potential financial transference as the client pays for their session.

I decided to ask my doctor for some recommendations, and she strongly recommended that I wear a mask at all times and require my clients to wear a mask. She advised me to wash my hands frequently and use antibacterial hand disinfectant with 70% alcohol. She told me to avoid touching my face and to wash my hands after touching any door handles.

Writing this article has helped me see that there is no magic business process that will allow me to feel perfectly comfortable returning to in-person sessions. We all have different opinions about this issue, and it can feel adversarial when colleagues communicate their judgment on social media. Writing this article has led me to decide to continue to practice telemedicine (via ZOOM) for now. Although it presents some challenges, I have been able to do important, clinical work during this time. Two weeks ago, I returned to the comfort of my air conditioned, quiet office, away from the many distractions at home and the noise of my neighbor’s bathroom remodel. I’m wearing my mask, washing my hands and using antibacterial wipes on the door handles. My doctor’s suggestions proved to be helpful as I navigated the reentry process, sharing a restroom and elevators with other people.

I will continue to reevaluate my decision as I learn more about the Covid-19 virus. I know there is no perfect solution, but it’s clear to me that I don’t want to do therapy with a mask on and I am not willing to risk my health or the health of my clients in order to see them in person. I’m interested in your ideas about this and would welcome a discussion.