Wednesday, July 22, 2020

Positive Vibes

This exercise is designed to get some positive sharing and discussion going with a group. This activity can work well in person as well as when using telehealth. There is a main version and an alternate challenge version.

Directions -

Everyone in the group should get one of the “positive vibes word topics”. The group leader can let people choose their own or assign them. One way to do this with telehealth is to cut and past the word definitions into messages using the chat function available on most telehealth platforms. In person, you can cut the words out and have people select from a pile at random or else pass them out. Its up to the group facilitator

Next, taking turns one by one, group members should share with the rest of the group about their positive vibes word topic. There is only one rule:

People can share any way that they want too as long as they keep it positive, but for those who may have difficulty with this, here are some suggested guidelines for sharing:

What does your word mean to you personally?

What are some examples of this in your own life?

What do you personally think helps to increase this positive thing in your life?

When each person is done sharing, to increase the positive vibes applaud if you want too. Then before the next person shares, process some of the group’s reactions and feelings about the presentation together as a group. Some suggested process questions for group members (optional):

What stood out to you about the presentation on this positive word?

Can you relate to anything you heard?

What can you use or apply in your own life with what you heard about this positive vibe word?

Version 2 – Challenge: Share, GUESS and Discuss

Version 2 is more of a challenge and may be better for a more experienced and cohesive group than version one which could work for just about any group.

Version 2 for this activity adds one challenge – The person sharing should not use their word in their presentation. Then, after the presentation allow group members to try to guess the topic based on what they heard. Then proceed with the follow up discussion as in Version 1

Positive Vibe Word Topics


Tuesday, July 7, 2020

Therapy Tips for Telehealth

Using telehealth as a therapist can have its challenges. 

Here are some telehealth therapy tips to help:

Know your platform – Whatever telehealth computer system you are using, it makes sense to practice working with it so that you understand all of the features and nuances of the platform. Learn how to share your screen for instance and also make sure you know how to use comments and screen backgrounds. A lot of these features can be very helpful, especially in group therapy

Prepare your telehealth environment – Using telehealth is not usually physically as comfortable as sitting in an actual room with your client(s). So, it makes sense to prepare your telehealth setting ahead of time to make it as comfortable as possible. For example, if you are running a group make sure you have a drink handy, as well as a pad and pen to take notes if needed and even have things like pillows and blankets for your comfort especially with longer sessions like IOP groups which can be 3 hours or longer. It may make more sense to have two devices handy in case you need the extra screen to look something up during the session. Having enough outlets and chargers nearby is also something to consider. Of course, also make sure your environment is confidential in addition to being comfortable.

Log on to sessions early – When possible try to allow some extra time to make the online telehealth connection, send links, and troubleshoot problems when clients are unsure how to connect for the session on the telehealth platform. Its best to be the first to log on so you can anticipate problems ahead of time and be ready for them and then help others to walk through technical issues on their end.

Have back up plan for technical problems – For example if the sound is not properly working, make sure you have a cell phone handy with a number that you are comfortable letting the client(s) know about. If using a personal cell phone and you don’t want the client to know your number, get a Google Voice number 

Be ready to do more listening than usual – This is especially if you are more of an active talker in session as a therapist. There may be a delay using telehealth at times, so it can be difficult to interject in sessions if that is something you are used to doing. It can be much more challenging to slip in follow up questions if the client is on a roll and for some reason the telehealth platform is not cooperating when you attempt to do so. You may find yourself having to carefully choose your moments to speak in session when telehealth issues disrupt the flow of the therapy communication.

Prepare, prepare, prepare! – Preparation is a good practice when it comes to therapy in general but during telehealth sessions preparing ahead of time has even more importance. This is especially true when using activities or other forms of media, as in group sessions. Everyone who has done telehealth so far has learned that some ideas that work well in person may at times not translate as well to telehealth – especially when the telehealth system is glitching or problematic. It is best to have back up simpler activities in case something you planned just is not working well. has a lot of stuff to choose from including group activities, power points, podcasts, and some videos for therapy sessions.

Have some “go to” questions and phrases ready to keep things going when sessions are lagging or just not flowing ideally -  When using telehealth for therapy, it is important to increase your “awkwardness tolerance”  - There are bound to be more awkward and uncomfortable moments when using telehealth, as communication can at times be strained or challenging when compared to talking in person. Having some prepared questions and other ideas can help break through these moments. Some prompts to start these types of questions/statements that can break things out of a funk may be something like: “Can you give me an example of…”. “It would be great if you could show/describe/expound a little more about …”, “Do you mind if I ask you about…”, “I would be really interested to hear your thoughts/views on…” – The key point is to be ready to kick start communication when it hits a lull due to telehealth issues.

Take advantage of telehealth “letting you in” – We often never get to see our client’s homes. Why not use telehealth to allow them to show you around if they are comfortable? Let them show their pets, their children, their backyard, or anything that they want to show you that is appropriate. These types of things can enhance the engagement process and help with building the therapeutic relationship. A real-life example: A therapist was working with a challenging teenager via telehealth and the teen was preoccupied complaining of hunger. The therapist allowed the teen to go to the kitchen to make a snack while they talked. This flexible approach ended up really helping the session build momentum when otherwise it had stalled. Allowing a restless client to take the session outside can be another way to let telehealth work for you instead of against you. (Always keep confidentiality in mind by reminding the client of this when new locations chosen)

Get in the habit of being more descriptive and ready to follow up for clarity and understanding when needed  (But not too much, don’t overdo it)- Keep in mind that using telehealth doesn’t allow us as therapists to have access to nearly as many nonverbal cues in communication which can be a challenge. Therefore, it makes sense to be prepared to take the extra time to follow up and ask your client(s) about their level of understanding of whatever it is you are discussing in session. Motivational Interviewing skills such as empathetic reflection, open ended questions, and summaries are essential tools for therapists in telehealth. Lack of nonverbal cues often necessitates making sure you are connecting by following up a little more than you may be used too when compared with in person therapy when a client’s body language, gestures and facial expressions are much more clearly seen in context.

Be flexible and positive (even when you don’t feel like it) If clients complain about telehealth, it can be helpful to show empathy by validating their concerns and even sharing that you too would prefer to be in person. However, the overall attitude about telehealth that you express is one of the most important factors in its success in your therapy sessions. Even if you do not like telehealth, embrace the challenge with as much positive energy and enthusiasm as you can. By contrast, if you go into telehealth sessions with dread and apprehension, it will likely show to your clients. It can help internally to remember to be grateful that telehealth is allowing you to keep working when otherwise you may not have been able too. Always try to look at the bright side of things even when telehealth can feel like an emotional grind as well as a technological nightmare at times. Telehealth, with all its flaws is still a much better reality than a world with no telehealth in times of need, so it is important to keep that in mind. “Let’s all do what we can to make the best of this” is a great way to look at telehealth challenges both with yourself and with your clients especially when things may not be going as smoothly as planned in telehealth sessions.

Practice self-care – We tell our clients all of the time to use coping skills and to establish healthy outlets to get through challenging times. We, as therapists need to practice what we preach for ourselves, especially when using telehealth which can be stressful. Have a plan for mini “doses” of self-care throughout the day by taking “two minute vacations” and giving yourself time to refresh by breathing, getting up for a minute to walk around, having a healthy snack, or doing whatever you know how to do to relax and refresh your mind, body and spirit. Also, at the end of the day a routine of healthy self-care, fresh air, exercise as well as positive outlets to disconnect and detach so you can “recharge” can make such a difference in a telehealth therapy environment.

Taking the Escalator Tools for Therapists (Click to view)

Wednesday, July 1, 2020

Describe, Draw and Describe

Describe, Draw and Describe

Intro – This is another activity that translates well to telehealth but also works face to face. The process of this activity directly corresponds to the title, which is self-explanatory:

Describe: The counselor or group leader should read one of the picture descriptions provided or use one of their own. When reading the description, try to use feeling and read the description in a slow, expressive manner so as to give the listeners time to think, feel and use their imagination

Draw: While the counselor is reading the selected picture description, each person in group should draw what they are hearing and feeling. There is not wrong way to do this as the focus of this activity is using art for self-expression, and this is in no way an art contest.  If someone feels that they are terrible at drawing, it is okay as the group has to agree that art is not to be judged on appearance but again the art is more of a means helping identification and articulation of one’s personal thoughts and feelings

Describe: When everyone is done drawing, the group should take turns showing their picture to the rest of the group. On telehealth, this can be done by holding up the picture in front of the camera so others in the group can see it*. While showing the picture to the group, the person who drew the picture should describe what they drew while expressing what they were thinking and feeling when drawing various aspects of the picture. At the end, the person who drew the picture should give a final explanation about what the picture means to them and how they felt overall about the picture. The counselor should be prepared to draw out the group participants thoughts and feelings with open ended questions to stimulate discussion *If anyone is really resistant to showing their picture, the counselor can provide the option for the picture to be explained without showing it. However, people in group are encouraged to take a chance and be willing to share without fear of judgement.

Take turns and allow everyone to show and share about their picture. If there is time the group can try more than one of the descriptions

Sample Picture Descriptions:

Thought/Feeling - Based Narrations for Drawings (Imaginative – free form)

“The Future I Hope For”
(Read title first) - ”The Future I Hope For”….What is that to you?...Think about where you want to be one day…when you are where you want to be…Think about why you are here today…and where you will be when you know that you have achieved your goals…You have the life you want…You have the people around you that you want to have in your life…You feel the way you want to feel when you have finally achieved your goals one day…Think about what your life will really be like…Keep it real and not just a fantasy…What will you be doing…What will you be thinking?…What will you be feeling?…What will the people you care about be thinking and feeling…What will this new life that you want so badly be all about to you?

“My Positive Escape”  
(Read title first) – “My Positive Escape” – Now that you are working on recovery from whatever issues you are facing, what do you do for a positive escape…Where do you go?...Who, if anyone is there with you?...What are you doing with yourself?….What is it like to feel the peace and satisfaction of taking a break from stress?....What’s it like to get away from your problems for a little while?…What are you thinking about when you are in your happy place, doing your happy thing?…What are you feeling?...What is happiness for you…

“The World I Want”
(Read title first) – “The World I Want” – This world has a lot in it that needs to be fixed, but for a few minutes think about the world you would want…What is it like there?...What are people like in your world?...What are some of the laws and rules…Who is there with you in your world?...What do you do in your world?...What are you thinking about it your world?...What does it feel like to live in your world?

“Rising from the Chaos Toward a Life of Peace”
(Read title first) - “Rising from the Chaos Toward a Life of Peace” – What was the chaos in your life that you want to leave behind…What specific things are in that chaotic life that you are letting go of…How do you feel as you are letting go of the things you don’t want or need in your life any longer?…Now what is it like to move forward toward a more peaceful life?...What is included in this new peaceful existence?...Who are you bringing with you into your new life?...How does it feel to move toward a better life and to feel inner peace?...What is this new life like?...

“What’s Up with You Right Now?”
(Read title first) - “What’s Up with You Right Now?” – How are you doing?...What’s been on your mind?...How have you been feeling?...Let these thoughts and feelings guide your hand as you draw…Draw whatever comes to mind when you think about how you are doing right now…What do you want right now?…What do you feel right now?…What is it like to be you right now at this point in your life?...Let your hand just draw whatever it wants, there is no right or wrong…

“My Future Goals”
(Read title first) – “My Future Goals” – Start thinking about some of your goals and how you want to draw them…Use your imagination when choosing pictures or symbols to represent your goals…There are no right or wrong answers here, just let the pen draw your goals in a way that feels right to you…Try make sure goals from different life areas are represented…Recovery goals…Career goals…Family Goals….Relationships Goals…Health and Physical Goals…Financial Goals…Spiritual Goals about meaning and purpose regardless of what you believe in…Include any other goals on your mind that are meaningful and important to you

“Values and Priorities: What Means the Most to Me”
(Read title first) - “Values and Priorities: What Means the Most to Me” – Think about what is important to you…Think about the people…the things…and the ideas that mean a lot to you (like freedom, love, respect and any others that mean a lot to you)…Use different pictures and symbols to represent your values….Place things in important places in your picture to show your priorities if you would like to…Think about how these important values make you feel as you draw…

Descriptive Narrations:

“The Field” – Draw a field, anywhere and anyway you want...Draw yourself in the field doing anything you want…Put some animals in the field with you…Now add some people…Add trees, mountains and parts of the landscape…Add some water: a river or a lake or a waterfall…Make sure to add some flowers and other plants…How does it feel to be in this field you are drawing…What is going on in this field?

“The Movie” – Create a scene from a fictional movie of your own imagination…Think about your setting and start drawing…Is this an action movie or a drama or a fantasy or sci-fi or perhaps a love story?...Make sure to put in your movie characters…Fill in the background with details…Think about what is going on in your movie scene and let yourself draw…How are the characters feeling?. How do you feel creating and then watching this scene?

“The Group” – Draw a scene with a bunch of people in group therapy…It should not be this group but a group from you own mind… What kind of group is it and what is being achieved in the group by its members? …
Think about the different kinds of characters and personalities you are putting in the group…What is everyone doing?...What kinds of behaviors are going on in the group?...What is the counselor or group leader doing?...What is he or she feeling while running that group?...What are different feelings people in the group are experiencing?...

For additional ideas for drawings see Suggested Topics for Artistic Expression or Journaling