Featured

An Open Letter to the North Dakota State Board of Psychologist Examiners

If you have been following my career antics, you know that I have been applying for licensure in North Dakota. The folks at ADHD Online had ONE psychologist serving the state, and that psychologist retired. Rather than telling the people of North Dakota, “Sorry, no accessible ADHD testing for you,” they offered to help me get licensed.

I am happy to say that I jumped through all the hoops, crossed all the Ts, dotted all the Is, and received approval to practice!

Photo by Matheus Bertelli on Pexels.com This is what comes up when you search “North Dakota” in free stock photos and it’s…not wrong.

As I was completing the qualifications for licensure, though, I stumbled upon a state law that unsettled me. North Dakota requires psychologists and other professionals to register any client that they diagnose as autistic in a state registry, including completing an extensive, two-page document with detailed personal information about each client. The North Dakota Department of Health has information about this law on their website.

Reporting your clients is mandatory, and failure to report a client results in a $1,000 fine plus a report to the board, which could cost your license to practice. What if an autistic client does not want to be registered with the state? Too bad! According to the FAQ page on the website, it’s legal because North Dakota says so.

When I first came across this law in my test prep materials for the state licensing exam, I thought they were testing me. I thought, “This cannot be legal. They want to see what I do when I find a law that directly conflicts with my ethics code.” It wasn’t a test. But here is what I do when confronted with an unethical law.

I will not be conducting autism evaluations in North Dakota while this law is in effect because I cannot do so in a way that is simultaneously legal and in accordance with my professional ethics code and personal moral values.

This does not affect my work with ADHD Online because, for some reason, the North Dakota government only feels that autistic people need to be put on a list.

However, I have written a letter to the North Dakota State Board of Psychologist Examiners and copied the Department of Health and Governor Doug Burgum detailing how this law violates the APA ethics code as well as international laws regarding human subjects in research. My letter to the board is attached to an email noting that I am happy to do whatever I can to help support the board in lobbying to change this law.

You can read my letter to the board here:

What can YOU do? You can report this unethical law to the Department of Justice. The Autism Support Society shared detailed instructions via this Twitter thread about how to do this, and if the DOJ gets enough complaints, they can pressure North Dakota to repeal the law.

If you live in North Dakota, especially if you fall under this mandatory reporting law, please join me in writing to your licensing board, the Department of Health, and the state government demanding that they repeal this law.

BE THE CHANGE, friends. For more information about how to support autistic folks, please check out the Autistic Self-Advocacy Network.

Life Changes and How to Overcome Them

Thank you once again to Julie Morris, recurring guest blogger, for sharing tips for coping with and overcoming three common life challenges and stressors. I love being able to share different ideas and perspectives here.

White woman standing in a field of sunflowers on a sunny day, smiling and looking up at the sky, wearing a floppy hat.
Image via Pexels

Life is constantly changing. Of course, some changes are more serious and drastic than others – and more difficult. If you’re trying to cope with a transitional period, there are some tips from Resiliency Mental Health that you can use to withstand any change.

Handling a Career Change

No matter how long you worked in the same career, any change can feel overwhelming. Whether taking a job in a new industry, attending school to increase your opportunities, or starting your own business, changing careers is a major life change. Remember to care for yourself during the process. Before changing careers, do plenty of research. Consider your interests, skills, and hobbies before you launch into a new venture. Remind yourself that changing your career is not a failure. Many people choose to change their careers multiple times throughout their lives.

If your career change involves starting your own business, ensure you know how you want to structure it. LLCs, for example, have various benefits, including limited liability, less paperwork, flexibility, and tax advantages. You can form an LLC on your own or use a formation service. Both options help avoid the high cost of hiring a lawyer. When forming your LLC, look into specific state laws. Every state has its own laws regarding LLCs.

Once you have your business set up, the next step is marketing. These days, much is made of advertising via social media – and for good reason – but don’t forget about old-fashioned approaches like business cards, we can still be extremely effective. If you’re looking for pre-made templates, here’s a possible solution to get you started. And best of all, it’s free!

Living With the Death of a Loved One

The loss of a loved one can be difficult to process. Give yourself time to process the loss and to accept the changes to your life that are about to happen with the person’s passing. When it comes to grief, reach out to your support system as much as possible. Remind yourself of friends, family, and other loved ones as you cope with the loss. Be patient with yourself as you go through the various phases of grief.

Starting a New Family

Growing a family can feel like a hopeful, exciting new beginning but can also be overwhelming. Your responsibilities are about to grow, but that does not mean you cannot prepare for them. Remember to take time for yourself when it comes to family planning. Set up a routine that brings you comfort and boosts your health. Set aside time every week for exercise and mindfulness. Experts explain that you feel healthier and happier when you engage in physical activity.

Starting a family sometimes means it’s time to start buying a new home. Before you begin shopping around, check your credit score. Your credit score will help creditors determine if you are trustworthy to lend to. You can also look into various programs that help first-time buyers. A real estate agent can help you find homes within your budget and that you can realistically afford. If you can just barely afford a house, you may want to look into more affordable options so that you have money saved in case of emergencies or home repairs.

Life changes can sometimes mean good things are coming, and while others may be more upsetting, if you know how to care for yourself during times of stress, you can handle any change and acclimate to it. If you plan to buy a home during any life change, ensure you are well-prepared to handle it.

Resiliency Mental Health offers worksheets, articles, classes, and other resources for therapists, counselors, social workers, psychologists, teachers, parents, and organizers who are doing their best during this trying time. If you have questions, don’t hesitate to reach out!

Tips for Requesting Prior Authorization from Insurance

I’ve written before about my frustrations with health insurance as a barrier to mental health treatment, particularly insurance companies’ insistence that we prove that services are “necessary” before they will agree to pay (and then deny the claim that they agreed to pay).

health insurance scrabble tiles on planner
Photo by Leeloo Thefirst on Pexels.com

Sometimes, I have to contact insurance companies to request authorization before they allow me to help someone. Apparently someone who works in insurance and not mental health, who has never met my client before, knows more about what my clients need than I do. Depending on the situation, I may call or write a letter. Other times, the client contacts their insurance for authorization.

Depending on what is needed, insurers may respond to the client in a more helpful way than to me. For example, I have had clients successfully request that I be covered as an out-of-network provider due to one of my specialties – if I call the company and say, “Hey, I have no interest in contracting with you. Pay me anyway?” they would laugh me off the phone. My client, on the other hand, can call and say they are having trouble finding an appropriate in-network provider to treat them. Your insurance company is required to offer out-of-network benefits if none of their credentialed providers are available or able to help you.

All that to say – I write these tips as a psychologist who has requested prior authorization many times, but these tips can come in handy whether you are calling as a provider or as a client.

Here are the tips I keep in mind when I’m requesting authorization from insurance companies:

  1. Be Assertive, Not Polite. You are not asking for a favor. As a client, you are getting approval for a service which you as a client are paying for. It’s ridiculous that you have to ask them to cover a service when you pay a premium. As a provider, you are demonstrating the necessity of services with someone who, frankly, is not qualified to disagree with you. I will note in my letters that I have the expertise to speak to what the client needs, and this is my professional recommendation.
  2. Be Concise But Thorough. Get to the point quickly, but also explain the extent of the problem. Unfortunately, if the insurance company can argue that the situation is not dire enough, they will refuse to cover services.
  3. Reference The Evidence Base. Yes, yes, I know, when it comes to mental health treatment, “evidence-based care” is a mixed bag at best. But insurance companies want to know that the service will “work” so that they don’t have to keep paying for treatment in the future. Mention and cite any research backing indicating that the service is appropriate. For example, some policies do not want to cover play therapy, so I have some sources on hand documenting its appropriateness and benefit for young children.
  4. Use Their Language. Reference that the service is “medically necessary” and then state why. As I’ve said before, this phrase is ambiguous, but it is intended to mean that you require the treatment. For example, an ADHD evaluation is medically necessary if an individual wants to pursue medication options for their mental health difficulties because the prescriber needs an accurate diagnosis in order to know what medication to prescribe.
  5. Focus On The Money. Insurance companies do not care about you, your well-being, your treatment, or your needs. “I am struggling and need help, which this service will provide” is good to mention as it documents necessity, but the insurance company cares only about their bottom line. Explain how refusing to cover a service will cost them more in the long run. For example, when justifying twice weekly therapy sessions, I will point out that higher frequency of sessions may prevent a much pricier hospitalization.

Insurance companies broke profit records in the third quarter of 2022. They make their money by not providing the service you pay for, by not giving providers money we earned for work that we did. Go get your money.

Advice for New Authors: Beware Vanity Publishers

I was approached on LinkedIn recently by a vanity publisher, and it made me realize that many new authors might not realize why this practice is exploitive and problematic. So, I did what I always do when I’m angry about something, and I wrote a blog post about it.

books with folded pages
Photo by Viktor Talashuk on Pexels.com

I have published my books two ways:

  1. Self-publishing – all editing, formatting, design, and marketing falls on the author. The author finds a printer to produce the book, but the printer simply produces exactly what the author brings them. The author is responsible for any and all financial cost that comes with publishing the book. In self-publishing, the author then keeps all royalties and profits from the book because they did all the work. They also retain all the rights to the work.
  2. Traditional publishing – I pitch a book idea to a publishing company. When they accept, I am given a deadline for writing the manuscript. They provide editing and feedback, and we work together to produce the final draft. They may ask me about my preferences for things like the cover, but they have the final say in this area (and hire professionals to do the design work). They help with marketing and distribution. My contract specifies what the rules are around the rights to the manuscript, and I lose a certain amount of creative control. I am paid a royalty, or a percent of the resulting sales.

Depending on your goals as an author, both of these options are valid and legitimate. Like I mentioned, a traditional publisher may retain some of the rights around my work – for example, I cannot print my own copies of Telemental Health with Kids Toolbox and sell them without PESI’s permission. They invested money and labor into the layout, editing, design, and marketing of the book, so they have a right to profit from it just like I do.

On the other hand, I retain all rights to Armani Doesn’t Feel Well. I can unpublish it, give it away for free, print as many copies as I want, or release a new edition without getting anyone’s permission. I have full creative control, and I’m responsible for every aspect of the book, what it looks like, editing, and marketing it. If I had used illustrations instead of photographs, I would have had to either draw them myself or pay an illustrator out of my own pocket.

When you contract with a traditional publisher, your job is to provide a manuscript. Vanity publishers expect you to provide a manuscript and cover various costs that fall on traditional publishers. The publisher who contacted me said that it could cost me up to $8,000 to publish with them.

Many new authors who are unfamiliar with the business and are eager to get their manuscript out there might not realize that this is not okay. These companies are profiting from royalties (though if you check their sales rankings, they aren’t making much in that area) and from exploiting authors by charging them to publish.

The publisher I spoke to told me the benefit of working with them is that I retain the rights to my work, but I already retain the rights if I go the self-publishing route. If I’m financially responsible for edits, design, and distribution, and I have to pay publication fees, what exactly does this publisher do for me that I don’t get from self-publishing? From what I can tell, nothing.

Traditional publishing has had serious gatekeeping issues, but the beauty of self-publishing is that anyone can get their story told with minimal investment. For my first book, I Don’t Want To Be Bad, I went with a pay-on-demand printer (Kindle Direct Publishing) and did all the design and edits myself. My investment was $0 (minus my time and labor that went into creating the book). Of course, I could have hired a designer to make my cover and an editor to do the line edits, which may have been a good idea because I did have to re-publish after the first week when a friend spotted a typo I had missed. But again, why would I sacrifice a percentage of my royalties to a company? Why not just hire those services directly?

These vanity publishers prey on writers who want to get their story out there. My initial contact was through LinkedIn, a message that simply said, “Hi Dr. Amy! Have you ever considered writing a book?”

A list of my published books is on my LinkedIn profile.

I asked what made them choose to reach out to me. They said they look for people who are “at the top of their field” and “have something important to say.” How did they determine that about me if they did not even see the list of books I had already published before messaging me?

The answer is: they didn’t. They cold message people and flatter them, then tell them that this is the way to get their book out there. All it will cost is $8,000.

Yes, your story deserves to be told. No, vanity publishers are not the way to do it. Please don’t give these people your money.

Edit

After I published this blog post, an individual on Mastodon shared with me an experience with a vanity publisher that shed more light into how predatory these organizations are. This individual’s colleague paid £5000 (over $6,000 USD according to today’s exchange rate) to a vanity publisher and never received a penny in royalties. The publisher said it was because they made no sales, even though friends and colleagues had bought copies.

If the publisher was telling the truth and they were unable to sell a single copy, what did the author pay £5000 for? But the author had proof they were withholding royalties. When you self-publish, you know about every sale that you make. These publishers, who are already scamming you out of your money to publish the book, are under no obligation to prove to you that your royalties (or lack thereof) are accurate.

Authors deserve better.

Joint Drawing Platform: Aggie.IO

Hello telehealth lovers! I’ve written about the joys of using art interventions via telehealth sessions in the past, so I wanted to share another platform I discovered that lets you draw with your clients in real time.

blue orange and white abstract painting
Photo by Steve Johnson on Pexels.com

Aggie.IO lets you and your client create a canvass/”room” where you can create something together, or they can create something while you see their process as they create.

Go to the website and click “Start Drawing.” You can select the drop down arrow to decide what size drawing you want to make. It will take you to either a blank drawing or, if you have used the platform before, it will show you your past drawings. Select “New Canvas” or a drawing in progress. This creates a unique link, which you can share with your client via chat or through email.

When your client joins with the link, they will be able to draw with you in real time!

One thing I love about this platform is that you can save works in progress, so if a client wants to finish something they started previously, they can. As always, third-party platforms like Aggie.IO do not offer a BAA, so let your client know not to write “THIS IS FROM [NAME]’S THERAPY SESSION” or identifying information.

This site has a wider variety of tools than other similar websites, and I like that it has the save feature. You can import images as well, so you could upload a coloring page if your client enjoys those, or a photograph if that fits with any interventions that you use.

Keep being fantastic!

4 More Alternatives to Breathing Activities

Remember when we talked about alternatives to breath-based relaxation techniques? Well, I came up with four more. According to a leadership assessment I took several years ago, something I am really good at is collecting. Basically I store up everything – resources, activities, information, even other people’s strengths. It’s why, when someone contacts me about a project I am not a good fit for, I can almost always say, “But I have a friend who would be perfect for this!”

Anyway, all that to say I figured it can’t hurt to always have more relaxation activities on-hand that do not directly reference breath for when deep breathing may trigger trauma or physical pain, or for when a client simply prefers something else.

silhouette of person sitting outdoors
Photo by Martijn Adegeest on Pexels.com

Singing

If a client struggles to deliberately take deep breaths due to anxiety or because “deep breathing” is a personal trigger, singing with them can cue the same activity without using the triggering term. The client can choose a song they enjoy or one that reflects their mood. While you may feel self-conscious joining them, having the therapist sing along can increase the client’s comfort with the activity while modeling singing as a self-regulation skill.

Self-Massage

If you’re able, reach your right hand to your left shoulder, and give yourself a squeeze. Giving yourself a shoulder rub can promote muscle relaxation and bring down big feelings without specifically doing a breathing or muscle relaxation activity.

Color Visualization

Have your client choose their favorite color or a color that symbolizes calm and relaxation for them. Together, slowly imagine the color filling them up, starting with the bottom of their feet, moving up their legs, up their torso, into their arms and hands, into their neck, and all the way to the top of their head. This can cue muscle relaxation and calming breaths, again, without having to speak specifically to these activities.

Balance Activities

Sometimes when we are escalated, we lose touch with what is happening inside our bodies. This is especially true for trauma survivors. Balancing on one foot can bring the brain’s attention back into the body. Note: for this activity, if a client struggles with demand avoidance or for any reason prefers not to follow set commands, you can present this as “Do you think you can balance on your right foot for 10 seconds?” rather than telling them to engage in the activity.

CareDash Database Updates

Remember CareDash, the website that was making directory listings without therapists’ permission, some of which included folks’ home addresses? Well, I’m told that some people have had success having their personal information taken down without having to “claim” their profile.

new contact directory on flat screen computer screen
Photo by MART PRODUCTION on Pexels.com

(Remember, if you “claim” your profile, you agree to CareDash’s terms of service. This means you consent to their policies, including their unauthorized use of people’s personal and business information on their website. Personally, I will not be claiming my profile.)

Unfortunately, the site continues to make these profiles with often incorrect information, putting therapists in a liability Catch-22: we have an ethical responsibility to ensure that advertisements accurately reflect our practice, but many of us do not feel we can ethically claim a profile and endorse CareDash’s practices.

Personally, I contacted all of my licensing boards to let them know that the profile is unauthorized and why I did not claim it. All basically said “Ok thanks for telling us, we’ve noted that you did your part to be responsible.”

You can submit your link to Google to ask that it be taken off of their search engine for inaccurate information – this of course does not get rid of the profile, but it at least gets it off of your search results.

A colleague shared with me a letter they wrote to their state representative asking for them to help get rid of the various websites that use unauthorized profiles to drive traffic. (CareDash is the one that brought about this blog post, but there are dozens out there.) The colleague was kind enough to let me share the wording with all of you, so that you can forward your own letters and make noise about this. For their privacy, I’ve redacted their personal information at their request.

Dear [Representative]:

I was made aware of a business called CareDash that takes NPI listings and creates online profiles for therapists’ businesses.

These profiles are not necessarily correct, and when I checked mine, it was cross-referenced with another person with a similar name in another state! This is false advertising and creates a risk for my licensure, with an undue burden for me to address this unauthorized advertisement.

CareDash refuses to remove my listing, instead encouraging me to “claim” my profile. They are not approved by the Better Business Bureau and have a very loose disclaimer that they are using public information. I do not want to put my time and energy into an unethical business model.

Posting incorrect information about mental health services is harmful to the public.

I made a complaint with [State] Attorney General, and I will be contacting [Other State Representatives] as well.

Thank you for taking the time to review this concern.

Respectfully,
[Therapist name and credentials]

Letter to state representatives

My colleague also shared with me a letter from a state representative requesting that CareDash’s business practices be investigated. Again, they requested that I redact identifying information but gave me permission to share this from the letter:

CareDash’s use of NPI numbers and practitioner information poses a risk to practitioners’ reputations and to consumers’ ability to make informed health care decisions. These concerns have been raised nearly 800 times to the Better Business Bureau and to the Federal Trade Commission with seemingly very little effect on CareDash’s practices. I urge you to look into this matter and consider limiting the way that NPI records may be used by private companies.

The two main issues with CareDash’s use of NPI records are the creation−and subsequent management−of practitioner profiles without consent and the use of those profiles to attract consumers to offer services from affiliated sites for CareDash’s monetary gain. CareDash claims to provide consumers with a centralized list of mental health professional profiles aggregated from publicly available information, including the NPI registry. The creation of these profiles is problematic in itself because it creates a presumed affiliation with CareDash that does not necessarily exist. Instead of opting in, practitioners with NPIs are automatically added to CareDash, putting the onus on practitioners to monitor these types of sites for the use of their NPI and the management of their online presence.

Upon discovering their profile, many practitioners have complained that the information on CareDash is incorrect, does not match the information in the NPI registry, includes personal information (including home addresses and phone numbers), and/or includes additional information of unclear origin. Moreover, there is no opt-out option or ability to delete a profile. Currently, the only remedy is for the practitioner to claim the profile on CareDash and edit incorrect information. This course of action confirms affiliation with CareDash even when the practitioner would prefer to not be associated with the site at all.

Incorrect information is not only a concern for the reputation of the provider but for the patient who is looking to CareDash for accurate information regarding available providers. Without accurate information, potential clients cannot make informed decisions that are in the best interest of their health and wellbeing.
Additionally, CareDash’s profit model is dependent on sending prospective clients to affiliated sites. CareDash seems to use a bait and switch approach. It claims to have available information on mental health professionals but then suggests other practitioners who are ‘affiliated’ with them to book an appointment. This practice “may amount to a misappropriation of
[practitioners’] names and reputations for commercial gain,” a concerned raised by the National Association of Social Workers. Likewise, the American Counseling Association views CareDash’s compulsory action as an ethical dilemma for its members, one that was not created by the practitioner themself.

Letter from a state representative regarding CareDash

Unfortunately, websites like this one make it difficult for providers to accurately market our services, and they make it more difficult for those seeking care to find accurate information and connect with a potential therapist. Basically, it’s a lose-lose for everyone except for the affiliates lining their pockets with revenue earned using our unauthorized information.

I hope this story ends with system-wide reform that improves access to mental health care and accurate service information. Stay tuned!

Call for Psychologists: Resiliency Mental Health’s CE Review Board

Happy New Year, friends! As you may recall, one resolution I am working towards for 2023 is to begin creating affordable, high-quality continuing education programs. My first step in doing this is creating a list of psychologists who will independently review my CE courses.

Photo by Pixabay on Pexels.com

If you are:

  • A licensed psychologist in the United States
  • Currently in clinical practice
  • Interested in being part of ensuring that our field’s continuing education options comply with APA’s standards

Please fill out this form to be considered for the review board!

Reviewers will complete a training to ensure that they understand the requirements for CE programs. You will be compensated for your time completing the training at a rate of $150 per hour (the training should be approximately one hour). You will also be compensated for the reviews you complete at a rate of $75 per review, and compensation is not impacted by whether or not you approve a program for CE credit.

While my clinical focus is pretty broad, my main goal in applying for APA sponsorship is to create trainings that focus on neurodiversity-affirming and trauma-informed care. I have noticed that we are severely lacking in training that is affirming of neurodivergent clients, and many of the resources that do exist are taught by neurotypical professionals speaking for communities which they are not part of. I’m hoping to be the change with this.

Please pass this form along to any psychologists you know who might be interested. Let’s keep helping our field grow!

Dr. Amy’s Life Updates, 2022 Edition

Wow, can you believe we are reaching the end of the 36th month of 2020? How many weird colors do I have to dye my hair before things settle down? Because it’s more than two.

This year, I started a private practice and became my own boss. It has been amazing. The hours are perfect, and my boss is a genius. (I think my husband has a crush on her though…)

Tuxedo cat asleep on a couch, sprawled out
Armani found this year exhausting too

In personal news, we became homeowners in 2022! It was not a good year to be house shopping, but I’m known for making things more difficult than they need to be. After more than two years working from home, I finally have an office. When I’m off the clock, I shut the door, and the office is closed.

My husband started a doctoral program this fall. Soon we will be a paradox. (Get it?)

Fluffy light brown cat laying on a bed, looking relaxed
Vera is taking a rest from her busy schedule

I didn’t have any book launches in 2022, but here is what’s coming down the pipeline:

  1. Telehealth with Kids Toolbox, Volume II is in publication now. I’ve chosen a cover that I can’t wait to share with you! PESI says it should be available this spring. Rest assured that when I know something, you’ll know something.
  2. Clinical Documentation with Children and Adolescents has a complete first draft. Routledge has a different process than PESI, so I need to complete a checklist before I send it in rather than them sending me one task at a time. I end up with more control over the final product but also more things on my to-do list, which I see as an even trade. If they like my draft and there aren’t a ton of revisions, this one may be out in the spring too. Otherwise we may be looking at a summer or fall release.
  3. Why Didn’t Anybody Tell Me – I spoke with over 50 awesome neurodivergent people about their stories and experiences! Thank you to everyone who shared with me. This is still in the planning stages and we will see what it turns into.
Selfie of a white woman with green hair, black heart shaped sunglasses, and a light purple shirt. She is sitting in a car.
My other life update is that I look amazing.

And now a look to the future! Here’s what I’m planning and expecting in 2023:

  1. A children’s book – I’ve submitted the pitch and am very excited to see where this goes. It’s a cute story aimed at teaching kids about neurodivergence, both the awesome and the difficult. That’s all I will say for now, but I hope to have some updates soon.
  2. Resiliency Mental Health is applying for APA sponsorship to offer continuing education! My hope is to keep offering awesome educational content, including being able to offer continuing ed credit for them, and making the CE credits affordable. Again, stay tuned for updates.
  3. I’m tweaking how I manage my social media presence. Over the past few years I’ve become kind of a medium deal on Twitter, but I’ve struggled to keep the balance, avoiding doom scrolling, all that fun stuff. (I also don’t love all the decisions the current management is making.) I’m still doing scheduled posts to share information, keep folks updated, and hopefully make a few people smile, but I’m refraining from checking notifications or interacting at this time. You can find me on Mastodon since their lack of algorithm makes it easier to check in and log out, and of course I’ll still update the blog with varying consistency.

I hope your 2023 is calm, restful, and restorative.

Telehealth Activity: Blackout Poetry

Get ready, kids, because I’m about to age myself with a personal story. Years and years ago, when I was still a high school student and was touring colleges, I sat in on an undergraduate creative writing course. (My plan was to be a famous poet – how things change!)

The professor handed out newspapers, an ancient form of sharing information from before social media. Imagine if someone delivered your Twitter feed to your front door at 5am. That’s how we used to get our news. Anyway, he had us create blackout poetry from various articles.

person holding white ceramic mug on newspaper
Photo by cottonbro studio on Pexels.com

Blackout poetry is a form of creative writing where you take a written page and cross out, redact, or cover up words to create a new poem or story out of the words that remain. It’s a great creative activity that can yield some interesting insights about a client’s thoughts and feelings

This website lets you create blackout poetry online. They have some public domain texts pre-loaded that you can choose from, and you can copy-paste any text you would prefer to use. As long as the activity is for a session and will not be distributed, sold, et cetera, you can paste pretty much any text into the box on the website and use it for blackout poetry. You can also write your own text and make blackout poetry off of that.

You can screen share and grant the client remote control, or have them pull up the website and share their screen with you. The website works by choosing your text, clicking on the words you want to preserve, and click “black out.” It will cover any words not selected to save, like on my example here:

for a moment she found herself very well.

Unlike doing blackout poetry with physical paper, online blackout poetry lets you correct mistakes. If I forget to select a word, I can go back and add it, and it isn’t permanently covered by ink, paint, or whatever medium I am using. This is great for kids who want their art to turn out a specific way because they have the opportunity to fix their poem. On the other hand, the in-person version creates an opportunity to practice letting go and moving forward. I think both versions of the intervention have benefits.

Another way you can do this activity is jointly. You and your client can take the same text and create a blackout poem on your separate devices, and then each share what you came up with. This is particularly fun with groups, as each client can share their poem separately. For groups in particular, this kind of creative activity can lower inhibitions, since they are working with words already written down rather than having to come up with something on their own, which can feel vulnerable.

This is another creative intervention that taps into different ways of thinking and explores new ways for clients to express themselves.

How Cold Is It Really?

We are under a cold advisory right now, which I thought made a great metaphor for how we process and talk about trauma.

If you’ve spent any amount of time in the American Midwest between November and March, you’ve heard our sacred motto: “The cold wouldn’t be so bad if it wasn’t for the wind.” Sometimes this is just a lie to make ourselves feel better about our long, frigid winters – as I am typing this, the air temperature outside is -3 (Fahrenheit) with a wind chill of -15. Personally, I feel like that is still pretty cold even without the wind!

Other times, though, it rings true. The wind chill might drop the temperature from a not-fantastic-but-tolerable mid-30s day into the single-digits. It really wouldn’t be so bad if it wasn’t for the wind! But the fact is, the wind is there, making the weather intolerable.

dog wearing crochet scarf with fringe while sitting on snow selective focus photography
Photo by Benjamin Lehman on Pexels.com

You have probably downplayed other things in your life like we Midwesterners downplay our weather. “It wasn’t so bad,” “Someone else had it worse,” “At least I didn’t _____,” however you say it to yourself, downplaying your experience to seem better than it was does not change the fact of what happened and how it impacted you.

Sometimes, it’s okay to just admit that the weather kind of sucks right now, and I wish it would change. Sometimes, it’s okay to sit with the knowledge that something was awful and had a big effect on you.

Wind chill also brings to mind how the way we perceive things can be so subjective, especially surrounding trauma. Many victims share that, when they reach out for support, they are met with people telling them that their experience is not as bad as they perceive it to be. How is that helpful? What does it change to tell me that the temperature isn’t actually as cold as it feels on my skin, it’s just the wind making me perceive it as worse than it is?

It’s valid to say the cold bothers you, even if there is a wind chill, even if it could be worse, even if it’s colder in Minnesota. Your perspective is valid, and you do not have to meet some threshold of discomfort or suffering to earn support.

I hope you are somewhere warm and safe right now.