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May You Live in Interesting Times

Gloriosa by Jitney58 is licensed through CC-BY-2.0

There is conflicting information about the origins of this expression, but it is generally agreed to be a curse. We are watching history be made as each day goes by, and frankly, I wish I lived during a more boring chapter of future history books. At the same time, though, it is through the difficult times that we grow.

As a psychologist, I’m used to walking with people through the difficult times. I usually can’t offer a quick or simple fix, but I can be there with tools, hope, and connection.

My goal in creating this site is to offer resources to a wide audience during these trying times. I want to reach those who share my drive to help children and provide them with the tools to do this effectively: teachers, social workers, counselors, and fellow psychologists. If there are specific resources that you would like to see, please let me know, and if I have the appropriate skills and knowledge, I will do my best to make it happen.

Thank you for joining me during these interesting times. Follow my site to stay up-to-date with resources.

I Got Vaccinated!

The last time I mentioned COVID-19 in this blog, social media flagged me as “potentially misleading news” even though all I said was that I wasn’t travelling. So quick disclaimer: I’m not a researcher or medical doctor. I’m not an infectious disease specialist. Literally all I want to do here is share my experience getting the vaccine to hopefully ease someone else’s anxiety about getting it.

Photo by Alena Shekhovtcova on Pexels.com

I received Phase I of the Moderna vaccine on December 26, 2020. It hurt less than most shots I’ve gotten, and I barely noticed when the nurse administered the injection. The day after, my arm hurt quite a bit, and this persisted for about two days. I also slept more than usual that weekend, though I can’t say for sure whether this was my typical “the week between Christmas and New Years is to make up for the sleep I missed the rest of the year” or a side effect.

There is an app that my hospital had me download when I got the vaccine, which they are using for research purposes to track side effects. This is a fantastic idea, but when the nurse told me about it, what she said was, “You need to download this so we can track you.” I mentioned to her that maybe that isn’t the best wording, you know, because of conspiracy theories. She assured me it wouldn’t keep track of my location or identity, just data about my side effects, so there you go.

The vaccine only works if you post a selfie on social media afterwards. (THIS IS A JOKE)

I got Phase II on Saturday, January 23, 2021. Once again, the injection itself was almost painless and super easy. They mentioned the app again and verified they were “tracking” me, so my suggestion about changing the wording was apparently not taken into consideration. But again, they are not actually “tracking” me. They are simply keeping track of everyone’s side effects for research purposes, which is a good and important thing to do. Oh, and you are allowed to just not download the app, so if you’re concerned, you can opt out of being part of the research.

The second shot hit me harder than the first shot. About six hours after the appointment, I started feeling exhausted and achy. You know how, when you have the flu, your skin sometimes feels like it’s made entirely out of nerve endings? It was like that. I went to bed early, slept for 12 hours, and felt slightly better in the morning. I spent Sunday resting and would probably have called out sick if I had worked that day. It was not great, but also not debilitating. I ate normally and drank more water than usual, binge-watched Worst Cooks in America, and snuggled my cats.

Armani is an excellent caretaker.

Today I’m two days post injection, and my arm is still a little tender where I got the shot, but only if I poke it. Unfortunately, because of who I am as a person, this means I’m poking it a lot to see if it still hurts. So all in all, not a painless experience, but worlds better than getting COVID (or passing COVID on to someone who’s higher risk than I am). I’m told it takes two weeks before the vaccine is effective, but I plan to wear the mask indefinitely just in case because I care about people.

Obligatory photo of round 2

Psychological Evaluation 101: Learning Disorder Assessments

When I was a graduate intern, I did about 200 learning disorder assessments for school kids in Arkansas, to the point that I could pretty much complete one in my sleep (and if dreams count, I often did). Learning disorders (like dyslexia) occur when someone struggles to take in and comprehend new information like they ought to. Usually, someone is diagnosed with a learning disorder in childhood because it interferes with their academic performance, but since it is a lifelong condition, adults can be diagnosed as well.

Photo by Kamaji Ogino on Pexels.com

In recent decades, we have gotten better at screening kids for neurodevelopmental issues, and so a child in 2021 is more likely to be diagnosed with dyslexia than a child in 1995. This is good because kids with learning disorders often think that they are just not smart enough to learn, even though “gifted” kids can also have learning disorders. A correct diagnosis helps inform how to play to individual strengths.

Since a learning disorder occurs when someone isn’t able to learn as well as they “should,” a learning disorder assessment consists of two parts: an intelligence test and an achievement test. These scores are then compared to determine whether your learning deficits are accounted for by another cognitive issue and whether they are severe enough to meet the criteria for a learning disorder. These kinds of tests have known cultural and racial biases, which is why psychologists need to be culturally informed if we are going to administer them.

Learning disorders are different from other diagnoses because, in the United States, the criteria for receiving academic accommodations varies by state. For example, when I worked in Arkansas, we had to use a statistical analysis of whether a difference between scores was “significant,” but in South Dakota, there is a chart that essentially says, “An IQ score of X has an achievement cutoff of Y to qualify.” It saves me a lot of time.

If you suspect a learning disorder, you can do a full achievement test or only test the areas where you suspect a deficit (for example, only reading tests if you think you might have dyslexia). The benefit of a full achievement test is that many people have more than one learning disorder, and more information is often better.

Testing for learning disorders is time-consuming – an IQ test can take more than an hour, and achievement tests can take several hours, plus the psychologist’s time interpreting the results. In addition, many insurance companies in the United States don’t think these tests are “medically necessary” and so refuse to cover them. (If you’re not familiar with the term, “medically necessary” is insurance-speak for “you can’t make us pay.”)

If you’re seeking testing for your child, often you will want to go through the school system, as many districts require testing be completed by their evaluator for accommodations. This typically means the district has to pay for the evaluation, which helps if the cost is prohibitive. Your child’s teacher or principal will be able to tell you who to talk to about getting a testing referral from the school.

As an adult, you can still be tested for a learning disorder, though it gets expensive. If you’re thinking about going to college, the diagnosis can qualify you for accommodations like extended time, recording lectures, or oral administration of exams. If you suspect you have a learning disorder but are at a point in your life where it isn’t affecting your work or relationships, you might not need to get a diagnosis – it’s an individual choice, and you get to decide what’s right for you.

Sand Art

I’ve talked before about using sand trays or sand drawing in telehealth sessions. Although you lose a sensory component when you move these kinds of activities online, it makes for easier cleanup and has a really cool visual component.

Recently, I discovered another sand-based telehealth activity at ThisIsSand. If your client is using a smart phone, they can download this as an app (it’s free) and share their screen with you as they create. But you can also go to the website on your computer, share your screen, and grant the client remote control.

To be honest, I’ve been spending some of my breaks making my own sandscapes.

Clients can choose colors or have the app randomize a group of colors that cycle through for some awesome effects. This makes for a great mindfulness activity, and you can download the finished drawing if they want to keep it!

An Interview with Jill Johnson-Young, Social Worker, Clinician, Grieftalker

I had the honor of sitting down to a (Zoom) conversation with Jill Johnson-Young, a grief therapist, to hear about her important work and how it has been affected by the pandemic and the current world as we know it. I also got to sit down with Frank, Jill’s poodle, who didn’t have much to say in the conversation but was a delight to meet.

Jill has grief resources available for free on her website and sees clients in California.

In talking with Jill, I realized that my graduate program did not specifically prepare me with skills for how to talk to people specifically about loss and grief, especially traumatic grief. Jill has been widowed twice, and she shared that a therapist she saw after her second spouse’s death asked her why she hadn’t checked her partner’s health prior to the marriage! Who requires their partner to get a physical before getting married? A common question therapists ask in treatment planning is the “miracle question”: “If you were to wake up tomorrow, and everything were better, what would have changed to get you there?” While this can be helpful when crafting SMART goals, when you’re talking to someone whose spouse just died, this question is almost laughable. When someone has lost a loved one, the only thing they want is that person, alive and healthy. It can be perceived as condescending to ask a question with an obvious answer.

Humans in general have difficulty responding to grief. We do not like to sit with “bad” feelings, which is why you hear platitudes like, “They’re in a better place!” or “At least they aren’t suffering anymore.” Jill points out that people need space to have their feelings rather than immediately being reassured: “Do more of the holding space and less of the talking.” They need to know that the person sitting with them can witness their grief without being burdened so that they can walk through it without repressing or getting stuck. Grief is also exhausting! Someone who is grieving might not have the energy to advocate for themselves when people say unintentionally hurtful things or “therapist shop” for the right fit.

Like many mental health professionals, Jill has seen an uptick in need since the pandemic started. She compares our experience with COVID-19 to other large-scale losses and disasters, like the AIDS crisis or 9/11, where we “share a common loss.” But one of the challenges of the ongoing pandemic is that we aren’t able to come together physically and hold memorials or funerals. Jill encourages those who have lost loved ones during this time to hold an in-person funeral when it is safe to do so, regardless of how long it has been since the death. That act of comforting each other and getting to say goodbye is essential in our collective moving forward.

Some might feel strange holding a memorial more than a year after the death, but grief does not have a set timeline. It’s not about when the death occurred because your feelings are happening right now; it’s about “marking the loss.” There is a tendency to compare our pain to others’, so one might think that those who have experienced more recent loss are more deserving, but there is no hierarchy or competition for who gets to have feelings. In a way, planning for these memorials can be a source of hope because it means we know one day we will be able to come together physically one day, not just to mourn what we have lost but to celebrate things to come.

Jill’s book, The Rebellious Widow, is available for pre-order on Amazon!

ADHD Online Presents: Managing Behavioral Issues in Parenting Kids with ADHD

Thank you again to the wonderful people at ADHD Online for allowing me to present on parenting kids with ADHD! If you weren’t able to view it live, or you want to watch it again, the video is available on Facebook.

The slides from the presentation are also available for download.

If you’re looking for more resources to help kids make better choices and communicate their feelings effectively and appropriately, check out I Don’t Want To Be Bad, available on Amazon and Kindle. If you have Kindle Unlimited, you can read it for free!

Psychological Evaluation 101: What is A Waiver?

A Waiver Evaluation (or Medicaid Waiver) refers to a specific psychological evaluation that determines an individual’s need for government-funded support and services. These are usually requested for adults, but sometimes children are referred for Waiver Evaluations also.

Photo by Alex Green on Pexels.com

Typically, these evaluations assess for Intellectual Disability, as adults with this diagnosis might need extra support in tracking finances or finding and keeping jobs. (Not everyone with this diagnosis will need this support, but the purpose of these assessments is to ensure that those who need or want these services have access.)

An evaluation for Intellectual Disability has two components: an assessment of the individual’s IQ and an assessment of the individual’s functioning.

There is a lot of debate over IQ tests, partially because even psychologists can’t seem to agree on a working definition of “intelligence” (one professor in graduate school said, “The best definition we have of intelligence is it’s what gets measured by an IQ test”). There is also significant evidence of cultural and racial disparities in IQ scores, particularly because these tests have traditionally been developed by white professionals based on white standards. This is why those of us in the field need to keep pushing for more culturally relevant standards to measure intelligence and make sure that we take these factors into consideration when doing these tests.

The functional component of a Waiver Evaluation looks at an individual’s ability to do the things needed to complete tasks or participate in jobs, relationships, and other areas of their lives. This helps determine appropriate service recommendations because it tells us what areas require support and how much support might be needed. A major issue with scoring functional assessments is that many provide scores known as “age equivalencies,” which essentially indicate what age tends to get that same score. Of course, there are serious problems with using age equivalencies, the most obvious of which being that they infantilize adults by literally equating them to children. This is why I only note these scores when they are required and make sure to explain thoroughly what they mean.

So basically, if someone’s IQ is below a certain threshold (usually 70 or below) and their functioning is below average in one or more areas, they meet criteria for an Intellectual Disability, which qualifies them for supportive services.

However, people with other diagnoses might need added support as well, including some Autistic individuals, people with certain psychotic disorders, or those who have experienced a traumatic brain injury. Again, not everyone with a certain diagnosis will need these services – that’s part of why we test, to match the services to the individual’s need.

If someone doesn’t meet criteria for an Intellectual Disability but could still benefit from services for another reason, I can use a personality assessment to determine diagnosis.

Waiver Evaluations, while problematic in some ways, are often necessary in gaining access to support and services. If you’re applying for services, finding a psychologist who is culturally aware and can meet your needs is essential.

Vision Boards

Goal-setting is an important part of the therapy process, and this can be especially challenging with kids and teens who probably weren’t the ones to decide that they “needed” mental health services.

When I did in-person sessions, one activity that a lot of teenagers enjoyed was making vision boards. We would take paper and magazines and cut out images that they related to or that fit with what they saw for themselves in the future. They could choose images when they had trouble finding the right words, which helped with communication.

Canva lets you create vision (or “mood”) boards online for free! You have to create an account if you want to save the board on their platform, but you can also just save a screen shot of the completed board if you don’t want you or your clients having to sign in to do the activity.

Plenty of free templates and images are available!

Canva uses stock photos, some of which are watermarked unless you have a paid account, but you can also upload any image that you want to your vision board.

In sessions, I typically have my client pull up Canva’s website and share their screen with me while they work on their board. I can narrate what they are doing and ask questions about their choices to facilitate discussion about what they are making. If you are working with a group, you can have each member work on their own board, but this can be challenging as you can’t check on each person’s progress as you go like you could if you did this activity in-person.

Vision boards are great for motivational interviewing, art therapy, and general goal setting. The online templates have been helpful with clients who get overwhelmed by creating their design and then struggle to focus on the project itself because the placement and color schemes are built into the program.

How have you used vision boards in your practice?

Interview with Tracy Gilmour-Nimoy, Therapist and Writer

Content warning: this post discusses late-term pregnancy loss.

Tracy Gilmour Nimoy is a therapist in California certified in Perinatal Mental Health. She has a wonderful blog about mental health and has some excellent resources on her website. Tracy was kind enough to take some time to talk with me about her practice and the story behind her clinical focus. I was deeply moved by her vulnerability and willingness to share, and I hope you are as well!

Tracy Gilmour-Nimoy,, M.S., LMFT, PMH-C
  • How did you get started with writing, and how did you find your stride as a therapist/writer?

I’ve always loved writing, but until recently, it was something I kept just for myself. After my 3rd trimester stillbirth and the delivery that almost cost me my life, I realized the power writing has to reach others. I took several months off of work and during that time, I devoured memoirs. I found such meaning and power in the stories of others, and it got me thinking, could my story have a similar impact? On a whim, I decided to submit an article to Scary Mommy, and they actually published it. This gave me just the boost I needed, to seriously commit to writing. I have a unique perspective as a therapist who has been a patient, and lived through so much of my own trauma. With my writing, I’ve been able to write about the topics that a lot of people think about, but are too scared to discuss. I love writing and speaking for the underserved, and that’s what motivates me to keep writing, sharing, and telling my story. I’m currently working on a memoir about my loss, and I also recently launched a mental health blog.

  • I was very moved by your piece about pregnancy loss! What was it like being so open and vulnerable with your own story?

Thank you! That piece is very meaningful to me. Anytime I write about my personal experiences, I get what I like to call, a “vulnerability hangover”. I feel insecure about putting myself out there, because I’m writing about the most intimate details of my life, which can be very unsettling. I think a lot of my fear and insecurities come from the fact that we just don’t talk about many of the things I write about. Pregnancy loss is taboo, even though it happens frequently. The statistics within maternal mental health are startling, and these experiences are quite prevalent. I felt so alone after my loss and I, a therapist (with a husband who also works in healthcare), desperately struggled to find the support I needed. Because of this, I knew I needed to become an expert and have maternal mental health as one of my specialties. I want to show up for people and provide the type of support that I didn’t get, early on. I have to say that hearing how my writing has touched people, has been so therapeutic for me. So many individuals have shared with me that they’ve experienced something similar, but never talk about it due to stigma. I’m putting my story out there, to help break this harmful notion that we shouldn’t talk about our heavy experiences. I’m creating purpose from an unimaginable, horrific story, and I’m creating a legacy for my daughter, allowing her memory to live on. I feel sick to my stomach each time I get ready to publish a new piece—I stay up all night and perseverate on every detail. Then I post it, and feel accomplished when others share feedback. It’s a never-ending cycle, but I’ve come to embrace it.

  • I’ve never been pregnant, but I have seen colleagues go through the process of sharing this with clients and going on parental leave. It’s a kind of self-disclosure we don’t do a lot in our field. Did that affect your own grief process? Do you have any advice for other therapists who go through this experience and have to respond to clients asking about their pregnancy?

It’s so true. We are trained to create a space that is entirely about the person we are treating. We’re allowed to utilize self-disclosure in the therapeutic setting, as long as we are careful not to shift the focus, which sometimes can be tricky. Because I was over 8 months pregnant at the time of my loss, all of my clients already knew I was pregnant and I had been preparing each of them for my upcoming leave. My loss occurred quickly, so I had to go out on work pretty abruptly. It was devastating for me not to be able to say goodbye/transition my clients in the way I had originally planned. I was able to email with each of them and I did inform them that I lost my baby, but I did not go into detail. I made sure that everyone who wanted to continue with therapy was linked to a new therapist, and I told each of them that I didn’t know when I would be back, but would notify them when I was. Most of the clients I was seeing then, have now returned to me. They’ve asked generally about what happened, but I have to say, they’ve all been really mindful of boundaries. I share about what happened when they ask, but I do not go into the gory details. If they ask, I would share, while being mindful to not shift the focus or traumatize them, as I do will all self-disclosure. Something that’s particularly interesting about working within maternal mental health, is that most clinicians have lived experience. There are a few specialties like this in mental health, such as substance use, LGBTQ, and eating disorders. And much like those other specialties, I think clients seek out providers who have lived experience. So, when I’m working within maternal mental health, I’ve found that people want to know more about my personal experience. My advice to other clinicians who are dealing with pregnancy loss is this: you get to choose what and how you share with anyone.

  • What does your clinical practice look like? Do you have a niche or specialty?

I work with many different populations. I have a lot of experience with youth of all ages, families, and adult individuals. I tend to work with individuals who have experiences of trauma, depression, anxiety, life transitions, relationship challenges, work/school stress, grief, and then my new specialty, which is maternal mental health. Maternal mental health is a pretty broad specialty, but my specific interests are surrounding loss (especially late loss), infertility, and trauma.

  • You mentioned you are working on a book. Can you tell me about that project? What is it about, and what made you decide to write a book?

I’m currently working on my memoir about the loss of my daughter, Addison, in the 3rd trimester, and the delivery that nearly cost me my life. I write a lot about the systemic challenges and discrepancies between mental health and medical healthcare. I write about the importance of trauma informed care, and how mental health is not commonly considered part of routine medical practice. There is a service gap, especially within women’s health, and we (society and all providers), need to do better. I pull from my personal and professional lens, to address these barriers.

  • When will your book be available for sale, and where can people purchase it?

I’m still working on the book and in the process of finding a book agent. Being part of the book world is still new to me, and I have a lot to learn. I’m hopeful that the book will be finished this year, but as with anything, I’m not 100 percent certain.

  • What else would you like to share?

Thank you so much for having me! I’m so passionate about mental health and it’s my hope that others have resources where they can learn more. In my recently launched blog, I talk about varying mental health topics. I also feature blog guests—different individuals who share about their professional and lived experience. The purpose of my blog is for people to learn, and realize that they are not alone. There is support and there are resources available to them. I guess that’s the biggest thing I’d like to share—life is hard and we all go through things that we think will break us, but we don’t have to do that alone. The expectation is not to forget or get over something so big, but rather, to get through it, and there are tools and services that can allow us to do just that.

Moment of Silence

I had a post cued up for today but I postponed it. I don’t have words for what’s happening right now because it all feels very heavy, so I am taking a moment of silence.

Photo by Dhivakaran S on Pexels.com

In case it needs to be said, I am against fascism, Nazis, white supremacists, the KKK, and all that. If you aren’t, or if you have a problem with the fact that I am, you’re in the wrong place.

Sand Drawing

Many therapists who work with adults have used some version of a Zen garden in their office, but they haven’t been the best choice for kids. One of the great things about telehealth is that concerns like cleanup and broken pieces aren’t an issue! (You can learn more about the cultural significance of a Zen garden here – and if you’re not a part of the culture, I strongly encourage you to examine how you incorporate this into your practice before doing so to avoid appropriation.)

The meditative concept behind raking the Zen garden is called Sand Drawing, which you can do virtually at A Game. Simply choose the color and texture of the sand, and you can add shells, draw designs, and wash the whole thing away with a wave.

Free Sand Drawing Game

Another site, Scratch, has a similar game with a more traditional Zen garden feel to it. You can add rocks and grass, and you rake the sand. As with the virtual sand tray, there isn’t evidence about how the tactile difference affects the outcome of this intervention, but I like that this makes the activity accessible to younger kids.

Virtual Zen Garden

To use either of these games in a telehealth session, you can either pull it up on your computer, share your screen, and grant remote control to your client, or you can send them the link and have the client pull up the website and share their screen with you. This is a great intervention for mindfulness!