A Change for Better: Sustainable, Accessible Mental Health

First of all, thank you to everyone who checked out I Don’t Want To Be Bad. Amazon can’t tell me if I made any sales until they ship, which takes some time when you print on demand, but the outpouring of support has been amazing. I have some other book ideas that I’ve been wanting to pursue, and the feedback has given me so much confidence!

Today I want to share with you all a startup I’m going to be working with. As we know, psychology is undergoing a shift toward telehealth right now. I know there are still some clients who benefit more from in-person sessions, but some great new research I saw presented at APA 2020 showed that telehealth can be equally, if not more, effective than in-person for many populations. It makes the services accessible for those who can’t physically come to your office, which is huge for me in South Dakota, since the state is about 90% farm land.

I met Ashley through a Facebook group for therapists. She told me about a project she’s been working on called A Change for Better, a company that would provide telehealth options for therapists that allows the therapist to set their own rate but also creates support options for low-income or uninsured clients.

If that alone didn’t peak your interest, A Change for Better will also have a ton of other resources for both therapists and clients. The goal is to make mental health sustainable by making sure the providers can pay their bills, but also accessible to the countless people around the world who don’t have access right now. It will also uphold ethical and legal standards for practice.

Ashley is looking for therapists to beta test this project so that it can be the best resource possible. For their help, beta testers will get to use the final platform at a discount.

If you’re looking to start or expand your private practice, or just offer better resources or reach underserved clients, please let me know! Comment on this post or message me through the contact link above, and I’ll put you in touch with Ashley.

Let’s make a change for better!

I Don’t Want To Be Bad

On December 31, 2019, I resolved that 2020 would be the year that I became a published author, and today, it is a reality. I Don’t Want To Be Bad is now available in paperback through Kindle Direct Publishing. Granted, this was not the project I had in mind when I made my resolution, but I don’t think anyone can say that this year has gone according to plan.

I Don’t Want To Be Bad by Dr. Amy Marschall is available on Amazon

Working as a psychologist is both frustrating and rewarding. Nothing makes me happier than to hear that a tool, technique, or suggestion I made has helped someone. At the same time, though, my reach is limited. I practice in Sioux Falls, South Dakota, which is not considered an underserved area, and yet providers in the area are only able to serve 50% of the local mental health needs. It saddens me to think, for everyone who comes into my office, there is at least one other person who needs services but can’t get them.

While I maintain that empathy is a good quality, it’s the reason why so many people in my field burn out. I Don’t Want To Be Bad is my way of reaching more families and more children without expanding my hours.

I Don’t Want To Be Bad is for therapists who want to add techniques for children and families to their toolbox. It’s for counselors who want to teach kids how to feel and express their emotions in ways that don’t get them into trouble.

I Don’t Want To Be Bad is also a tool for parents. Although no book should be used as a substitute for therapy, parents who want to better connect with their children can use this book to build that relationship. Some kids struggle with self-regulation but do not necessarily meet the diagnostic criteria for a mental illness. Those kids can still use support and understanding from their parents, and they can find that in these pages.

If you find my book helpful, please hop on Amazon and give it a review! Also feel free to subscribe and follow my blog for more tips to help kids communicate and make good choices. After all, kids don’t want to be bad!

Photo by Pixabay on Pexels.com

Battleship

A popular therapy game is Battleship. It takes focus, it takes planning, it’s a combination of strategy and luck, and it’s a fun way to build rapport. I’ve also used Battleship with kids who are working on memory by keeping my ships in the same place a few games in a row so that they can try and remember where they were.

Photo by Marc Coenen on Pexels.com (There were no free stock photos of the game, but I think this communicates the same message)

I have heard of therapists using the original Battleship board game if both the client and therapist have access to it – similarly to how you would play in person, each person sets up their ships and guesses locations while sitting in front of the camera. This, of course, is dependent on whether your client has their own Battleship game. I’ve also heard of using a template on Excel or just with grid paper to play this way, but that can get confusing and complicated with younger kids.

This website lets you create a private Battleship game with a client. You can choose between two versions: “Classic” and “Russian,” with classic most closely mimicking the board game we all grew up with. As with all games, there are some differences between Battleship for telemental health and Battleship in a traditional session.

The pros of online Battleship, in my experience, include:

  1. Since there are two different versions, your client can choose how many ships they want on the board.
  2. There is a “randomize” option, so you can choose not to spend time placing your ships and spend more time on the game.
  3. If you are working on honesty and playing fair, the online game doesn’t allow the client to “cheat” by peeking at your ships.
  4. Since ships can’t touch each other, “hits” narrow down the remaining options quickly, so the game can go by fast.
  5. You click instead of stating your guesses, which makes for easier flow of conversation if you are talking while you play.
  6. You won’t constantly find those tiny pegs around your office.

The cons are:

  1. Whoever creates the game always goes first – I haven’t found a way to let my client take the first move unless they know how to set up the game. EDIT: I figured it out! It’s not whoever creates the game that goes first – it’s whoever clicks PLAY first. So just have the client tell you when they click PLAY and they can go first.
  2. You can’t place ships touching each other, which some kids like to do.
  3. As with most online games, the rules can’t be changed based on your or your client’s preference.

If you or your client is using wifi that blocks game sites, you can also play Battleship via telehealth using this free Google spreadsheet. It includes detailed play instructions and is super easy to use!

Is Battleship a game you use in your practice? How does it compare online versus in person for you?

Coming Soon: I Don’t Want to be Bad

Blueline copy of my manuscript

I am excited to announce that I’ve decided to self-publish my manuscript! I’ve been compiling worksheets and interventions that I use with kids and parents when the child has behavioral problems.

I Don’t Want to be Bad helps parents understand their role in the child’s behavior and help the child learn to express and cope with strong emotions appropriately.

Coming soon to Amazon, as soon as I finish the final run of line edits this weekend!

Whatever You Do, Don’t Think about Pink Elephants

Photo by Pixabay on Pexels.com

Something a lot of my clients struggle with is thought stopping. Thought stopping refers to shutting down a thought that is unpleasant, distressing, or uncomfortable. We are all constantly thinking, all the time, without even trying. Sometimes when a thought is upsetting, it can be hard to let it go.

Kids sometimes have trouble understanding that they could have a thought that they don’t want to have because thinking often feels deliberate, so I use this activity to help them see that thoughts can be automatic and not intentional. Then I use a mindful visualization activity to help them replace a “bad” thought with something calming or enjoyable.

You can create your own template or use the one I created below!

Chess

Today I want to talk about chess as a therapeutic intervention over telehealth.

Photo by Skitterphoto on Pexels.com

My first practicum supervisor told me that, to be a good therapist, I had to learn to play chess. He recommended chess as an intervention for clients of all ages, especially kids, and since then I have always kept a chess board in my office. It’s really popular with many of my clients, so when I moved to telehealth full-time, I wanted to see if I could bring this intervention with me. Chess takes focus, planning, patience, frustration tolerance, and executive functioning – all things that can be part of a child’s treatment plan!

Fortunately, Lichess lets you create a special link to play chess with a friend online. My husband and I used Lichess when we were living apart while I completed graduate school, so I was already familiar with it before I started doing telehealth. You can choose whether games will be timed (kids who have high anxiety might struggle with a time limit, but kids who have trouble remembering it’s their turn can benefit from the added structure), and there are several variations you can choose from if the client wants to mix it up.

Now, I am not a chess master by any means, but compared to most 8-year-olds, I am quite good. Different therapists will have different approaches to this, but when I play chess with a client, I might change my “difficulty level,” but I don’t let them win. Kids have told me they appreciate this because they know, when they win a game, they truly beat me.

That being said, Lichess has an option when you create a game with a friend to have custom setup (on the website, this option is called From Position). If a child wants, they can have me start the game with fewer pieces or give themselves extra pieces to make the game easier or more interesting. They can also choose to play Antichess, Racing Kings, Horde, or a few other variations.

Compared to playing chess in-person, I’d say Lichess has some definite pros:

  1. Kids can add extra pieces that you might not have on hand.
  2. You can choose whether or not turns are timed.
  3. When you select a piece, the game automatically shows you where you can move that piece – less time is spent teaching the child the game.
  4. You can “take back” moves, but only if the other person approves it, so the therapist can use this as part of their interventions if they choose.
  5. You can “take back” as many moves as you want because the computer remembers all the moves you’ve done.
  6. The game tracks whether or not someone is in check, so that frees up the therapist to focus more fully on the child.
  7. The child can’t flip the board out of anger if they lose. 🙂

Cons of chess online are:

  1. If you are taking a non-directive approach, you can’t let the child change how different pieces move or add their own rules. Computers don’t really understand child-centered play therapy.
  2. Kids have to ask every time they want to “take back” a move – you can’t set it to just let them do this if they want to. (Of course, this can be a great way to work on impulse control!)
  3. You can choose your next move before your opponent takes their turn, which has proven tricky with highly impulsive children who are trying to stay in the moment with me.

If you want to play chess with a more non-directive approach, PlayingCards.IO has a chess board that allows you to move the pieces any way you want and change the rules to the game. The drawback is that this variation doesn’t show instructions, so if you are teaching a child the “correct” rules, you will have to talk them through it.

So there are options for structured and non-directive chess in telehealth. Either option can help kids build executive functioning and frustration tolerance.

Don’t Forget to Take Your Meds!

Happy Sunday to everyone! I created a video to review and talk about a product to help people with executive dysfunction remember to take their medication. Check it out!

I was a little nervous about doing the Vlog format since I communicate better in writing, but I hope this was helpful

Here’s the TimerCap you see in the video, which can be purchased directly from their website!

Trauma-Informed Teaching with College Students

This one-hour course is intended to help college and university professors implement the tenants of trauma-informed teaching in college-level courses. It also specifically applies these ideas to online classes, as many universities are offering online learning this fall. The course is available for purchase for $20.

Subscribe to get access

Read more of this content when you subscribe today.

COVID-19 and ACEs

In my Introduction to Trauma-Informed Teaching course on Skillshare, I talk about the Adverse Childhood Experiences study from the CDC and Kaiser Permanente. Basically, the study determined that certain stressful or traumatic life experiences in childhood have a huge impact in adulthood and can lead to mental illness, physical illness, and early death. Kids with higher ACEs scores are more likely to have certain behavioral and learning problems in the classroom – hence the need for a trauma-informed approach to teaching.

Photo by Pixabay on Pexels.com

What situations are considered ACEs? The researchers determined that the following life events cause significant stress or trauma: emotional, physical, and sexual abuse, neglect, witnessing domestic violence, divorce, and having a parent who abused drugs, had untreated mental illness, or went to prison. What do these experiences have in common? Usually, they involve long-term stress, feelings of chaos and lack of control, and cause the child to realize that the adults they rely on might not be able to keep them safe.

For the past several months, children in the United States and around the world have experienced chaos, uncertainty, change, and instability due to the COVID-19 pandemic. They have to ask themselves questions that might not have occurred to them before: Will someone I care about get sick or die? Is it safe to go places? When will I be able to go back to school? What if my parents don’t have the power to keep me safe?

Basically, every child in 2020 is getting a plus one to their ACEs score simply by existing during this time. What can we, as the adults who care for them, do?

Bessel Van Der Kolk, author of The Body Keeps The Score and leading expert in childhood trauma, shares in one of his courses that trauma response often has less to do with the trauma itself and more to do with the support a child receives after the traumatic experience. That is why being trauma-informed is so important. Parents, daycare providers, teachers, and therapists need to approach children through this lens now more than ever.

Therapy During A Pandemic

Photo by Edward Jenner on Pexels.com (You don’t have to wear masks for video sessions!)

In April 2020, I wrote an article for The UpTake about telemental health and telepsychology. At that time, I had been working remotely for about one month and had just gotten certified in telemental health. I also thought that working from home was a short-term solution. Weeks have become months, and although schools are looking to resume in-person classes this fall, my practice continues to be entirely online. Although I already had some experience and training in telemental health, there has been a bit of a learning curve, especially with young children.

With these challenges, though, there is a silver lining. Clients of all ages who struggle with leaving their homes (due to agoraphobia, sensory issues, or severe depression) who normally would have cancelled or missed appointments because they could not get to my office can meet with me without having to get out of bed. Those with unreliable transportation don’t have to find a way to get to me because I can come to them. Sioux Falls Psychological Services says, “We meet you were you are, offering hope,” and that is true in a literal sense now more than ever!

If you’re dealing with mental illness, whether symptoms are new or have affected you for years, telemental health offers access that was not possible years ago. Although clients who are used to in-person sessions have had to adjust to online therapy, most are able to do so, and research has shown that treatment outcomes for telemental health are comparable to in-person sessions.

It’s always the right time to ask for help!