Archive for Therapy News

Scammers Are Calling About SSL Renewal

Scammers Are Calling About SSL Renewal

One of our clients received a phone call pretending to be their website’s SSL certificate provider. The caller went on to explain that our client’s website would experience issues if they didn’t renew.

It’s a scam.

The caller is using scare tactics to intimidate our clients and others.

5 of our clients, so far, have received a voicemail from the same number.

Hang up and block the number if you receive a similar call.

How The Caller Knows About Your SSL

Anybody can view a website’s SSL certificate.

If you’re using Chrome, go to your website, click the padlock to the left of your domain, and click “certificate.” It looks like:
In Firefox, click the padlock, and then the arrow next to “Connection Secure,” and then “More information” to view the certificate. It looks like:
An SSL certificate is public because it’s a sign of public trust. In other words, an SSL certificate tells the world that your website is safe to browse.

That makes them easy targets for scammers selling their own SSL service. They can see when a website’s certificate is expiring and intimidate the owner into buying the scammer’s SSL certification.

The scammer may not even be checking the SSL certificate on a particular website. They may be scraping phone numbers and trying their luck by calling every number they collect.

Don’t give them your information.

You Will (Likely) not be Notified About SSL Renewal by Phone

Here’s the script the spammer used for one of our client’s websites:

Hi ____, my name is _____ I’m calling in regards to an expiring SSL certificate for URL — the current one in your Go Daddy certificate on the site to set to expire tomorrow around 4 o’clock Pacific standard time. Once it does, the site will start loading with the privacy error message. If you’d like to get that certificate renewed beforehand you can give me a call back on my direct line at 626-508-1560. Thanks and have a nice day.

The person calling may even be running a real business. Their marketing tactic is what’s unethical. Their vague language suggests that they’re the website’s SSL provider.

In reality, they’re independent and they’re calling people who aren’t familiar with SSL to sell them their company’s services.

Determining if an SSL Renewal Notification is Real

If your website’s SSL certification is going to expire you will likely receive an email from your provider.

Many people implement SSL through their hosting company, such as GoDaddy, Namecheap, Siteground, or Bluehost. If that’s the case all you have to do is log in to your hosting account on the provider’s website to renew the certificate.

Free certificates issued through Let’s Encrypt automatically renew.

If you’ve implemented through another company then you will likely receive an email from them if it’s time to renew.

However, be aware that some scammers do try phishing by email.

Do not click links within an email if you’re unsure.

Always go to your provider and log in to the website directly to be safe.

Our Clients Don’t Need to Worry About Renewing Their SSL

At Counseling Wise, we keep you and your website safe without worrying about the hassle of renewing SSL.

If you work with us and receive a phone call or email, ignore it or let us know.

We implement free SSL from Let’s Encrypt which automatically renews every 3 months, or we implement SSL through GoDaddy and Sucuri which also automatically renews.

If you receive a phone call or email and feel hesitant feel free to contact us.

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So, Your Therapy Client Wants to Try Psychedelics?

So, Your Therapy Client Wants to Try Psychedelics?

Psychedelics are no longer the taboo they once were. They’ve become a topic for dinner-table conversation. What was once considered a stigmatized icon of sixties counterculture has entered the mainstream as a therapeutic treatment for mental health.

Study after study has shown that substances such as LSD, psilocybin, and MDMA provide relief for people suffering from a host of disorders. But because psychedelics are still largely illegal people are taking it upon themselves to self-medicate. Experimentation is not isolated to clients either.

Many therapists are also trying psychedelics on their own—or in groups (you may be one of them)—to learn why so much attention is being given to these substances after so many years of disapproval. There is a mad rush to understand, both in scientific and mental health communities. Once curiosity is let out of the bag it’s near impossible to stuff it back in.

Therapists have clients visiting them who are reporting either an interest in psychedelics or reporting a good or bad experience. In this article we want to educate therapists as to how to respond to clients in these three situations:
1. Clients are interested in having an experience and need to be educated for harm reduction.

2. Clients have had a “good” experience and need help finding meaning and to integrate the experience into their lives.

3. Clients have had a “bad” experience and need help resolving the trauma, finding meaning, and education to reduce future harms.

How did this psychedelic revolution happen?

Author and journalist Michael Pollan published How to Change Your Mind: What the New Science of Psychedelics Teaches Us About Consciousness, Dying, Addiction, Depression, and Transcendence in 2018, and it hit The New York Times nonfiction Best Seller list for the year. In it, Pollan discusses the history of psychedelic treatments, details his own experiences with psychedelic substances, and shares ongoing research exploring psychedelic-assisted treatments for PTSD, depression, and a host of other mental health issues.

While there have been efforts, prior to Pollan’s book release, to alter the cultural perception of psychedelics since they were made illegal, Pollan’s book helped turn those rumblings into a national discussion.

For now, most psychedelics remain the purview of researchers in clinical environments—they’re a long way from receiving FDA-approval for medical treatments. As far as the rest of the population is concerned psilocybin, LSD, MDMA, DMT, and their ilk remain illegal. But that hasn’t stopped a homegrown movement.

What should you, as a therapist, know about the burgeoning use of psychedelics?

A Very Brief Overview of Psychedelics

A complete history of psychedelics needs its own textbook. So, we’ll stick with what’s happening today, and what you should know as a therapist.

Currently, there are a handful of organizations running clinical trials to study how psychedelics may be used as a therapeutic aid, including the Multidisciplinary Association for Psychedelic Studies (MAPS) as well as the John Hopkins Psychedelic Research Unit, among others. While research has increased in recent years due to a shift in cultural attitudes, studies have been ongoing since the fifties.

And what has recent research uncovered?

Psychedelics have had an enormously positive impact in helping alleviate an array of disorders. They’ve been used to treat PTSD, anxiety, addiction (psilocybin has helped smokers quit cigarettes, permanently), depression, and cluster headaches. And that’s only a sliver of the potential psychedelics pose.

Studies are ongoing. There is a small army of researchers working to discover the full potential of various substances.

What is a “psychedelic”?

It’s important to understand what exactly is being referred to with the word “psychedelics”. Well, some of the substances currently being studied for therapeutic purposes include:
  • LSD (Lysergic acid diethylamide)
  • Psilocybin (aka Magic Mushrooms)
  • DMT (a chemical substance found in many plants and animals)
  • Ayahuasca (a brew also known as yagé from the Banisteriopsis caapi vine )
  • Ketamine (previously used as an anesthetic)
  • Cannabis (Medical Marijuana)
  • MDMA (commonly known as Ecstasy or E)
There is no strict one-to-one correlation between a particular psychedelic and its application to a particular disorder, as of yet. MDMA has shown promise as a treatment for PTSD and other traumas, and both ketamine and cannabis have also been effective in trauma treatment, as well.

Are they safe?

Yes. Psychedelics are physiologically safe. At least one study concluded that psychedelics are non-addictive, do not cause brain damage, and do not lead to mental health problems. In his book, Drugs Without the Hot Air, Professor David Nutt, speaking of LSD and psilocybin, writes:
“It’s virtually impossible to die from an overdose of them; they cause no physical harm; and if anything they are anti-addictive, as they cause a sudden tolerance which means that if you immediately take another dose it will probably have very little effect.”
He goes on to state that while physiological harm is virtually unheard of, psychedelics in the wrong hands can cause psychological harm.

If someone were to unknowingly ingest psilocybin—as a topping on their pizza, let’s say—they might think they were losing their mind. Mitigating psychological harm is a matter of being informed and working with knowledgeable people.

Dispelling Urban Myths

There are urban myths surrounding psychedelics that are worth dispelling to have a reasonable conversation. A classic relates a hapless hippie who took LSD and believed he could fly, jumping out of a window while flapping his illusory wings. The apocryphal story is the Reefer Madness of psychedelics. There is no evidence that this event took place, though it has been circulated by word of mouth for decades.

And the above story is just one piece of a junkyard of stories that’s been used to fearmonger rather than inform. People are far more prone to injure themselves and others under our legal form of self-medication, alcohol.

What is the Psychedelic Experience Like?

The most difficult question to answer is “What is the psychedelic experience like?” Language tends to fail the desire to describe what happens. Though books like Aldous Huxley’s The Doors of Perception have made the attempt. What we can say with a degree of certainty is many people self-report their psychedelic journey as being one of the most profound experiences of their lives:

“Psychedelic experiences are notoriously hard to render in words; to try is necessarily to do violence to what has been seen and felt, which is in some fundamental way pre- or post-linguistic or, as students of mysticism say, ineffable. Emotions arrive in all their newborn nakedness, unprotected from the harsh light of scrutiny and, especially, the pitiless glare of irony. Platitudes that wouldn’t seem out of place on a Hallmark card flow with the force of revealed truth.” -Michael Pollan, How to Change Your Mind

“It’s a very salutary thing to realize that the rather dull universe in which most of us spend most of our time is not the only universe there is. I think it’s healthy that people should have this experience.” -Aldous Huxley, The Doors of Perception

“Taking LSD was a profound experience, one of the most important things in my life.” -Steve Jobs from Steve Jobs, Walter Isaacson

While no single quote will perfectly summarize the experience we hope the above conveys the profundity some people have felt.

Legality of Psychedelics

Almost all psychedelics are labeled as Schedule 1 dangerous substances, which means the federal government recognizes no accepted medical use for them. That includes cannabis, heroin, LSD, peyote, ecstasy, psilocybin and quaaludes, among others. The current labeling places psychedelic substances in the same category as heroin and quaaludes.

Today, psychedelics are only legally consumed in clinical research trials (or if you’re a member of the Native American Church). However, psilocybin mushrooms are decriminalized in Denver, Colorado, which may be the first signal of a legal shift on at least the local level. That does not mean mushrooms are legal for consumption but that law enforcement treats their possession as a low-priority for enforcement.

However, the FDA has granted Breakthrough Therapy designation to MDMA-assisted psychotherapy. It is a signal that the federal government is paying attention to the flood of research, as well as the diligent work of nonprofits, researchers, and institutions, that have pushed for a shift in perception.

With that little background, we can now delve into how psychedelics may help your clients.

What do I do if my client wants to have a psychedelic experience?

You can’t stop a client from experimenting with a substance no matter how much you may try to persuade them. The eternal truth is that people will do what they want to do. That doesn’t mean you shouldn’t try to advise your client if you feel its against their best interest.

It’s ultimately up to you to decide how much you’re willing to talk about psychedelics with your client.

If you want to engage your client then start by asking them what their intentions are. Why are they interested in psychedelics?
  • Have they heard about psychedelic research as an aid to therapy?
  • Are they seeking a spiritual experience?
  • Are they curious about the experience itself because of the rise in popularity of psychedelics?
Help them introspect to discover what it is that’s motivating them.

No matter what their answer the next step may be the most important. Encourage your client to educate themselves. (We’ve included a host of further resources at the end of this article.)

Psychedelic substances induce powerful, sometimes life-lasting experiences. Contrary to high-school movies and pop-culture they should not be viewed as party drugs—though they are certainly used in that way by some people. For clinical purposes, they’re best viewed as tools.

Some therapists have an ethical dilemma

Therapists who have clients with crippling depression, anxiety, trauma or relationship issues are torn about what to do. If they’ve done their research around how these substances can help, they may feel morally obligated to support their clients to find help, even if that means referring their clients to underground psychedelic guides.

If you’re in this situation, we get it. However, we also want to be clear that if you refer your clients to underground guides or other sources for illegal substances, you are putting your license at risk. We understand if your ethical commitments supersede legal considerations, however, we want to be clear that there is a legal and professional risk.

The role of the therapist/guide

The benefit of your clients working with underground therapists/guides or being part of clinical trials is that someone is with the person undergoing the psychedelic experience. These people might be called sitters. They are there to anchor the experience, helping the person through any crisis that may arise—MAPS provides a thorough manual detailing the role of the sitter.

The sitter is someone who has had their own experience but remains sober to help the person, bringing compassion, understanding, and knowledge to the experience to foster growth.

Trained therapists also typically help a person reintegrate into their day-to-day life as powerful psychedelic experience often lingers in the days and weeks after the event. This is because unconscious materials often manifest themselves during the experience: thoughts, memories, and notions of the self that challenge who we think we are.

*The role of the sitter is the most important aspect of any psychedelic experience, whether it be used as an aid to therapy or spiritual growth or curiosity.

Proper dosage

Every substance works under its own dosages. LSD is measured in micrograms (a single microgram is one-millionth of a gram), whereas a common dose of psilocybin may be anywhere between 1 and 5 grams. It’s important that the person understands the typical dosage of the particular substance they plan to ingest.

What makes up a psychedelic experience

There are three factors which heavily impact a psychedelic experience. And no two experiences are self-reported in exactly the same way, though some similarities exist. What determines a psychedelic experience is threefold…
1. Set: refers to one’s mindset.

2. Setting: the environment in which the experience takes place.

3. Dosage: both the substance and the dosage of the substance.
Substance: each psychedelic also fosters its own experience, i.e. an LSD experience is often radically different from a DMT experience.

Before you advise your client to seek a substance you may suggest that they try more legal means.

Legal Alternatives

You may want to advise your client not to dive into the world of psychedelic substances straightaway, particularly if you believe it’s not beneficial for them. There are legal alternative therapies in the same vein as psychedelic substances. These therapies also produce non-ordinary states of consciousness and can be therapeutic.

Breathwork is particularly popular. It’s easy to overlook breathwork as the equivalent of yoga. But, it can produce as positive, altering effects. Holotropic Breathwork was developed by Stanislav and Christina Grof, Stanislav Grof being a psychiatrist that studied LSD until they were made illegal in the 1960s.

In states where cannabis (marijuana) is legal, there are a number of cannabis-related clinics, typically used to treat PTSD. The same is true of ketamine, which has been used to alleviate both severe depression and PTSD.

Psychedelics are not lifelong therapy

Unlike anti-anxiety medications such as valium and Xanax, psychedelics are not intended as a lifelong treatment. Often, people take a psychedelic substance for a limited time (until they’ve recovered from a particular ailment) and stop. These are not ongoing treatments.

There is an often-shared quote from Alan Watts that illustrates this point: “When you get the message, hang up the phone. For psychedelic drugs are simply instruments, like microscopes, telescopes, and telephones. The biologist does not sit with eye permanently glued to the microscope, he goes away and works on what he has seen” (The Joyous Cosmology, Adventures in the Chemistry of Consciousness).

A smoker does not continue to take LSD after overcoming their addiction; a person who suffered from PTSD does not continue to ingest psilocybin mushrooms. After the experience, the former-sufferer lives their life.

What makes psychedelics psychedelic?

What binds each psychedelic substance under the category of “psychedelic” is their effect on conscious experience. The word “psychedelic” means “mind-manifesting.” It’s a helpful etymology to keep in mind.

Unfortunately, words—especially in this short space—are only capable of capturing the experience to a small degree. What occurs is a deconstruction of the ego: the systems which combine in the brain to create everyday (ordinary) conscious experience are disrupted or shifted. That may sound frightening. And it can be if the person is unprepared. However, the overwhelming number of people who report positive experiences as a result of psychedelics is evidence that a kind of mental vacation is a lifelong beneficial experience.

Your client already had a psychedelic experience and needs help

For the sake of simplicity, we’re dividing the types of psychedelic experiences into two camps. (In truth, like a symphony, there may be, and often are, many highs and lows in a single experience). Unfortunately, without having direct experience with a psychedelic yourself you may find it difficult to relate to your client. However, what you can do, as with all therapies, is listen to your client while keeping an open mind, helping them talk through what they’ve undergone.

Positive Experiences

Numerous reports abound about positive psychedelic experiences. Clients may gush if they’ve had the experience recently. Or, they may be relating a memory of an experience which they believe had a meaningful impact on their life.

One word of caution, which really applies to the client, is that psychedelics often induce experiences of profound meaning. People tend to want to act on these experiences right away, such as, say, quitting a job. It’s important to emphasize that any person who has recently undergone a psychedelic experience should always take time to consider any momentous change in their day-to-day life, with all faculties of the mind, i.e. reason and emotion.

Even if your client’s experience was positive, a lot can be gained by helping them integrate the experience and meaning into their lives. This is something you can help them with.

But it’s all-too-easy to focus solely on the positive aspects of psychedelic experiences without pointing that there can be negative experiences as well.

Negative Experiences

Difficult psychedelic experiences are not talked about enough but do happen. Colloquially, they’re known as “bad” trips, although the nomenclature is changing, and many therapists and clinicians prefer to call them challenging trips. Why? Well, there is almost always something beneficial to be gained from the experience so long as there is a trained therapist helping the person talk through the lingering unconscious manifestations in the following days and weeks after the experience. Otherwise, the experience may linger as a deeply painful memory.

Challenging trips occur for a variety of reasons. In most circumstances, they’re a natural consequence of the psychedelic itself. Traumas buried in the person’s unconscious rise to the surface once the psychedelic has broken down the brain’s normal defense mechanisms. A challenging trip as a result of the substance is normal, and nothing to be ashamed of, but are one of the reasons why it’s important that someone undergoing an experience have someone to guide them.

It’s when external factors influence the experience that additional trauma is created instead of being relieved.

Proper dosage

Due to the underground nature of psychedelic-assisted therapy, negative experiences often occur due to a poor guide. Lack of certification and an enforced standard of behavior has created a motley economy of guides offering their services. Some are excellent, but as with anything, there are also those who taint the psychedelic-assisted therapy community. That may be the result of inexperience, their own unresolved trauma, a person prone to take advantage of their clients in a vulnerable state, or an inflated ego that believes it’s responsible for the effects of the medicine rather than the medicine itself.

Unfortunately, there are also guides who engage in unethical behaviors. Psychedelic experiences put people in a particularly vulnerable position. This enables them to face unconscious traumas, addictions, and behaviors with a proper guide. But they can also be taken advantage of by opportunistic charlatans. A wise soul said, “Many people who have an investment in control become teachers,” and these people shine in the underground therapy environment.

We don’t want to disparage those who have created safe environments to help people. There are many people doing excellent work. But it’s also important to be aware of those engaged in questionable practices. We’ll soon be publishing a post detailing what therapists and clients should know in regard to unethical underground therapists.

Overseas Clinics

Due to the legality of psychedelics in the United States, some people travel to other countries such as Jamaica, the Netherlands, or one of several South America countries where some psychedelics are legal. Clinics have popped up in these countries like mushrooms after a rainstorm. As with poorly trained underground guides (detailed above), these clinics have both good and bad actors. It’s difficult to determine what you’re getting yourself into, alone.

There are websites that review retreats. We recommend taking a look at Psychedelic Experience as well as AyaAdvisors before committing to any particular place.

Again, this is why education is paramount. Both clients and therapists need to be aware of what it is they’re signing up for and with who.

Psychedelic-assisted therapy may be the future

Counterculture’s association with psychedelics substances earned them a stigma but the tide is finally turning. While it’s unlikely the federal government will change its position on psychedelic substances in the short-term, people’s curiosity due to study-after-study has created an underground sensation that is unlikely to fade. Whether you support or discourage psychedelics, they are here, and they are near-impossible to ignore when there is a national conversation occurring daily regarding their place in mental health treatment.

While we haven’t been able to cover the entire galaxy of psychedelics, their research, and therapeutic applications, we hope this brief overview has been helpful. If you have any questions please leave a message in the comments and we’ll do our best to answer them.

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How to End a Challenging Session Smoothly: 13 Eminent Therapists Share Their Wisdom

How to End a Challenging Session Smoothly

13 Eminent Therapists Share Their Wisdom:

Do you struggle with how to end a challenging session smoothly?

If so, you are not alone. In fact, mastering the art of closing a therapy session without leaving your client feeling cut off is a challenge for many, and a skill that is worth learning.

So we posed the question to some expert therapists who were very gracious in responding with their best advice:

What have you found to be a smooth and effective way to close an emotionally-charged session on time?​

It’s obvious that these senior therapists have gems to share. They have learned through years of practice what works (and what doesn’t) to wrap up the session smoothly and on time. Don’t miss the summary at the end of this article!

Frank G. Anderson, M.D.

The Foundation for Self Leadership, Executive Director

Dr. Anderson’s expertise focuses on the treatment of trauma, including single-incident trauma, complex trauma, dissociative identity disorder, and post-traumatic stress disorder (PTSD). He also specializes in the treatment of attention deficit hyperactivity disorder (ADHD), autism spectrum disorders (ASD), and lesbian, gay, bisexual, and transgender (LGBT) issues. In addition, Dr. Anderson has training in sensory motor psychotherapy (SP) and eye movement desensitization and reprocessing (EMDR).

“Here is what I typically do and routinely teach therapists who are having trouble ending a therapy session, especially with clients who suffer from trauma histories. Note: the “internal parts” here are Internal Family Systems constructs.

1. I always let them know that we have 5 minutes left in the session.

2. I have them check “inside” and see if there is anything that the internal parts of them want the client to know before the session is over. For example, stay connected, check-in daily, promise to follow-up next week, etc.

3. I ask the parts to take back their energy and try and go to a safe place in the client’s mind, until our next session.

4. Make sure you (the therapist) follow-up with the issue you were discussing when you see the client next. It is important to not make false promises.”

Dr. Anderson is in private practice and he expanded his professional focus in 2004 after he met Richard Schwarz, Ph.D., founder of Internal Family Systems (IFS). Dr. Anderson learned to integrate the IFS model into his passion for psychopharmacology, neurobiology and trauma therapy; He and Dr. Schwartz currently teach IFS, Trauma and Neuroscience, a five-day intensive training for therapists. In 2013, Dr. Anderson was named the chairman of the Foundation for Self Leadership (FSL)—a nonprofit organization dedicated to advancing IFS via research, scholarships and outreach. Dr. Anderson serves as FSL executive director and continues to provide consultation, individual therapy and couples therapy at his office in Concord, Mass. Additionally, he maintains an active career as a speaker, teacher, consultant, writer and researcher who travels the globe, often conducting seminars, workshops and training programs. He also remains affiliated with the Center for Self Leadership and Trauma Center at the Justice Resource Institute.

Wendy T. Behary

The Cognitive Therapy Center of New Jersey
The New Jersey Institute for Schema Therapy

Wendy Behary specializes in cognitive and schema therapies, as well as narcissism. Cognitive therapy is a type of psychotherapy in which negative patterns of thought about the self and the world are challenged in order to alter unwanted behavior patterns or treat mood disorders such as depression. Schema therapy addresses broad, pervasive themes regarding oneself and one’s relationship with others, developed during childhood and elaborated throughout one’s lifetime, and dysfunctional to a significant degree.

“As a therapist who is not only an educator but who works with really challenging clients like narcissists (my specialty), I know the importance of paying a lot of attention to time. We start with a very keen attentiveness to time. We work diligently to be very attentive while using emotion focused strategies, or working to illicit emotion in the client, or if the emotion is just getting activated spontaneously with more fragile clients. With a client who enters into states of vulnerability easily, it is very important to be aware of time.

Attention to time is important when working to heal old maladaptive themes in a client’s life, to meet unmet needs, and to recalibrate the way a client is holding a distorted position in the way he is thinking that sets off the emotional charge. Or if it’s something that’s happening in the therapy relationship, something in the transference or counter-transference (where as we would say in schema therapy, schema’s are getting activated on both sides), these are good moments for realness. So you can say something like, “Time is real, and I care about you, so let’s see if we can use some strategies before we end the session. Let’s make sure that we save some time at the end to debrief.”

Always make sure you have debriefing time where you’re making sense out of the discoveries and the emotions that have gotten activated. Make sure you have time to do some regulation work, whether it’s teaching them mindful awareness, using the breath, body scanning, or safe place imagery. There are many different skills for helping patients get grounded before they leave the session. Ending the session on time helps the client feel more grounded, feel that they can stand up, walk out and face the world again.

One sure fire way that I use in ending a session on time is to cut away at the end, pick up my phone, open up the recording app that I use, and record a message to the client. Therefore, in real time they can listen to it throughout the week. I say, “We’re coming to the end; I know there are still some painful emotions hanging in the air; I know this is upsetting for you and this is a challenging time.” Then I either give them something to practice when they’re at home as an emotion regulation strategy or I say, “I want you to listen to this and as you’re listening, please recognize that I’m going to help you; we’re going to get through this; it’s not going to feel like this all the time; you’re doing really hard work; you’re very courageous; I’m very proud of you; I’m here; I’m on your side.”

Preparing and presenting the tape for them is a way of shoring up that they can exit with a sense of connection to you with a helpful transitional emotional object. These emotions are the things that make it frightening and sometimes impossible to walk out of the room because they don’t feel they have resolution or they don’t feel they have sturdiness to carry themselves forth.”

Wendy Behary is the founder and director of The Cognitive Therapy Center of New Jersey and The New Jersey Institute for Schema Therapy. She has been treating clients, training professionals and supervising psychotherapists for more than 20 years. She is also on the faculty of the Cognitive Therapy Center and Schema Therapy Institute of New York, where she has trained and worked with Dr. Jeffrey Young since 1989. Wendy is a founding fellow (and supervisor) of The Academy of Cognitive Therapy (Dr. Aaron T. Beck). She was also the President of the International Society of Schema Therapy (ISST) from 2010-2014.

Betty Cannon, Ph.D.

Boulder Psychotherapy Institute, President

Betty Cannon specializes in providing Applied Existential Psychotherapy (AEP) at the Boulder Psychotherapy Institute. AEP integrates the concepts of contemporary existential and psychodynamic approaches with techniques inspired by Gestalt and other experiential therapies.

“I have no problem with emotionally charged sessions. In fact, I like them. They’re often just what the client needs. But closing in the middle of working with an emotionally charged issue that is far from complete can be a challenge. It depends on the situation entirely, but here is one way I might handle this. First, I would try to be aware of the time so that we have a little space for closure, which in this case would not mean tying everything up neatly, but acknowledging that we’re working with an important issue that will need to be continued at the next session or sessions. If I’m doing empty chair work and the dialogue is between parts of the self or the child-self and the internalized parent or adult self, I might have one part say to the other something like: “I know we’re not done, and I’ll be back to continue this with you next week.” If the client often works on dreams, I might suggest paying attention to dreams over the next week.

Then, I would give the client a few minutes to ground (feet on the ground, seat in the chair, and breathe) and get ready to meet the world outside. I would not express doubt or alarm since I usually feel confident that the client can handle and move forward with her own process. If the client is really charged, I might invite her to sit in my waiting area until they’re ready to drive or otherwise go out and meet the world. I would spend a bit of extra time if the client appears dissociated, having her notice objects in the room and work on grounding and coming back into the present. I would not allow the session to go over the allotted time more than five minutes since this shows lack of confidence in the client, which the client may then internalize and become afraid of their ability to work with their own deep issues and feelings.”

Betty Cannon, Ph.D., is the president of the Boulder Psychotherapy Institute. BPI trains therapists in Applied Existential Psychotherapy (AEP). Betty is its founder. She holds doctorates in both literature and psychology. She is Professor Emerita at the Colorado School of Mines and Adjunct Professor at Naropa University and Regis University. She is the author of many articles and book chapters on existential therapy. Her book, Sartre and Psychoanalysis, is considered a classic in existential psychology. She has worked with individuals, couples, and groups in Boulder for over 30 years and trained therapists for over 20 years.

Lisa Ferentz, LCSW-C DAPA

The Ferentz Institute

Lisa Ferentz’s specialties cover a broad spectrum: trauma, attachment, affect dysregulation, shame, self-injury, depression, anxiety, dissociative disorders, and relationship issues.

“This is actually an important question. Ideally, processing emotionally charged material should be agreed upon between client and therapist prior to beginning the conversation. In this way, the therapist can do several things to decrease the likelihood of client dysregulation or flooding. Keeping one eye on the time is imperative. The first 5-10 minutes of the session should be used to remind the client of internal and external resources for grounding, self-soothing, and safety. This can include mindful breathing, using aromatherapy, a “safe place” image, an agreed upon object for grounding such as a pillow, or a smooth stone.

The actual exploration of emotionally charged material should be time-limited as well, leaving anywhere from 5-15 minutes at the end of the session to integrate the aforementioned strategies so any effect can be contained. I also believe that the therapist should invoke pacing throughout the emotional work: toggling back and forth between activation and self-soothing. This approach prevents the work from becoming a “runaway train,” and helps the client to be “forward,” and stabilized at the end of the session. If a client attempts to bring up an emotionally charged subject at the end of a session, I thank them for the courage it takes to want to go there, explain why it would be too de-stabilizing to open that door with 10 minutes left in the session, and then use that time to prepare them for our next meeting when we could safely begin to explore their issue.”

Lisa Ferentz is a recognized expert in the strengths-based, depathologized treatment of trauma and has been in private practice for 32 years. She presents workshops and keynote addresses nationally and internationally, and is a clinical consultant to practitioners and mental health agencies in the United States, Canada, and the UK.

Eric Gentry, Ph.D.

Board Certified Expert in Traumatic Stress
Arizona Trauma Institute, Vice-President

Eric Gentry’s work is rooted in the belief that we all have the innate drive urging us toward our health and maturation. Because of difficult experiences from our past and present, he believes that this drive becomes thwarted and we become stuck in our problems, negativity, and symptoms. His work is about helping individuals confront these obstructions, navigate successfully through them, and realign with their natural maturational processes. He has a wide range of both experience and training in a variety of psychotherapy styles and techniques. He has actually created a process for session closure and trauma containment.

“When a client is either overwhelmed by a trauma memory or has accessed some difficult material in the last 1/3 of a session you can use this technique to contain the traumatic material or safely bring a session to a close.

  • (FOR SESSION CLOSURE) Give client paper and colored markers…ask them to draw what it feels like inside right now. 2 minutes only.
  • (FOR TRAUMATIC CONTAINMENT) Give client paper and colored markers…ask them to draw what it feels like inside right now. 2 minutes only.
  • After two minutes say: STOP. Put your marker down and look at me.
  • While the client has been drawing, retrieve a 9 x 12” envelope. Ask the client to place their drawing in the envelope. Next, hand the client a stapler and tell them: Put as many staples in the top of this envelope as you need to make certain that this drawing stays in here. Allow the client to staple as many times as they wish.
  • Say to client something like, “OK. You and I both know that you still have some work to do on this material and we’ll get to it. However, therapy happens here, in my office, and life happens out there. If it is OK with you, I would like to hold on to this drawing and all the fear and feelings associated with it. I will keep it safe, locked in my filing cabinet. When you are ready to work on it, we will take it out and address it. But until then, will it be OK if I hold on to it?”
  • Remember to show to the client upon their first return to your office following this session and ask them if they wish to address this material today or wait until another day.

Eric Gentry is a board certified expert in traumatic stress. He is the current vice-president at the Arizona Trauma Institute. He is slow to view problematic behaviors and beliefs as pathological and, instead, helps individuals identify the utility of these “problems” so that they can adopt more healthy and useful behaviors and beliefs.

Stanley E. Hibbs, Ph.D.

Psychologist | Life Coach

Dr. Stanley Hibbs’ specialties are anxiety treatment, productivity coaching, wellness coaching, and marriage counseling. Even with the variety of specialties, Dr. Hibbs has a simple prescription for closing a session: it’s his job to watch the time, not the client, and he will let them know when that time is approaching.

“During my first session, I tell my clients that they may sometimes notice my glancing at the clock. I don’t do this because I’m bored or eager to end the session. I do it because it’s my responsibility to keep track of the time to make sure we cover everything we wanted to in the time allotted. It’s my job to worry about the time; not theirs. Clients usually appreciate this, so I rarely have a problem with ending sessions on time.”

Stanley Hibbs is a licensed clinical psychologist, certified life coach, seminar leader, and published author who has helped thousands of individuals and couples over his 30 + year career. His books include Consider It Done!: Ten Prescriptions for Finishing What You Start, Anxiety Gone: The Three C’s of Anxiety Recovery, and Anxiety – Treatment Techniques That Really Work: A Practical Guide for Therapists. He says, “Perhaps the highlight of my career was traveling the country leading my seminar “Anxiety: Treatments That Really Work” for thousands of mental health professionals.”

Dr. Harriet Lerner

Psychologist | Author

Dr. Harriet Lerner is best known for her scholarly work on the psychology of women and family relationships. She has many best-selling books on anger, intimacy, marriage, connection, deception, and more. Feminism and family systems theory are the central themes of her work. Dr. Lerner’s private practice is the heart of her work, but she also tours nationally to speak and consult.

“Although a therapist may be tempted to be apologetic about ending an emotionally charged session on time, the people we work with are ultimately assured when we can maintain time boundaries and end sessions in a calm, confident, and professional manner.

One can say warmly, “Our time is up. We’re in the middle of something important and I look forward to continuing this conversation when we meet again.”

Obviously, as when a patient is suicidal or in unmanageable distress, more is required. No position should be rigidly held. But, as a general rule, it’s important to keep to the time limits and relate to the client’s competence to manage the strong emotions that a session may evoke.”

Harriet Lerner is a clinical psychologist and a contributor to feminist theory and therapy. From 1972 to 2001 she was a staff psychologist at the Menninger Clinic in Topeka, Kansas and a faculty member and supervisor in the Karl Menninger School of Psychiatry. During this time she published extensively on the psychology of women and family relationships, revising traditional psychoanalytic concepts to reflect feminist and family systems perspectives.

Lynn Lyons, LICSW

Psychotherapist | Author

Lynn Lyons focuses on anxiety disorders in adults and children in practice. She has written several books on the subject and identifies the role of anxiety in families and the need for a preventive approach, both at home and at school.

I am a big proponent of homework assignments between appointments and of working toward goals. When a session is emotionally difficult, I want to connect what we did in the session to how and what the client will work on between sessions. I have a stack of index cards in my office and I routinely write things down and hand the cards to clients. About 10 minutes before the session comes to a close (I do 60 minute, 90 minute, or 2 hour sessions), I reach for an index card, and say something like, “Let’s write down what we’re working on.” Maybe it’s a mantra, like “It’s normal for me to feel uncomfortable as I step into new situations,” or “Just because I think it, it doesn’t make it so,” or “Every time my heart pounds, I will remember what we talked about and keep moving.” Sometimes I write down the homework to be worked on between sessions: “When I am in situation X, I will change my pattern by doing Y.” This helps both end the session, makes a connection between sessions, and helps my clients move concretely toward their goals in therapy.

Lynn Lyons is a licensed clinical social worker and psychotherapist in Concord, New Hampshire. She has been in private practice for 28 years and specializes in the treatment of anxiety disorders in adults and children. She travels globally as a speaker and trainer. With a special interest in breaking the generational cycle of worry in families, she is the co-author of two books on anxiety: Anxious Kids, Anxious Parents: 7 Ways to Stop the Worry Cycle and Raise Courageous & Independent Children, and the companion book for kids, Playing with Anxiety: Casey’s Guide for Teens and Kids. Lyons’ latest book, Using Hypnosis with Children: Creating and Delivering Effective Interventions is a how-to guide for helping professionals looking to incorporate hypnotic strategies for the treatment of depression, anxiety, medical procedures, pain, and sleep.

Tammy Nelson, Ph.D.

Psychotherapist | Author

Tammy Nelson is a well-known sex and relationship expert. She manages a balance between physical and emotional obstacles and growth when digging through years of unhelpful patterns and helps her clients find love, healing, and passion.

“Many times I see couples in sessions where the emotions run high, and an hour or two is not enough to process years of relationship stress. It can be challenging to process intense feelings in the treatment room, opening up delicate memories, and pent up resentments. At the end of a session, when the clock reaches a few moments before the next couple will arrive, the clients need to be wrapped up enough to not only go back out into the world, but to go back into their world together. Many times they are in the same car, they have to drive home, resume their lives, pick up where they left off.

One way I help them to come to a safe conclusion in an emotionally charged session is to remind them of where they started in the beginning of our time together, and then ask them to share with each other one thing they are taking with them from today.

They review what they have learned, and then share with their partner something they will take into their week. And then I close with one thing they appreciated about their partner in the session. Usually, they can find at least one thing they appreciated, even if it is as simple as, “Thank you for showing up today.”

Most couples look forward to this ritual and find it is helpful in many areas of their life outside of the therapy. I remind them to be “light and polite” on the ride home and not to over process everything that happened in our time together.”

Tammy Nelson, Ph.D., is a sex and relationship expert, an international speaker, an author and a licensed psychotherapist with almost 30 years of experience working with individuals and couples. In private practice she focuses on helping people of all ages, orientations and genders find love, healing and passion. Tammy is a Board Certified Sexologist, an AASECT Certified Sex Therapist, a Licensed Professional Counselor, a Certified Imago Relationship therapist, and a Licensed Alcohol and Drug Abuse Counselor. She is the author of The New Monogamy; Redefining Your Relationship After Infidelity and Getting the Sex You Want; Shed Your Inhibitions and Reach New Heights of Passion Together as well as What’s Eating You: A Workbook for Teens with Anorexia, Bulimia, and other Eating Disorders.

Elana Rosenbaum

Psychotherapist | Author
Stress Reduction Clinic at the University of Massachusetts Medical School, Adunct Faculty

Elena Rosenbaum’s love is practicing and teaching mindful living through meditation and focus. Due to her personal experience, she finds fulfillment in working with cancer patients. Mindfulness as a practice is described as “Paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally” and “Bringing one’s complete attention to the present experience on a moment-to-moment basis.”

“My approach is simple. I say, “We’ve got to stop now,” in a calm tone and I physically begin moving up from my chair and will walk toward the door and open it. My client follows my example and I tell them we’ll take up where we left off next time.”

Elana Rosenbaum, MS, LICSW, is a leader in the clinical application of mindfulness meditation to cancer care. She has authored Here for Now: Living Well with Cancer through Mindfulness and Being Well (even when you’re sick). In 1995 she was diagnosed with Non-Hodgkin’s lymphoma and subsequently underwent stem-cell transplantation. Her ability to thrive and embody mindfulness in the face of adversity led to the development of a mindfulness-based intervention for bone marrow transplant patients at the University of Massachusetts Medical Center, Emery University and Dana Farber Cancer Institute. She is adjunct faculty at the renowned Stress Reduction Clinic at the University of Massachusetts Medical School where she worked directly with Jon Kabat-Zinn as one of the founding teachers. She’s been teaching and educating patients and healthcare professionals in mindfulness, including leading cancer centers, for over 25 years. Elana has a private practice in psychotherapy in Worcester, Massachusetts and is a sought after teacher, speaker, workshop leader and research consultant.

Richard Schwartz, Ph.D.

Internal Family Systems, Founder
American Association of Marital and Family Therapists, Fellow

Dr. Richard Schwartz founded Internal Family Systems (IFS), a model that combines systems thinking and multiplicity of the mind to address client descriptions of various parts–many extreme–they experience within themselves. When these parts feel safe and clients concerns are addressed, they are less disruptive and more likely to accede to the wise leadership of what Dr. Schwartz came to call the “Self.” In developing IFS, he recognized that, as in systemic family theory, parts take on characteristic roles that help define the inner world of the client. The coordinating Self, which embodies qualities of confidence, openness, and compassion, acts as a center around which the various parts revolve. Because IFS locates the source of healing within the client, the therapist is freed to focus on guiding the client’s access to his or her true Self and supporting the client in harnessing its wisdom.

“In Internal Family Systems (IFS), we can have the client tell the part that is so emotional that we have to stop but will pick up with it in the next session right where we left off. So, if it could separate now a little, then we can finish helping it next time. This usually works well, but it means the therapist must remember to bring it up next time.”

Richard C. Schwartz, Ph.D., is on the faculty of the Family Institute at Northwestern University. He is the coeditor of the Handbook of Family Therapy Training and Supervision, the coauthor of three books, and author of over 40 articles on a variety of topics in psychotherapy. He serves on the editorial boards of five professional journals and is a fellow of the American Association of Marital and Family Therapists.

Ronald Siegel, Psy.D.

Assistant Professor of Psychology, Harvard Medical School

Dr. Ronald Siegel is a teacher, speaker, author, and practitioner of mindfulness, psychotherapy, and mind-body treatment. Dr. Siegel’s approach to mindfulness provides step-by-step action plans to help clients become more focused and efficient in daily life.

“This is very challenging for seasoned clinicians as well as beginners, since we need to strike a balance between holding the therapeutic framework and being a decent, caring human being. If we see this coming (it’s 10 minutes before the end of a session and a person is working with difficult material), it’s usually best to say something in advance indicating that you want to help them think through what they need right now, given the end of the session coming soon. That can help your client or patient be a collaborator in managing your time together.”

Ronald D. Siegel, PsyD, is Assistant Professor of Psychology, part time at Harvard Medical School, where he has taught for over 30 years. He is a long-time student of mindfulness meditation and serves on the board of directors and faculty of the Institute for Meditation and Psychotherapy. Dr. Siegel teaches internationally about mindfulness and psychotherapy and mind–body treatment. He has worked for many years in community mental health with inner-city children and families, and maintains a private practice in Lincoln, Massachusetts. He is the coauthor of Back Sense: A Revolutionary Approach to Halting the Cycle of Chronic Back Pain, which integrates Western and Eastern approaches for treating chronic back pain. He was also coeditor of the acclaimed book for professionals, Mindfulness and Psychotherapy and Wisdom and Compassion in Psychotherapy: Deepening Mindfulness in Clinical Practice, and coauthor of the new professional text, Sitting Together: Essential Skills for Mindfulness-based Psychotherapy.

Jim Thomas, LMFT

The Colorado Center for Emotionally Focused Therapy, Director
Denver Children’s Home, Director Emeritus
Psychologist | Life Coach

Jim Thomas is an active life coach, trainer and psychology therapist. His specialty is emotionally focused therapy (EFT). EFT is a structured approach to couples therapy formulated in the 1980s and has been developed to expand understanding of the dynamics in couple relationships.

“When I see the time winding down on the clock as a couple is winding up or remains wound tight, I know it is time for me to breathe. Taking a few deep breaths, my heart opens up. Look to the couple and what brought them to the session, to this work. Ask, how can this highly emotional reactive process be seen in a meaningful, positive light? What positive intent drives this behavior and the underlying emotion? As a fellow therapist taught me, how does this reflect the intensity of their bond? Then find a way to reflect this back to them, meeting them where they are. ‘I see how upset and troubled you both are. The train picked up speed today and you might leave here feeling frustrated, lost or hopeless. Yet, there is something important about all this. I see how much you care, how important this is to you both, wanting to be heard and to change things. How might we all take a moment to slow down and reconnect before you leave today?'”

Jim Thomas is a licensed Marriage and Family Therapist, EFT Therapist, Clinical Fellow and an AAMFT Approved Supervisor as well as an ICEEFT EFT Supervisor. His work focuses on helping people to be more fully aware and engaged in their lives. He accentuates their wholeness and strengths while dealing with real issues. He says, “When people connect more deeply with themselves, they can step beyond self-imposed limitations.” Jim is now a Director Emeritus of the Denver Children’s Home. After stepping down as Director of DFI, Jim became the Director of the Colorado Center for Emotionally Focused Therapy. He is active as an EFT Therapist, Trainer and Supervisor. He also enjoys providing life coaching and positive psychology therapy support to individuals in his private practice.

How to End a Challenging Session Smoothly

There you have it: 13 secrets to closing a challenging therapy session based on personal and professional experience of expert therapists. Here are some important points to remember:

  • Closing sessions on time is an issue even for seasoned clinicians. With practice, however, it is possible to close challenging sessions compassionately and respectfully.
  • Although your client may be activated, if you relate to their strengths, they will go forth with more confidence.
  • Utilize your modality in composing your closing; for example: an EFT therapist may address the client using a heartfelt expression to end the session; a schema therapist may acknowledge discoveries and activated emotions while reminding the client to breathe, feel their feet on the floor, and stay calm; an IFS the therapist might reference the parts within their client and let them know that we will be back to continue next time. The idea is to relate to your client in the same manner as you approach counseling.
  • Be cognizant of any serious issues that may come up toward the end of a session. If a client is suicidal, you must follow normal procedure.

We want to thank all of the experts that contributed their wisdom to this post. And all other therapists, please let us know in the comments below what you found most helpful for how to end a challenging session smoothly and on time.

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