Anxiety disorders are very common in our culture. The fast pace of life, multiple roles that we play, and pressure to keep up with multiple demands at the same time can easily result in a diagnosable anxiety disorder.  The most common anxiety diagnosis is called generalized anxiety disorder (GAD), which includes chronic worry about a variety of different topics, feeling on-edge and restless, feeling tense and having trouble relaxing. You also might notice sleep and appetite disturbances, and that your thoughts are sped up with GAD. 

Treatment for anxiety disorders can include either medication or talk therapy, or a combination of both. Many people like to try talk therapy first, to assess whether medication is necessary. Counseling sessions for anxiety are usually focused on identifying the source(s) of your worry, identifying thoughts and beliefs that aren't helpful, and learning mindfulness techniques to notice and redirect your unhelpful thoughts as you go about your daily life.

Counseling sessions can also help you better define your personal goals, and provide a sense of direction. Regular sessions provide accountability for following through with the goals that you've set for yourself. Personal goals can be related to work, intimate relationships, family dynamics, physical health, self-care, friendships, leisure time, or any other aspect of life that is causing worry. By identifying concrete steps that you can take toward your goals and having someone holding you accountable to take those steps, you are more likely to succeed. 

Assessing GAD in our office is quick and easy by answering a few questions in your first session. You may find insight into your thought patterns and daily habits that can turn down the volume on the worried thoughts and turn up the peace and calm. 

Depression is sometimes perceived as a character flaw, being overly emotional, or just having a bad day. It's not. It's a real condition with treatment options, and real consequences when untreated. 

• Isolation
• Decline in physical health 
• Missed work and lack of job security
• Impaired relationships
• Substance use and addiction
• Suicide

All can be consequences of untreated depression.  Studies show that counseling can be as effective as medication in some cases, and is highly effective in combination with medication. So talk to your doctor and visit a therapist if you have 5 or more of these symptoms:

• Sadness lasting all day almost every day for 2 weeks or more
• Loss of interest lasting all day almost every day for 2 weeks or more
• Appetite changes
• Sleep changes
• Intense guilt
• Difficulty concentrating
• Chronic fatigue
• Feeling physically sped up or slowed down
• Suicidal thoughts and hopelessness

by Kambria Kennedy-Dominguez

​We just wrapped up our very first art therapy series at Flourish, and it was a great success. We found the physical and emotional expression of painting images, shapes, and colors on canvas to be a soothing exercise. Painting, drawing, and creating are ways to do something with emotional experience. Counseling is often about defining what you feel. And often clients ponder this question out loud, "so I know what I feel, what do I do with it?" Most often I answer, "accept". You don't need to do anything with the feelings, except acknowledge and accept.

What you do is better based on what you value, not on what you feel. 

Still, sometimes we need some kind of release, expression, resolution, and way to cope with the myriad of emotions that most of us feel every day. Anger, sadness, worry, regret, indifference, fear...to name only a few....are difficult to sit with. So if we can take a walk or a run, go a yoga class, snuggle with our partner or our pet, read a good book, take a warm bath, or paint a picture, these activities may help us endure and sit with the feelings. 

Because of the success of the first art therapy 5 week series, we are offering it again, and hope to make it a staple of our services at Flourish. During the series, participants will learn how to use art as a relaxation exercise, how to incorporate meditation into the creative process, and how to build self-compassion. Part of our mission is to help others find what healing practices work for them, whatever that happens to be! Check out all of our groups here.

Alcohol is everywhere in our culture. Drinking is often viewed as an integral part of socializing and even doing business with others. It's relied upon as an anxiety reducer and a social lubricant. It's no surprise then that it's easy to over-indulge and create unhealthy habits with drinking. April is Alcohol Awareness Month, so a good time to reflect about your own alcohol intake and how it's affecting your health and daily life.  Below are a few resources to help.

​

• National Institutes of Health

Check whether your drinking is healthy or excessive. This link will take you to their easy-to-read web page about alcohol use.

• National Council on Alcoholism and Drug Dependence

This PDF is their list of national organizations that provide support for addiction recovery.

• Centers for Disease Control

This PDF is the best infographic to illustrate the lines between moderate and excessive drinking. 

2018 has some major changes in store at Flourish, and it's time to share our plans! We are growing both our space and our staff to be able to offer a wider variety of services and rates. 

First, we will have access to two more offices in our current building at 509 N Winnetka. In addition to our suite 207, we will add offices 202 and 205B. Now that we can book multiple appointments at once, we will be able to see more clients. Plus we can now customize new spaces for play therapy, art therapy, and groups. 

More space means more counselors! We are currently adding several new counselors to our staff at different levels of licensure, which will allow us to offer a variety of rate levels. For the last several years, Megan Kennedy has offered reduced rates while she worked toward her license to practice independently. We are happy to report that she is now fully licensed LCSW! Congrats Megan! While her rates are no longer reduced, we found a significant need in the community for lower rates, so we will be adding more provisionally licensed staff to our team. We have several LPC-Interns who will soon be joining us, and will possibly be hosting a few student interns.  Both licensed and student interns will be able to offer more affordable counseling sessions. We are also adding two fully licensed staff who bring unique interests and expertise to our clinical team.

We will post bios and pictures of all of our new staff as we bring them on board in the next several weeks. Can't wait to introduce you to them! 

In the meantime, meet Dr. Lin, our newest addition to the team. She is a counseling educator and supervisor, and she played a critical role in the development of both Kambria's and Rosie's counseling skills as their former professor and supervisor. Dr. Lin speaks English, Mandarin, and Taiwanese, and specializes in counseling Asian Americans. We are privileged to have her join us!

by Kambria Kennedy-Dominguez

I've learned through my last few years as a counselor that grief is not what I once thought it was. I used to think that it only began after a loss had occurred, and generally that loss had to be severe, like the death of a loved one or the ending of a marriage. 

But then I started working in hospice, and visiting family members of those who were dying from terminal illnesses. Sometimes these family members had been caring for their loved ones in declining health for up to 10 yeas...or longer. And I realized then that the grief process starts much earlier than I'd imagined. The loss is not always a dramatic final ending, rather sometimes it's the small losses along the way that are the more critical experiences to mental health.

 In this article, I will focus on losses that occur gradually, and the experience of grief as a cumulative process. However, of course, there are times when losses occur suddenly and unexpectedly. Such as losing a loved one in an accident or to an acute health condition. My goal is not to minimize or dismiss those very real and devastating sudden experiences of grief. Rather my goal is to help us bring light to how grief operates in other, less understood, ways. Here are a few examples. None of these stories represent one person I have seen. Rather they are bits and pieces of stories that illustrate how grief can operate in unexpected ways.

I was working once with a wife who had been caring for her husband with Alzheimer's for about 9 years, when he finally stopped remembering the vintage cars that had been one of the joys of his life. This particular escalation of his memory loss was one of the hardest parts of the journey for her. The cars had meant the world to him. He had spent countless hours looking at them, naming them, talking to friends about them, and sharing his passion for them. She asked herself, "Who was he if he didn't remember the cars? Was he still her husband, and why was it harder to relate to him now, to see him the same way?"

​Another time, I was working with a husband whose wife had a form of dementia that in some ways mimics schizophrenia with visual hallucinations and delusions. He struggled most at times that surprised me. It wasn't when his wife saw things that weren't there or rambled on about ideas that didn't make sense to him. The difficulty came when his wife, who had always been diligent in decorating their home in meticulous detail, no longer recognized important objects from their family history. This change represented a tremendous loss for him because her remembrance of care for family heirlooms was fundamental to how he defined her. 

Another time, a young woman came to counseling to work on issues in her marriage that were resulting in her drinking alcohol to excess at times. Over the course of our sessions she also shared that she had learned that her mother had been diagnosed with an illness that was degenerative and incurable. She was seeing a decline in her mom's ability to use words, to navigate around her house safely without falling, and to learn and retain new information. We discovered that her drinking problem had arisen just at the time that her mom was diagnosed with this illness. For her, the knowledge  of the incurable diagnosis was the most difficult loss. She hadn't realized that she was coping with the loss by using alcohol, and that in turn was seriously impacting her marriage.

Discovering losses and recognizing grief are common aspects of work done in counseling sessions. Normalizing and educating ourselves about grief can have a tremendous impact on healing. The five stages of grief are denial, anger, bargaining, depression, and acceptance. They do not always occur in this order, and do not represent finite periods of time or intensity. And they do not always begin after a death has occurred. In the case of illnesses and changes in loved ones that are more gradual, the grief process begins early. And knowing that grief starts early can help us better name our emotional experience and help us be more compassionate with ourselves through moments of suffering. 

I regularly encourage clients to develop a "self-care" plan as a way to manage the challenges and difficulties that life regularly presents to each of us. Self-care can be anything that provides a sense of ease and comfort, and varies depending on each individual. Sometimes we identify things like exercise, meditation, joining social groups, reading, watching movies, aromatherapy, hiking.

​Because my personal and professional experience tells me that yoga is an effective tool for self-care, I often encourage clients to try it and sometimes I teach them yoga during our sessions. Likewise, I often hear clients say that they find a sense of peace in the outdoors, I encourage them to go to natural places as regularly as possible, as much as our urban environment here in Dallas allows. 

​This past week, I came across two articles about these very things. 

This article in Medical News Today outlines three new research findings that support the use of yoga as a supplement to treatment for depression. They each followed patients who scored high on depressive symptoms prior to starting a yoga program (Bikram in one study and Hatha in the other two studies) and found significant symptom reduction at the end of the program. In one of the studies, symptom reduction lasted for at least four months after the end of the program.

​These study results are no surprise for those who have personal experience with the mental benefits of a regular yoga practice. We are learning more and more that empirical research findings support it as well.

The Japanese call it taking a "nature bath", referring to the practice of fully immersing oneself in the sights, sounds, smells and textures of natural places. What a wonderful way to describe the common feeling of peace that many of us experience when hiking, camping, swimming, and discovering beauty in nature.

​This article in Time magazine outlines how connecting to "green space" can improve mood and wellbeing for many of us. It highlights that the quality of greenspace is more important than quantity. For instance, cleanliness, accessibility, and the ease of connecting to others are more important factors than the size of the greenspace. So for those of us that live in urban environments, local parks, walking trails, and tree lined neighborhoods are resources to our mental health.

So... if you're finding your mental health challenged today, if you're feeling down or anxious or stressed or angry... break out that yoga mat and do some downward facing dogs and sun salutations. Take a walk to your local park and circle it a few times. Take some deep breaths of the soft breeze. Watch the birds, and listen to them. Feel your heart beating as you move and know that you are giving yourself a wonderful gift!

by Kambria Kennedy-Dominguez

I am pleased to announce that I can now offer EMDR therapy at Flourish. EMDR is a therapeutic modality that stands for Eye Movement Desensitization and Reprocessing. It was developed by a therapist named Francine Shapiro in in 1989, when she noticed a healing effect from side to side eye movements for anxiety and mental distress. The approach has evolved in many ways since that time. I recently attended a 3-day EMDR training to learn how to use this modality with my clients, and I am so excited to share it, especially for those individuals with either complex or single-incident trauma in their history.  Complex trauma involves repeated exposure to abuse, neglect, life-threatening or terrifying situations. Single incident trauma, in contrast, occurs as the result of a one time traumatic event. EMDR is helpful for all types of trauma.

EMDR doesn't always involve eye movement. Researchers have found other types of "alternating bilateral stimulation" to be just as effective. I use a tool called the Theratapper, which clients hold in either hand as it pulses in one hand then the other. Below is a photo of the device. We use this tool once clients have a clear understanding of the clinical reasoning behind it, and how this bilateral stimulation seems to have a healing effect on the brain's ability to process difficult memories and experiences. 

Modern research into trauma treatment tells us that the physical body is highly involved in how survivors cope with and re-experience terrifying situations. The fight, flight, freeze response is an energetic process that occurs in concert between body and mind, and is designed to protect us. However, neural pathways that are laid down to respond in times of crisis or in times of chronic stress became habituated to be set off in similar but "triggering" non-threatening situations, which can significantly disrupt the daily lives of survivors. Disruption occurs because traumatic memory is  implicit. Implicit memories are retrieved unconsciously, beyond our desire or will, such as flashbacks and intrusions. In contrast, explicit memory is consciously retrieved when and if we desire to. This distinction is key to understanding how EMDR works in the brain to heal the lasting effects of trauma. For more information about the complex but immense wealth of knowledge we now have in trauma treatment, here are a few highly regarded books about trauma's effect on the brain and body. Much of this research supports the use of EMDR as a treatment for trauma.

• The Body Keeps the Score, by Bessel Van der Kolk
• Waking the Tiger, by Peter Levine
• The Body Remembers, by Babette Rothschild

Laurel Parnell has modified the original eight stage protocol that was developed for EMDR, to simplify the process and allow for modifications when necessary. She sums it up with these four basic steps. You'll see the first step is the most critical and takes the most time.

1. Start with Safety
EMDR therapy starts the same as any other type of therapy, with a solid assessment of the presenting concerns, and building of the therapeutic relationship. We move then into the resource-building phase where coping skills are instilled to help clients stay stable before processing their traumatic memories. The below guided imagery exercises can be used to build resources.

• We might in great detail imagine a container for the difficult mental experiences, and practice placing thoughts, feelings, memories, situations in this container when we don't have the energy or desire to manage them. 
• We might create in the mind's eye a nurturing figure that can accompany us to ease painful experiences, and ask this figure to stay with us while we are hurting. The figure can be a real person, an imagined, person, an animal or object.
• We might imagine the most comfortable place we can. This place is relaxing, calming, and safe, and it's accessible to us at any time. We use this place when we need comfort.

Resource building also includes identifying and practicing regular self care activities that help us live a balanced lifestyle, such as following a healthy diet, exercising, meditating, and engaging in activities that are enjoyable and safe. We may use the theratapper for alternating bilateral stimulation while clients are building these resources, which strengthens connections in the brain and make these resources easier to access when needed. 

2. Stimulate the Memory Network
​Once these resources and coping skills are in place, clients are ready to work with the traumatic material. The speed and way in which this traumatic material is worked through is always dependent upon the client's ability to stay emotionally stable while doing so. Clients are asked to recall what represents the worst of the trauma for them, including any emotions, beliefs or bodily experiences.

3. Add Bilateral Stimulation
​Bilateral stimulation activates the resources and coping skills needed while processing the traumatic material. Alternating bilateral stimulation activates the prefrontal cortex, keeping clients present in the moment while also intentionally contacting the traumatic memory, Activation of the prefrontal cortex moves memory from implicit (unconsciously retrieved such as in flashbacks and triggers) to explicit (retrieved when we consciously try to.) We work at the client's pace, stopping at any time the client wants to stop. A key part of trauma treatment in instilling the sense of personal choice. 

​4. End with Safety
​It's essential that after a session of trauma processing, clients are able to leave feeling safe and emotionally stable. This can be accomplished by a few moments of wrapping up, speaking about what they will be doing when they leave the session, going over other treatment goals and making a plan for the next session, having a few moments of silence, taking a few moments of intentional breathing, or using any of the resourcing activities described above that can maintain emotional stability. 

For more information about trauma, EMDR, and other treatment interventions, I recommend visiting Linda Curran's website at ​https://www.trauma101.com/. Linda provided the 3-day training that I recently attended, and is immensely knowledgeable about this topic. Don't hesitate to contact me if you have questions or concerns about EMDR or other interventions we offer at Flourish. 

We have signed a lease on a new space at the corner of Davis and Winnetka in North Oak Cliff. For Cliffdwellers who frequent Norma's Café or the Kessler Theater, you'll know this building!

​It's a corner office on the second floor that has lots of light, lots of character, and our main reason for moving...lots of space. We will be transitioning both the Buckner office and Sylvan office clients to this new location starting May 1, 2017. 

​We have immense gratitude to Don Zablosky for subleasing his space to us for the past three years at the Buckner office and allowing Flourish to have a place to land in its infancy. And then, we totally lucked out when Sync Yoga and Wellbeing welcomed us into their space 1.5 years ago, honestly one of the most peaceful environments Dallas has to offer. Without their support, the growth of our practice would not have been possible. So many thanks to them!

I'm excited to announce that we are now offering SMART Recovery meetings! I have long been a believer in these free, science-based, addiction support meetings, but have been disappointed by the fact that they seem to missing in the downtown Dallas area. 

SMART is an addiction recovery support network that is based on the ideas of cognitive behavioral therapy, specifically REBT (Rational Emotive Behavior Therapy). I'm currently completing the facilitator training that will last for the next 6 weeks, and want to share some of what I've learned so far. These are some of the official positions of the SMART approach.

Meetings are currently being held on Wednesdays from Noon-1pm at Sync Yoga and Wellbeing. 1888 Sylvan Ave Ste F250. Contact Kambria for more information!

​Learn more about SMART here.