Ask a marriage and family therapist! Anything you've wanted to ask a therapist, about therapy or life in general? Ask me anything!

May 23, 2018

Great Oaks Therapy Center is home to a group of marriage and family therapists, who have come to adopt an honest, authentic practice of therapy. Heck, their tagline is “where being a messy human is expected, encouraged even.” They are not your run of the mill “how does this make you feel” kind of folks. They focus on helping folks find their authentic voice within their own story; navigate through the chaos of various seasons of life.


This motivated, energetic group of women and men, are focused on empowerment of the client- they believe everything a person has to heal is already within them- it’s all about uncovering the tools a person already possesses!

Lindsay Ryan, is the resident blogger, expressive therapist and experiential therapist at Great Oaks Therapy Center. She heads up the blog WORTHY EXISTENCE, which is a therapist’s take on self-care and personal growth. She curses a lot, and has a habit of wearing workout clothes to work, but has a caretaker’s heart, and the ability to help folks see their patterns to keep them stuck! She is heading up this AMA, and with the help of her fellow clinicians at Great Oaks, will do their best to respond :).

Lindsay believes authenticity is the truest form of connection, and only by being vulnerable with others is this amazing change going to happen. Lindsay offers a variety of services and is ridiculously passionate about having conversations with others that allow them a vulnerable experience.

From Lindsay:

“This mental health stigma makes these topics difficult to talk about! As a therapist, working on her own personal growth, I feel the effects of the stigma all the time. In the therapy office, I help folks navigate this path of life, I’m working through it myself! My blog, Worthy Existence talks a lot about the struggle of the high functioning person with mental health issues. It is my hope that the conversations we start in the therapy room will take seed and bloom outside of closed doors. Connection cultivates growth. Also, the beauty of having a group practice is to have support ourselves and have more minds focused on our clients! I'm gonna rely on my fantastic co-therapist clinicians to help impart authentic wisdom. Lol. Let’s have a conversation!”



Ask me anything!

Check out more of Lindsay's work at Worthy Existence, and connect with her via Facebook, Twitter, Pinterest or Instagram!


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What tips can you give to people who suffer from anxiety? What can be done to get some peace of mind?
May 30, 12:34PM EDT0
Can you use EMDR therapy for treating panic and anxiety?
May 30, 8:16AM EDT0

Lindsay: For SURE! I have personal experience with EMDR (I have generalized and social anxiety), as well as professional experience working with those who have anxiety. Let me back up a bit, I'd always advise you to consult with an EMDR therapist before you jump right in, as that is best practice, and any EMDR therapist worth your while will definitely do this. 

Generally EMDR is used to treat trauma, however I would say that a good portion of anxiety stems from "little t" traumas or "big t" which tends to have bigger symptoms.

In EMDR we do extensive preparation phases and resourcing which is designed to help the body relax, decrease anxiety and prepare the mind for trauma work. 

I personally found resourcing as VERY helpful in my personal life for anxiety (I had less nightmares, physical symptoms and rumination), and clients have reported large decreases in symptoms of anxiety after EMDR therapy. 

May 30, 9:03AM EDT0
Where can one learn more about the group therapy courses you offer?
May 28, 10:26PM EDT0

New groups are in the works :). Our practice is in a transition phase, from which we will be able to offer new groups to best fit hte needs of our clients! They will be under the services tab on the Great Oaks Therapy Center's website!

Also, Worthy Existence is working on a special online self-care project, which will have a group component! Stay tuned!

May 30, 8:57AM EDT0
You have a lovely Instagram profile. Where do you get the inspiration for creating your posts?
May 28, 8:34PM EDT0

Lindsay: Thanks!! Research, personal experience and current books I (and the practice) are reading! 

A lot of times, the quotes come from meaningful interactions I've had with people throughout the course of the week, and also, as always, instargram documents the journey of self-care :)

May 30, 8:55AM EDT0
How do you maintain the confidentiality of clients?
May 28, 4:45PM EDT0

Stay up to date on HIPPA laws :)

In short, the law, and our code of ethics for MFTs states that we cannot break confidentiality except if we suspect harm to self, others, or elder or child abuse. Also, if a minor is showing risky behavior, often times we need to get the parents (or others safe, supportive adult) involved for the safety of the child.

Other than that, we are, required by law not to break confidentiality. I keep client files behind two locked doors, or password protected computer files. 

I do not use clients names or identifying information in emails unless they are encrypted, and I do not go around telling others about what we discuss in therapy. 

There would be pretty negative repercussions if a therapist was to break confidentiality, such as, as up to losing their liscence.

Even within family session, if I have seen a family member individually, I am required to maintain confidentiality. 

May 28, 11:20PM EDT0
Are there specific ways to try to avoid letting your work and your personal life and relationships blend together?
May 28, 4:31PM EDT0

Go to therapy ourselves. Ha! But really. Vicarious trauma, burnout, projection, etc is alive and well. My specific way to avoid letting work and persona life blend? Go to therapy, self-care (do things that help me de-stress) and meet regularly with a good supervisor/consultation therapist to help you check yourself!

I honestly used to have nightmares about failing clients, would get triggered when a clients situation was similar to mine, or if I client projected on to me. I had great professors who caught this early on, and helped me find the right supports so that these two things do not get blurred! 

For more ethical issues, we are required to take 3 contiuing education credits focused on ethics of the practice so we are always up to speed on the latest research os we can continue working under best practice!

May 28, 11:14PM EDT0
How do you think your type of therapy can be more effective than other approaches?
May 28, 1:02PM EDT0

Being a systems therapist, I am totally biased, but "family therapy" or "systems therapy" takes into account the whole environment of the client.  Even if I am seeing someone for individual therapy, I keep in mind the system in which they live (work conditions, family life, social life, etc)

What's beautiful about this is you can see equifinality, many ways of getting the same end result. Family therapy gives context to why people act the way they do, and can provide insight into family patterns. If a family has a history of avoiding the problem, or being very rigid, chances are the client is going to do this, in their own way. 

I think it is more effective, because we get to the underlying issues, just by nature of taking ones system into account. Instead of focusing on the content of a problem, we look at the underlying patterns of process. 

May 28, 11:06PM EDT0
What are the working conditions for a marriage and family therapist at Great Oaks Therapy?
May 28, 12:54PM EDT0

Well, working conditions are pretty awesome! 

Michelle, might have more to add on this, but right now we are all contract therapists and clinical interns! We set our own schedules, have our own offices, and consult/complete supervision regularly. The cool thing about having so many therapists in one office is that we can collaborate when necessary and a lot of co-facilitation. 

We rent out the second floor of a cool old building, and have really gotten a lot of say in how our practice grows!

May 28, 11:09PM EDT0
How would you characterize how your work is similar or different to other family therapists? Your approach, your ideas?
May 28, 12:04PM EDT0

I think most of us that go through a marriage and family therapy program are trained in a systemic approach. Meaning, our lens in therapy is seen within the context of the family. We believe a lot of our issues stem from the system we find ourselves in, and in relation to others. 

I am a huge, huge believer in the Internal Family Systems model, as well as Common Factors Theory. I use both of these, and a little bit of SFBT and narrative therapy in my work! I also am a feminist at heart, and employ the feminist theory lens as well. 

I could talk theory all day long, but my approach is that people have all the tools within themselves to heal, therapists are more of a guide to point them in the right direction. I believe our internal wounds influence and shape the way we interact with others and that our story, ultimately, is written by us. I see therapy through this lens, so it totally influences any interventions or discussion in therapy.

May 28, 6:45PM EDT0
What experience have you had with crisis situations and how did you handle it?
May 28, 9:08AM EDT0

I worked at a children's psych hospital early on in my careers and in intensive outpatient group setting here recently. Fair number of crisis situations, though, thankfully, all turned out safely. Safety is number one. 

I keep a list of community hospital providers, both mental health and otherwise in my office. I am a mandated reporter. I have a duty to warn others if a client has mentioned they are going to harm someone.

Currently, as a private practice provider, we are not set up to provide the support that an agency would have, thus I defer to authorities or higher level of care for crisis management. Though I can point the client in the right direction. I tell clients if they are experiencing an emergency to call 911, or, if they are safe enough, drive to the nearest emergency room. If I suspect suicidal intent, we make a safety plan. We find who is on the client's support list, and who can be there for them if a crisis occurs. If a client reports intent or plan, I call a hospital with a patient to get them admitted. 

Sometimes we have to call the proper authorities to complete wellness checks. 

It is our job to stay calm in a crisis situation and get our clients the support they need.

May 28, 4:45PM EDT0
Do you deal with addictions? What is your advice to someone who lives with an addict? At what point is it fair to give up and focus on your own life?
May 27, 9:11PM EDT0

Lindsay: Yes I have worked with folks who have experienced addiction personally in their life, as well as with clients living with loved ones who are oppressed by addiction. My experience with addictions was in a hospital setting, and thus patients were very supported, as well as their families. I have worked with less clients oppressed by addictions in my private practice and outpatient work.

I think that is a decision that is unique to the persons involved. It truly is such a case by case basis, but I do know that we all deserve happiness, health, and yes, that might look like parting ways with someone.

I'd encourage anyone who lives with someone oppressed by addiction to absolutely seek counseling or therapy so that they can have objective support in making a life decision such as this! 

Sometimes, you just need ot know where to start. SAMHSA may be a good site to check out. 

May 28, 3:51PM EDT0
What sort of speaking engagements do you usually have? Do you think there is enough done for mental health education in school and how can it be improved?
May 27, 5:21AM EDT0

I usually am asked to speak about the benefits of music therapy within the mental health community (presentations to doctors, other therapists, administration, master's students in various programs around Kansas). I have been advocating for music therapy all of my professional career, and it seems to be an "out of the box" modality of therapy people are curious about adding to their treatment offerings. It does have a ton of evidenced based research and I am very partial to this therapuetic medium.

To your second question the answer is no. There is not enough done for mental health education in schools and there is a systemic problem here.

I think sometimes it's a case that schools are completely open to getting more mental health services for parents and students, but they simply do not know how. Funding is an issue. Stigma is an issue. We've talked to many school counselors who have a caseload of 40 kids, and are up to their eyeballs in paperwork. While they would love to be reaching out more, it's simply overwhelming. Those of us in private practice have the capacity to come in and support school staff and administration. But there is a disconnect. 

At Great Oaks, we've actually been talking about this a lot. After three very public completed suicides within the past year in our community, a group of us in the mental health therapy field reached out to offer free services to students, parents, teachers, administrators and anyone effected  in the aftermath. We offered our space for free groups, offered a safe space to experience grief, shock, sadness, anger or whatever else might be in the hearts of our community. We offered to come in to homes, and the schools to sit with folks. No one took us up on this offer. 

I don't think it's because our community does not believe we need it, I think it's a conversation that is hard to have, and we don't know where to start. 

It can be improved, first and foremost by continuing the conversation. Sure, we talk about it for a week, a month maybe, but it must be ongoing and we must have more folks come to the table. True improvement takes a community. A local community to care enough about our people to start to make change. 

Last edited @ May 27, 9:47AM EDT.
May 27, 9:45AM EDT0

As a therapist, do you believe that constant awareness of your own emotional balance and the effects of interactions with clients on this is crucial to remain effective?

May 27, 3:20AM EDT0

Lindsay: Yes, yes and yes. So glad you brought this up. As a therapist, I am constantly monitoring my emotions about the situation. 

I think this is a two fold answer. The first part being, I think all therapists should be seeking therapy for themselves, due to the nature of the job. Or at the very least supervision and consultation with other mental health professionals. If we are truly going to help clients sit in their emotions, shouldn't we be mastering this ourselves? Our professors in grad school always used to say "you cannot take a client further in their emotional journey than you have gone yourself." 

Two, emotions experienced with clients in the therapy room in an emotionally charged situation, have the power to repair or purpetuate the problem.

An example: When I was a younger therapist, I had clients yell at me, stating I am not helping them (in more colorful language) and that I should be doing something different to help them. Generally, I would feel so bad about this interaction that I would give them three referrals and send them on their way. I would believe I could not help them. Just because they got angry (or scared or sad). Maybe for some clients, this was the right choice, but for others this may have just served to tell my clients "see no one can help you." 

What I've done more recently in the same sitaution, is just get calm and curious in the face of an angry client. I ask, "how do people generally react when you treat them like this?" or "When you speak to me this way, I find it difficult to hear what you are needed. I'd love to help, but this tone makes it hard to connect." Sometimes I'll just validate that anger, cause Lord knows people have very just reasons to be angry, and maybe even at me. 

It yields much better results to be curious, open and constantly aware of the emotional impact you are having on others. And not to take anything personally. 

May 27, 9:18AM EDT0

"therapy can provide relief, insight and freedom, but only if the client is willing to put in the work" is it possible for you as a professional or anyone to be able to make the difference between someone trying and not succeeding and someone not willing to put the work?

May 26, 7:55PM EDT0

Lindsay: I'm glad you asked!  The biggest factor in whether or not therapy is successful is the relationship between the therapist and the client.  When I say "only if the client is willing to put in the work" what I mean is that it's easy to go through the motions in therapy, but really taking a hard look at yourself can be a monumental challenge. I can tell when someone is just in therapy to apease a spouse, or there because they have to be, and are not interested in change.

One of the biggest things you can do if you're considering trying out therapy is making sure that the therapist is a good fit.  It's okay to meet with several to make sure you're compatible.  I would rather be "fired" by a client than waste their time if they're not feeling it.  A good therapist will be watching for this too.  A good therapist will also create an environment where it is safe to be vulnerable, which needs to happen in order for a client to "put in the work."  

Also, we know clients will get stuck, we know clients will have to revisit tasks, and some weeks, motivation will be low. Very rarely do I see clients not trying, but also, there has to be a desire for change for change to occur. As much as I wish I was a miracle worker, I can't work harder than my clients.

May 26, 8:25PM EDT1
When working with couples do you have sessions together with both partners or separately? How does what they share differ in both cases? What would you advice for couples in order for them to be more open with each other without causing arguments, are there some known tricks?
May 26, 3:34PM EDT0

Lindsay : Both, together and seperately!

The content of what they share is totally up to the person. I do not have any preconceived assumptions or notions about the couple, and what each person brings into the therapy room is what they need that day. Sometimes I will get curious about content that was brought up in session, sometimes I ask "what's on your mind?" Depends on the dynamics of the couple. 

It can be so healing to have your partner in session, and I don't hesitate to do a split session if it will help further the couples progress. All depends on the couple. 

One thing I do screen for is domestic violence (DV) and sometimes I will see partners seperately if I am concerned about safety for one of the partners. 

There are a lot of proven communication styles that promote honest and non-argumentatitve conversations. Also, it's hard to practice open communication right off the bat. Allow yourselves imperfection, but strive for better.

One "trick" (communication tool) that I use is asking couples to use "I " statements and avoid "you" statements.  This sounds cliche and hokey, but when you are shifting the focus to you, instead of your partner when you speak,  it is less blameful of the other person. When you don't accuse your partner, you do not assign blame. It's not meant to trick the other person, but to stop yourself from attacking.

This allows a couple to have a shot at addressing the underlying issues (attachment, abandonment, emotional hurt, cutoff, etc) without getting defensive or having to put up protections to "fight" the other person.

There are a ton more communication tools, but to find what works for you and your s/o sometimes it is helpful to have an objective third party to help navigate :)

May 26, 10:09PM EDT0
Do men and women differ in the way they deal with stress? Would you say it is easier for one of the genders to seek help or it is just individual?
May 26, 3:15PM EDT0

Lindsay: I think there are a couple of cultural factors that make seeking help difficult for both women and men.  The big one being the way we as a society view mental illness.  I think there is a general impression of people needing therapy for life-long issues, when the reality is that some of these stressors can be a lot like having a cold.  A day or two away from work with some solid self-care, and you're back on your feet.  The problem arises when you're attempting to cope with much bigger symptoms, or even worse, ignoring them. 

I think for both sexes there is the misimpression that seeking help is a sign of weakness, but I view it as a sign of strength.  That said, I think it may be even tougher for men.  In our culture we hang on to the "rugged individualist," which can place a heavy stigma on men seeking help.  lf you look the ways men are depicted in popular culture, often times the ones we see as heroes are the ones who put it all on their backs in order to save the day.  That isn't to say that we don't do the same women the same way, but I think it happens more for men.  

I say all of this, but I also think we're starting to see a shift in these attitudes and that gives me a lot of hope.  The more that these issues are brought into the light of day, the less scary they become.  Great question!  I'm really glad you brought it up! :)

May 26, 8:04PM EDT0
What are the limitations of qualitative research?
May 26, 10:20AM EDT0

Lindsay: I think, just by nature, it has more room for biases and saying something is "definitely this" or "definitely that" is more difficult because there are a lot of influences at play. People's background, personal biases and varience in self-report affect this. 

I've found, it is hard to have definitive answers in any qualitiative research or self-report, because of human error, therapuetic influence and in general, consistency of reports. 

Causality is really difficult to investigate-but also, you gain a lot of insight and you begin to see patterns arise within qualitative research. It's really, to me, an important thing in therapy, and I am so excited to continue and learning. 

It's so important to keep learning and to remain curious. 

May 26, 9:26PM EDT1
Can you expand on blocked parenting, the link to the article on your site (ironically) goes to 404 page:)
May 26, 8:32AM EDT0

Lindsay: Agh! Ha, I can appreciate that. Yes, here should be the correct link. 

Blocked care is when a parent or caregiver is so overwhlemed physically, emotionally or otherwise, that that no longer feel empathy or positive feelings towards their kids. 

Basically, it's a situation where you love your kid, but don't like your kid. You find yourself parenting out of obligation. 

And to the parents feeling this, it is not that you are a bad parent. There is a biological explanation for this.

Basically, its a normal reaction to prolonged, stressful situations and encounters with their child.  Parents can find themselves in blocked care, and then feel awful about that fact that they feel nothing but anger, frustration and "stuck" when interacting with their kiddo.

This is totally reversable with the right support and care. 

Dan Hughes (creator of DDP and AFFT) has great research on it. 

Hope that link works :)

May 26, 9:09PM EDT1
You work with kids too, kids in puberty are a pain usually so how can a parent tell it is more than just the age and they need to seek professional help for their kid’s behaviour and emotional state?
May 26, 5:55AM EDT0

Lindsay: Absolutely. You are the expert on your kid. Which is a wonderful non-answer. :) There are some things that are going to really stand out- withdrawing from family and friends, irritability, heightened anxiety, self-harm, suicidal writing- but also, you are so right, this can get confused with "normal" (is there such a thing?) emotions of the brain on puberty.

First off, it never hurts to ask, or come to a therapy session with these type of questions. I get it all the time, actually, and make it a point when I see kids and teens, to meet with the parents first. I'd much rather have a parent, teen or kiddo come to therapy as a precaution or preventative measure, versus coming to therapy as a reaction to a crisis.

Pubuerty can have a hard suck factor.

The best thing you can do, in a loving, understanding, and curious way and say "I love you and I'm worried" and then listen. Hold space for your kiddo who experiencing difficult emotions. And if this was a difficult exeprience, or your kiddo withdraws, know this is also a common thing for children and teens.

If this does not feel like enought support, reach out to a professional- we can point you in the right direction!

May 26, 8:41PM EDT1

Can therapy solve anything? Are there cases you have not been able to resolve?

May 25, 8:18PM EDT0

Lindsay: For real though. I ask myself that same things some days. :) Short answer: if the client is ready, willing and able, YES. 

I've come to realize good therapy is more of a way to illuminate possible paths to a resolution. If that is what a person really needs.  People have all the tools they need to change within themselves, and if they are ready and willing to delve into their "yucky" stuff, their shame, their pain, the more likely they are to experience positive change. Ultimately, the less a therapist trys to "solve" anything, the better. The more a therapist is present, honest and authentic with a client, the better their ability to begin to make change. Also, clients are the expert on their lives, therapists are just walking, talking guideposts.  

Also, quite frankly sometimes people are dealt sh*tty hands in life, or believe that staying uncomfortable, is safer than trying to make any lasting change and sometimes there is not resoluation.

But yes. Early in my career when I was trying to save the world, I felt I had to be superman and resolve all the things. I did not. I could not. There were kids who were still given up after having been adopted a year earlier, there were still couples who got a divorce, there were still families who reported not feeling anything had changed after months of therapy with me.

 Ultimately, therapy can provide relief, insight and freedom, but only if the client is willing to put in the work. 

May 26, 7:26PM EDT0
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