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So you’ve never been to therapy

4/9/2025

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Here is what you can expect:

By Elena Fenner Apr 9, 2025


In honor of April being Counselor Awareness month, I thought it would be helpful to shed some light on what starting therapy looks like. Taking that first step and deciding to reach out to a counselor can be scary. Hopefully by providing some information about the process of therapy you and your family can feel a little more at ease, and a lot more prepared for what goes on there. 

The First Step

The idea of starting therapy, for some, can be intimidating. First we may make the decision that we need help, or extra support, or we just need someone to talk to. After that comes the part where we find a therapist and make a call, send an email…etc. Making that first phone call can be scary, so let’s talk about what that looks like and eliminate some of the mystery around the process of therapy.

When you call you will be asked your name, maybe your age, the insurance that you have and probably your availability. Depending on the therapy practice this initial phone call can vary, but ultimately it is just to gather more info. The person on the phone may be a therapist, they may be a receptionist or an intake coordinator (this is someone whose sole job is to take your call and ease you into the process of starting counseling). They might ask you about preferences for therapy (this is when you would say if you prefer a male vs female therapist, LGBTQ+ affirming, someone who works with trauma…etc.).

Then, and this may be the most intimidating part, you will be asked about what brings you into counseling. You only have to share what your level of comfort and trust allows! You may feel pressure to share the intricacies of what is going on, or you may not want to share a thing. No matter what you feel about this part of the process, you are the one in control here. Here are some examples of things you may feel comfortable sharing here:

“I am struggling with some anxiety and would like some extra support”

“I have been feeling depressed lately and would like to talk to someone about that. “

“I have been experiencing flashbacks, nightmares, and panic attacks. I'm not sure what's going on, but I would like some help."


Ultimately however you decide to navigate this portion of the call, you will not be judged ( and if you feel like you are- call somewhere else!!)

Now what?

After you’ve done this phone call you will be connected with your therapist and set up either a consultation or an intake session. A consultation is a brief meeting between you and your therapist to see if you are comfortable with them, and decide whether or not you two are a good fit for each other (typically consultations are free, but not always. Make sure to ask about the practice policy on this!) If you meet and think that you don't click, there is no judgment or shame in asking to meet with someone else! Therapists are taught that the majority of “good outcomes” in therapy are due to the therapeutic relationship. This means that the relationship you have with your therapist will be influential in healing and making progress in counseling. Consultations are typically requested during the initial phone call and occur before an intake session if you are doing one.

If you would like to jump right in with the counseling process then you would set up an intake session. An intake session is where you meet your counselor and go over a wide range of things that will be a launching pad for the work you do together. Before anything is shared in this session your counselor will go over informed consent and confidentiality. This is an essential part of the first session where the therapist will explain your rights to privacy, autonomy, and agency in the counseling relationship. This will also cover potential instances when a therapist has to break the confidentiality agreement. Not to worry though, this is typically only done in certain instances like if you have plans and intent to hurt yourself or others, otherwise what you say in therapy stays in therapy!

The counselor will also ask you for quite a bit of background information like medical history, family of origin, symptoms you are experiencing, your thoughts and perceptions about therapy, and treatment goals. In this session your therapist may give you paperwork to complete, or you may complete this beforehand. 

The therapist will also talk to you about their educational background, share their experience counseling and go over their theoretical orientation (this is the way that the counselor views therapy and their beliefs about the process and treatment). 

You are now officially a therapy client!You did the hard thing!! Remember that when you are going into counseling you have a say in everything that happens there. You are in control of the pace and have the right to change therapists, pause treatment or even ask for additional support. Finding a therapist that is right for you may take time, and the first person you meet may not be the fit for you. Don't give up! You deserve to have the acceptance and help you need to heal and grow. 


“We know from experience and the growing body of supportive literature […] that the therapeutic relationship a counselor forms with each client can be the most powerful tool for helping clients change.”
- Cochran and Cochran, 2015, p. IX


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For any inquiries, please contact: [email protected]
https://www.openmindscounseling.com/elenafenner.html



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Nutrition for Mental Health

4/1/2024

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It seems that the old adage is true, “you are what you eat”. Research suggests that the food we eat, and the bacteria in our gut, has a direct impact on the chemicals that our brain uses to communicate, also known as neurotransmitters. These chemicals are created in the gut as well as the brain which is why diet and nutrition is so linked with mental health.  This connection between what we eat, and our brain is called the Gut-Brain Axis and connects the intestines, and other bodily systems, with the central nervous system.  
Interestingly, much of the well-known neurotransmitter Serotonin is created in the gut. Serotonin promotes feelings of happiness, calm, and relaxation. Eating the amino acid Tryptophan is one of the ways we can produce more serotonin. Foods high in tryptophan include: 
  • Meat and poultry (turkey, pork, beef)
  • Fish and seafood
  • Legumes (tofu, edamame)
  • Whole grains (quinoa and oats)
  • Nuts and seeds (black walnuts, chia seeds, cashews)
  • Dairy and Eggs (cheese and milk)
The neurotransmitter gamma-aminobutyric acid (GABA) is another The neurotransmitter gamma-aminobutyric acid (GABA) is another chemical that is important in regulating mental health. GABA is an inhibiting neurotransmitter, which means that it decreases a neuron’s ability to receive and send messages—it basically slows down the excitatory process in the brain. GABA’s role in mental health is linked to controlling stress, anxiety, and fear as well as aids in improving focus. Foods that boost GABA include:
  • Certain probiotics like the ones in fermented foods (kimchi, kefir, some yogurt)
  • Legumes (fava beans, soy beans, peas)
  • Nuts and Seeds (walnuts, almonds, chestnuts, sunflower seeds)
  • Fish and Seafood (shrimp, halibut)
  • Fruits and Vegetables (citrus, tomatoes, berries, spinach, broccoli, sweet potato)
Another well-known and versatile neurotransmitter, Dopamine is often thought of in its role in feeling pleasure and the brain’s reward system. This makes it a key chemical in addiction among other mental health processes. Dopamine is also important for movement, memory, and executive functioning. Research also suggests that there is a link between the dopamine that is created in the gut and different autoimmune diseases like Crohn’s Disease and Irritable Bowel Syndrome- though more research is needed. Just as serotonin is created in the gut through ingesting an amino acid, so too is dopamine! The amino acid Phenylalanine is linked to the creation of dopamine. Note that if you have phenylketonuria it can be dangerous to ingest this protein. Foods high in Phenylalanine include :
  • Proteins (Meat and Fish)
  • Fruits and Vegetables (bananas, apples, avocados, artichokes, leafy greens)
  • Nuts and Seeds (pumpkin seeds, sesame seeds, peanuts, pecans)
  • Legumes (chickpeas, velvet beans)
  • Eggs and Dairy (cottage cheese, yogurt)
  • Whole Grains
The fight or flight neurotransmitter, Norepinephrine, is not only important to arousal, but also alertness and responsiveness. Norepinephrine is produced both in the adrenal glands and in the oldest and most primal part of the brain: the brain stem. This area is integral in the “fight or flight” response and helps the body react when confronted with a threat. Norepinephrine is also linked to cognitive and executive functioning making it one of the most important neurotransmitters we have! Foods that contain elements that boost norepinephrine include:
  • Meat (poultry, beef liver)
  • Dairy (cheese, chocolate)
  • Legumes (tofu, velvet beans)
  • Fruits and Vegetables (bananas, apples, avocados, leafy greens)
  • Grains (oats)
GABA’s foil is a neurotransmitter called Glutamate. Its function in the body is to activate and excite cells—it speeds things up. As one of the most common neurotransmitters, it is important to memory and learning. In addition to basic foods, glutamate is also found in salts. Foods rich in glutamate include:
  • Meat and Seafood (dried cod, salami, caviar)
  • Fruits and Vegetables (tomatoes, seaweeds, mushrooms, spinach)
  • Dairy (parmesan cheese)
  • Salts and Sauces (soy sauce, fish sauce, MSG)
In addition to eating protein rich and diverse foods, supplementing your diet with pre and probiotics help balance the bacteria in your gut. Probiotics are live bacteria and have many different functions in the body. There are many kinds of probiotics and research shows that ingesting healthy amounts of probiotics decreases symptoms of depression and anxiety. Prebiotics are the things in food that bacteria love. Prebiotics are found in high fiber foods and help keep the microbiome diverse and healthy. Foods that are rich in pre and probiotics include:
  • Yogurt and Buttermilk
  • Cottage Cheese
  • Kombucha
  • Fermented foods (sauerkraut, kimchi, miso)
  • Chickory Root Fiber
  • Jerusalem Artichoke
  • Potatoes and Beans
  • Raw Onions and Garlic
There are many different components that make mental health so complex, including diet. If you are struggling with severe mental health issues, a healthy diet or specialized nutrition will not be sufficient in alleviating your suffering. Psychiatric medication and therapy may be necessary to your mental health so that you can be the best version of yourself. If you are struggling with severe mental health issues please reach out to your primary care physician, therapist, or local crisis line for help.

References
  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5986471/
  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4393508/
  3. https://diposit.ub.edu/dspace/bitstream/2445/60791/1/MDP_TESIS.pdf#page=78
  4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7911410/
  5. https://www.researchgate.net/publication/340516439
  6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5509543/
  7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9822089/
  8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9822089/
  9. https://pubmed.ncbi.nlm.nih.gov/26706022/
  10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10490379/


Written by: Alexandra Jade Adalbert, LPCA, MS
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5 Grounding Techniques you didn't know existed By Elena Fenner

3/5/2024

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Whether it's bouts of stress, anger, or a panic attack, there are times in our lives when we are overwhelmed and go into crisis mode. When we are experiencing this state of panic it can be difficult in the moment to think of what to do to bring ourselves back to the present. In the world of counseling, the act of bringing ourselves back to the present moment from a state of disarray is called grounding. Grounding provides us with stability and helps us regulate our bodies and our minds. There are many things that people do to manage stress such as exercise, schedule management…etc. However those are not helpful things when we are in crisis mode. Telling someone who is having a panic attack to “calm down” or “snap out of it” is often more hurtful than it is helpful. Below are some things that we can use to help us regulate ourselves, so that we are prepared for the next time we have a panic attack. 

  1. 5 Senses exercises
If you have been exposed to the world of therapy you may have already heard of this exercise, and that is because it is a popular and effective method for people to use in order to ease themselves out of a state of panic. 
For this exercise you will identify:
5 things you can see
4 things you can feel
3 things you can hear
2 things you can smell
1 thing you can taste

  1. Hold a piece of ice
This one might seem a little odd, but it can  be just as effective as any other tool in your therapy tool box. When our bodies are heightened, sympathetic nervous systems respond in kind.This is the system in our body that controls our anxious responses, most familiar being the “fight-or-flight” response. This means that we may hyperventilate, cry, sweat, feel dizzy…etc when we have a panic attack. By holding onto ice our body sends a signal to our vagus nerve which activates our parasympathetic nervous system which works to override our sympathetic nervous system. By holding ice, our parasympathetic nervous system is kicked into gear and calms our body down, and our mind will follow that lead. 

  1. Breathing exercises
One of the most noteable symptom of a panic attack is the feeling that the individual is dying. Many individuals suffer through panic attacks with a great deal of fear and anxiety and sometimes have anticipatory anxiety of an oncoming panic attack. By practicing breathing exercises individuals will be able to slow down their heart rate (sometimes also warding off accompanying sensations such as dizziness and nausea) and remind themselves that they are not in fact dying. 
There are many different methods of breathing exercises. The most popular are:
  • Belly Breathing: start by placing a hand over your stomach and breathing in through your diaphragm so that your stomach expands when you inhale. Watch your hand go up and down with the breaths you take. Repeat this 5-10 times, or as often as needed.
  • Box Breathing: Breathe in through the nose for 4 counts, pause for 4 counts, exhale through the mouth for 4 counts, and pause for 4 counts. Repeat this box pattern for breathing as many times as necessary to regulate breathing
 
  1. Body Scan
    1. When we do a body scan we are bringing our awareness back to our bodies. A body scan is a mindfulness exercise that has us focus our attention on each individual part of our body, making note of sensations, tensions, or anything that might come up for us when we bring our awareness there.
    2. To begin either sit or lay down in a comfortable position. Take a couple of calming breaths and clear your head as much as you can. Bring your awareness to the tips of your toes and be present in that part of your body for 1-2 breaths. Then guide your attention up your body to your legs for 1-2 breaths. Repeat this sequence of slow breathing and mindfulness up the length of your body, bringing your attention to your knees, thighs, hips, belly, arms, fingers, chest, back, neck, jaw, eyes, and forehead. 
  2. Talking back to anxiety (cognitive restructuring)
    1. There are times when the anxiety is louder than anything else inside our heads. During a panic attack we can talk about our anxiety outloud. Talking back to our anxiety takes power away from intrusive thoughts, and returns the power back to us. Some examples of talking back to anxiety are:
  • Speak it outloud:
  • “I am safe”
  • “I am not dying”
  • “I can breathe”
  • “This moment will not last forever”/ “this moment will pass”
  • “Stop” (Literally telling our anxiety to stop may sound silly, and it can still be effective in quieting its noise).
  • “I am not alone”
  • “I am in control”

Grounding is a mindfulness exercise that has been known to be highly effective with those struggling with stress, anxiety, and panic. Try these techniques out and let us know how they go!


https://www.goodrx.com/health-topic/mental-health/grounding-techniques-anxiety-coping

https://www.sciencedirect.com/science/article/abs/pii/S0304394019300199#preview-section-cited-by


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​​Elena Fenner is interning as a counselor in training at Open Minds Counseling. She is a graduate student in Northwestern University’s counseling program with the goal of becoming a Licensed Professional Counselor who specializes in adolescent therapy. Elena embraces the philosophy that the client is the expert in the room, and here job as a counselor is to listen and create an environment that is safe and welcoming. Elena's approach centers on interventions from Cognitive Behavioral Therapy and Internal Family Systems therapy models. She is passionate about working with adolescents and individuals in transitional adulthood.

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Notes From a Therapist in Therapy: A Wellness Playlist

2/6/2023

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I am a therapist in private practice specializing in young adults with mood disorders such as depression and anxiety. I have also been in therapy for many years. Below are some of the mindsets and tools from my experiences that have helped me and my clients manage mood disorders and start living a more intentional life. 

Understanding the Cognitive Behavior Therapy (CBT) model 
  • According to the CBT model our thoughts, feelings and behaviors happen in a cycle. The cycle starts with thoughts, which impact our feelings, which in turn impacts our behavior choices.
  • You can build awareness around your thoughts and interrupt the cycle during the thinking stage by offering a replacement thought that is positive/neutral, leading to less negative feelings. This is called cognitive reframing and it takes lots of repetition to notice an impact on our feelings, but it leads to big changes over time.
  • Naming our experiences helps to depersonalize how we view them. Instead of heaping on judgment of ourselves for having a negative feeling we can label it  as something we are dealing with, not something that is wrong with us. Example: “  Depression is making it hard for me to feel motivated right now”  
  • The power of gratitude. Simply speaking, it is hard to hold negative thoughts at the same time as gratitude. The more gratitude you can have, the less opportunity negative thoughts have to weasel their way in and lead to negative feelings. 

Believing that self worth is inherent simply because you exist
  • This is radical self love. It provides a counter argument to the unkind voice inside that says you are not good enough because you are flawed. 
  • Replacing the not good enough beliefs can help leverage a new belief of worthiness into cognitive reframes.  An example is if I’m exhausted and feel the need to rest but there are dishes to do, I might judge myself  that I am being lazy. Instead I can use the reframe “I love myself too much to ignore my need for rest.”.
  • Once we can detach our meaning of self worth from conditions like productivity and attractiveness we make space for the question “What do I owe the world?” and the answer is not perfection, thinness, or productivity. None of these things are tied to self worth so we can give ourselves permission to question if our negative thoughts are aligned with our values. Spoiler alert: They almost never are!

Investing in yourself 
  •  It can be difficult to make space for self care. It helps to look at it as prioritizing your needs as necessary in order to give to others. In other words, you can’t pour from an empty cup.
  • Thinking beyond manicures and girls' night. Self care is getting enough sleep, eating a balanced diet, scheduling doctor appointments for yourself, prioritizing time to move your body, engaging in hobbies, investing in your relationships and regular therapy.
  • Lean into what lights you up. Find something that gets you excited and make time for that.  It doesn’t matter if it’s playing video games, pottery or picking weeds. 

Having boundaries
  • Stay in your emotional lane. Practice asking yourself the question “is this something that directly affects me?”. If the answer is no, move on without getting involved with someone else’s emotional work. 
  • Empathy and enmeshment are different things. You can still have empathy and show care without getting emotionally enmeshed with someone else. 

Having a mantra
  • Ten years ago a coworker handed me a piece of paper with a quote handwritten on it. The quote was “Discontent and disorder are signs of energy and hope, not despair” by Dame Wedgwood. I still have that piece of paper at my desk. 
  • This quote means so much to me because I can apply it to anything difficult I’m experiencing  and it’s a reminder I always have a choice. I can choose to surrender to despair or I can look for  hope. 
  • “I am doing a really hard thing and I'm doing my best” is another mantra that I use with many clients. It is simple but it challenges the judgemental thoughts we have towards ourselves. It is a really compassionate reframe. 

Surrounding yourself with content that lifts you up
  • There are lots of things we cannot control but the content we consume is ours to curate.
  • Brene Brown is my favorite. Brene rubbles with topics of shame and vulnerability and goes to the hardest emotional spaces. The spaces we usually run like hell from at the first sign of shame. In comes Brene with a running start as she cannonballs herself into the deep end of the pool of vulnerability. She shows us that when you hit the water it's shocking  but also refreshing. You realize you can swim and that you've known how this whole time. You can face scary feelings and they don't have to threaten your self worth. 
  • “The truth is that falling hurts. The dare is to keep being brave and feel your way back up.” - Brene Brown

Daring to be vulnerable
  • Building on the concept of radical self love creates space for believing that imperfection is not evidence of worthlessness. So we don’t have to be afraid of vulnerability.
  • Embracing our faults and imperfections is scary but also freeing. The energy you spent worrying if you were good enough is freed up for things that serve you better.

Finding your meditation
  • We know meditation is a helpful tool but how many of us can meditate while sitting on the floor in silence? That kind of meditation is not easy and for many it might mean getting creative to achieve that mindfulness state. 
  • It doesn’t matter how you get there. Anything that pauses thinking about the past or worrying about the future counts. If freestyle dance works, do it often. I like to sing in the car, especially when I feel tense or anxious. After a few minutes of signing I can feel the benefits of the mindfulness in my body and mind.
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Religious Trauma and Why All Daughters Deserve Better

2/6/2023

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Remember that John Mayer song Daughters?  You know the one, …”Fathers, be good to your daughters, daughters will love like you do, girls become lovers who turn into mothers, so mothers be good to your daughters too”.  Women and religious trauma were probably not what John Mayer was calling to mind when he wrote it but it’s what I think of these days when I hear this song.


Religious trauma comes in many forms. I want to talk about the trauma that is inherent in all major world/patriarchal religions but isn’t talked about nearly as much as cults and fundamentalist trauma is.  Patriarchal religions are fundamentally contradictory to womens’ healthy development of sense of self. The trauma women experience through the sexism and misogyny built into patriarchal religions is long lasting and deeply impactful. The oppression of women is infused into our culture, workforce, marriages, politics, entertainment and most costly, into our parenting and so much of it is greenlit and defended through religious teaching. 

As both a mother of a daughter and an atheist it is incomprehensible for me to imagine teaching my child that she is subservient to males or that she is inherently sinful and should feel shame about her body, menstruation or sexuality. This is a person I love more than anything else in the world. Everyday since she was born my life has been centered around making sure she is safe, healthy and has everything she needs to thrive. Why would I ever consider teaching her that she is inferior to anyone, nevermind a whole gender? Let's really think about this for a minute. 

Say that a devout christian couple has every intention of raising their future children in their religion. Okay fine. They are planning what they have been taught you do, raise your child in your religion. But then their first child is born, a daughter, and she is their whole world. They are loving dutiful parents. At six months or so they dress that precious baby girl up in a white gown and baptize her in a religion that will someday too soon shame her and oppress her. This choice defies every instinct we have as parents.They love their child so much. Yet they literally throw a party to celebrate an induction into a religion that openly and unapologetically disenfranchises their child. How can they go through with this now that they have this baby daughter in their arms? To a non religious person it must sound like a really messed up thing to do. This is your child. Don’t you want what is best for her? Why would you send her into a community that will work hard to uphold male superiority and power to her detriment?

I think that is a very good question and one every religious parents need to ask themselves. Parents, I know it's uncomfortable, more than uncomfortable, painful, intolerable even, but please do it anyway because your child is worth it. Your daughter deserves to have a chance to grow up believing she is equal in all ways to men.

When parents make the choice to raise their daughters in a patriarchal religion it plants a seed in the child. A seed that no amount of love, attention or encouragement can compensate for. That seed is a message of worthlessness. We are talking about a basic sense of humanism stripped from our daughters. You can’t believe in your own inalienable rights as a human and believe what patriarchal religion teaches about a woman's place at the same time. Those are fundamentally contradictory concepts. 

The patriarchal religious teachings are not subtle either. “ Woman sinned first”, ”Women shall submit to their husbands” "Husbands are the head of the family and priesthood” “Women must remain pure for their husbands”. The expectations of women are loud and clear. Stay sweet, be good, serve others, be obedient, don’t question.

I do not believe that as an atheist the love I feel for my children is greater than the love christian, jewish or muslim parents feel for their children. I do believe that religious parents are avoiding a deeply uncomfortable truth about the cognitive dissonance involved when you choose to bring up your very loved child into a sexist, oppressive religion.  

As a therapist I see the impact that being raised in a patriarchal, misogynistic religion has on the grown up daughters first hand. Many women struggle to deconstruct and untangle their sense of self worth from the religious teachings they were brought up with. It is common for women raised in religious families to struggle with anxiety, depression, and low self esteem. In some extremes the indoctrination has left women believing they are going to hell and undeserving of love.

Parents, we can do better by our daughters. Being good to our daughters means believing she is just as worthy a human as her father and brothers, as all men.

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